will u help & guide me n my case about CVA hemorrhagic?

Question

will u help & guide me n my case about CVA hemorrhagic. wil u teach me some things about this case?

her's my assessment.pt. s male,72 y.o.,long time smoker & drinker.Admitted 7/18/06
V/S upon admission BP=160/100, T=37,RR=24,PR=80.few hours prior to admission pt.complains of dizziness & numbness in the lower exremeties. pt has a history of chronic hypertension but no family history of other CVD,DM. Admitting diagnosis: CVA THROMBOSIS 2ndary to HCVD II.
Final Dx:CVA HEMORRHAGIC.
During my assessment (shift) 7/31/06
V/S BP=140/70,RR=13,PR=63,T=37.1
paralysis on d right side,can recognize family members,difficulty speaking,has NGT,Ozygen at 4 LPM,with condom catheter & diaper,poor capillary refill. wat will be ur possible questions to me regarding this case?i knw der r still a lot of importtant data dat i lack. Pls. help me regarding this case. I need ur knowledge & guidance

i haven't seen his CT scan result coz it was'nt in the chart. i have no other access of gaining information about the patient other than the chart and the relatives (since pt. is having difficulty speaking.i mean he could talk but i could not understand/slurred speech.) Could'nt ask the nurses on duty coz they are very busy. i might interfere with their work (after all,im still a student who does'nt have the right to disturb them).
My job only as a student is to assess & assist the pt., take V/S, administer meds. CBC as of 7/30.06 WBC: 15.6 10Eq/L, Lym: 1.4, Gran: 13.0, RBC: 4.30, Hgb: 133 g/L, Hct: 39.0%, Platelet, 236 10Eq/L. Chemistry result: Glu: 141 mg/dl, Crea-M: 1.2 md/dl, Na: 132.3, K: 3.54. what does this lab values indicate. so im here begging for your help. i don't even know why the admitting diagnosis was changed to CVA hemorrhagic. i guess it's difficult to figure out because i was'nt able to read the CT scan result.huhuhu. do you have an idea why it was changed? help

I haven't seen his CT scan result coz it was'nt in the chart. I have no other access of gaining information about the patient other than the chart and the relatives (since pt. is having difficulty speaking.i mean he could talk but i could not understand/slurred speech.) Could'nt ask the nurses on duty coz they are very busy. i might interfere with their work (after all,im still a student who does'nt have the right to disturb them).
My job only as a student is to assess & assist the pt., take V/S, administer meds.
CBC as of 7/30.06
WBC: 15.6 10Eq/L, Lym: 1.4, Gran: 13.0, RBC: 4.30, Hgb: 133 g/L, Hct: 39.0%, Platelet, 236 10Eq/L.
Chemistry result: Glu: 141 mg/dl, Crea-M: 1.2 md/dl, Na: 132.3, K: 3.54. what does this lab values indicate?
im here begging for your help. i don't even know why the admitting diagnosis was changed to CVA hemorrhagic. I guess it's difficult to figure out because i was'nt able to read the CT scan result.huhuhu. Do you have an idea why it was changed? help

Answer 1

First off... What caused the respiratory depression?
What was the patient's blood gas status? Alkalotic, Acidotic, etc.
What medications were given to drip the patient's vitals?
How much did the patient smoke in Pack Years?
Why is the patient having poor capillary refill?
What did the CT look like?
Why was it considered hemorragic stroke rather than non hemorragic?
Could you use TPA in this patient?
How about other thrombolitics?
What percentage of patients get a hemorragic stroke vs. Ischemic?
What was the patient on for his chronic HTN?
When was the last time he was seen by a doc prior to admission?
What is considered a hypertensive emergency?
What are the signs of cauda equina syndrome?
How is the pattern of numbness different in this gentleman?
Why do you order a non contrast CT first?
What is Todd's Paralysis?
What is a TIA?
What are the chances/ likelyhood that this guy has a TIA?
I would like to know, glucose, b12 level, thiamine, etc....
Would you give these to him now?
what order do you want to give them?
Good luck.

Answer 2

1

Answer 3

Questions I'd want to know the answer to:
What changed that caused the admitting diagnosis to change from a CVA caused by a thrombosis to a hemorrhagic CVA? Why did they think it was a CVA caused by thrombosis initially? Did they treat it as a thrombolytic CVA, and then diagnosed the hemorrhagic CVA? Because the tx for a thrombolytic CVA can be deadly for a patient with a hemorrhagic CVA (or at least make it much, much worse).
How's the patient doing? Is he getting worse, or is he stable?
How's his blood sugar? Hyperglycemia can make CVAs worse.
I'd want to make sure that all labs are WNL, and I'd want to make sure his hemorrhagic CVA is not getting any worse. Is the patient going to need surgery to correct it, or is it kind of a wait and see thing?
I'd want to see how his family was coping. Are they being supportive of the patient?
What is the patient's expected outcome? What kind of meds is he on? Is the patient capable of understanding what others say, or making decisions? Is the patient able to help in his physical care or therapy?
Why a condom catheter and not a foley? Just curious, for my own info - I've never seen a patient in the hospital with a condom catheter, only in nursing homes.
Also, and this is just for your own info - I don't mean to be evil or anything, but you might want to work on your spelling and grammar. Very important if you want to be taken seriously in the medical profession.
Hope this helps - have a wonderful day!

Answer 4

Some things I can think of...in no particular order...what medications was he taking prior to episode? Any head trauma? Heart rhythm? EKG? Coag values? Complete metabolic panel? CBC? Other risk factors for CVA? What was his exam like upon admission compared to the physical exam done on 7/31? Did his symptoms progress? What did a head CT or MRI show? I will let you know if I can think of more...It's late.

Answer 5

Lets see, this guys ruins his life with cigs and smoking and is given extra years by nothing more then Gods grace and someone wants to make a case-there is no case-life lived-CVA deserved, -if you are a good nurse your knowledge of CVA should be sufficent, your typing is not

Answer 6

Please see the webpages for more details on Cerebral hemorrhage and Hemorrhagic stroke. You have suffered Cerebro-vascular Accident due to your life style.

Answer 7

No. Do your own homework!