What safety concerns this client have

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Reference no: EM133420909

Assignment:

John a 87 years old male with past medical history of atrial fibrillation (initially not on anticoagulation with CHA2D52-VASc score of 7 because of traumatic intracranial hemorrhage in the past), TIA, myocardial infraction, hyperlipidemia, QSA ( not on CPAP), seizure disorder ( on Depakote) initially presented with transient left sided weakness with left-sided facial droop, patient was admitted with a working diagnosis of TIA, to rule out acute CVA/stroke. Patient underwent CT/CTA of the head and neck which showed complete occlusion of the right internal carotid artery proximal to the neck and distally to the terminal segment in the head, unchanged focal 0.2 cm outpouching in anterior communicating artery and reflect a small aneurysm. Vascular surgery team was consulted and they did not recommend any surgical intervention teleneurology was consulted and recommended full stroke work-up.

An MRI of the brain was done which eventually showed areas of infraction on the right cerebral hemisphere, echo was done which showed left ventricular hypertrophy, with right ventricle showing severe dilation and moderately hypokinetic, mild TR with mild pulmonary hypertension, ejection fraction was 60%. Because of right afferent pupillary defect, the patient's case was rediscussed with teleneurology at MGH who has recommended the patient should be started on anticoagulation. He was placed on heparin drip and was planned to be transitioned to a novel anticoagulant prior to discharge.

Patient's right monocular blindness at the side of internal carotid artery occlusion is most likely embolic in nature. Vascular surgery was once again reconsulted who did not recommend any surgical intervention but rather continuation of medical management. Given the patient has a history of atrial fibrillation for which she is not on anticoagulation given a history of intracerebral hemorrhage from a fall, cardiology was consulted for recommendations. They are in agreement with neurology recommendation to atrat patient on short-term anticoagulation of 4 to 6 weeks, at which point he will need to be evaluated for possible watchman device placement. Patient was eventually transitioned to Eliquis. He has worked with PT/OT/ speech therapy in the hospital and they have recommended the patient be discharged to acute rehab for ongoing therapies.

Question

What safety concerns this client have?

• What can you teach your client?

• What psychosocial concerns do you have for this client? What would you do about it?

Reference no: EM133420909

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