Reference no: EM132676689
Mr. J is 78-year-old black man who arrived in the emergency department lethargic, vomiting, unable to speak clearly, and with weakness on the right side of his body. Mr. J has a medical history of hypertension and diabetes mellitus type 2. His family (wife and daughter) reported that for the past 3 months he has been having right-sided weakness and slurred speech that resolved within an hour of onset. Mr. J also has glaucoma, gout, and a history of atrial fibrillation (managed with drugs). Mr. J's family reported that he was taking the following drugs at home: digoxin, allopurinol, furosemide, NPH (neutral protamine Hagedorn) insulin twice a day, lisinopril, baby acetylsalicylic acid, potassium chloride, and eye drops.
Mr. J's wife, 77 years old, reported that approximately 3 days ago Mr. J stopped taking his blood pressure drugs (lisinopril and furosemide) because he had spent the money on a horse race. Two nights ago, he started to experience more frequent numbness of the right arm and slurred speech, but she did not think it was important because it disappeared after several hours. Today, she had difficulty waking him up, and her daughter told her to call the ambulance.
Mr. J's blood pressure on admission was 220/120 mm Hg; his heart rate was 126 beats/min; respiratory rate was 28 breaths/min; and temperature was 98.9° F (37° C). He had right-sided hemiparesis and hemiplegia. His speech was slurred and at times incomprehensible. Mr. J was able to maintain his airway at this time.
Oxygen via nasal cannula is started at 2 liters per minute (L/min), and a peripheral intravenous line is started with normal saline intravenous fluid therapy at 80 milliliters per hour (mL/hr). A 12-lead electrocardiography (ECG) is performed, and Mr. J is sent for computed tomography (CT) of the head.
1. Which one of Mr. J's symptoms supports a diagnosis of stroke?
2. What are the risk factors that Mr. J presents for the development of stroke?
3. Indicate the type of stroke Mr. J most likely had and support your answer.
4. What evidence is presented to support that Mr. J had experienced previous TIAs?
5. Why is atrial fibrillation a risk factor for embolic stroke?
6. Identify a nursing diagnosis based on Mr. J's assessment and develop an appropriate nursing care plan.
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