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A 60-year-old man is brought to the ER by ambulance because of slurred speech and left side weakness. His wife states they went to bed at 11pm and woke up at 5am when she noticed his symptoms. He is right-handed with a history of coronary artery disease, hypertension, and hypercholesterolemia and a heart attack at age 50.
· He currently is unable to move his left arm and leg.
· He had an episode of amaurosis fugux (blindness)in his right eye one month ago that lasted for 5 minutes.
· Around 3 months ago his wife states he had bilateral pain in his legs while they were on a walk that lasted about 15 minutes.
· He is taking a baby aspirin a day an ACE inhibitor, and statin as well.
· He does have a history of alcohol use and smoking in the past but stopped after his heart attack.
· His blood pressure is 195/118 Pulse 106, Respiratory rate 18, Temperature 99.8, O2 sat is 97% on room air.
· Although his pupils are equal and reactive, and the ocular movements are intact, he is unable to turn his eyes voluntarily toward the left side.
· The neck is supple, there is no jugular vein distension, and there are no bruits.
· The lungs are clear heart sounds regular without murmurs, and abdomen is normal.
· The limbs are not well perfused distally.
· The neurologic examination reveals that he is alert and oriented, although he does not recognize he is sick.
· He shows loss of awareness and attention with respect to objects or stimuli on his left side.
· He has mild dysarthria but, his speech is fluent, and he understands and follows commands very well.
· There is mild weakness on the left side of the face and left sided homonymous hemaianopsia, but there is no nystagmus or ptosis, and no tongue or uvula deviation.
· He is not able to move his left arm and leg, has hyperreflexia, and the left great toe is upgoing.
After reading the case scenario, please respond to the following questions:
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· What are two questions you would ask this patient?
· Identify the subjective data for this patient.
· Identify the objective data for this patient.
· What Social Determinants of Health would be relevant for this patient?
1. Question to ask
-what time is it? (Question with time concept)
-2+2=? (Questions with analytic concept)
If the time concept is impaired then it is a Right CVA, if it is analytic then it is a Left CVA
2. Subjective data:
-demographic data( age)
-wife states they went to bed at 11pm and woke up at 5am when she noticed his symptoms
-(history of illness) is right-handed with a history of coronary artery disease, hypertension, and hypercholesterolemia and a heart attack at age 50.
-wife states he had bilateral pain in his legs while they were on a walk that lasted about 15 minutes.
-medication history--taking a baby aspirin a day an ACE inhibitor, and statin as well.
-history of alcohol use and smoking in the past but stopped after his heart attack.
-had an episode of amaurosis fugux (blindness)in his right eye one month ago that lasted for 5 minutes.
Objective data
· - vital signs --His blood pressure is 195/118 Pulse 106, Respiratory rate 18, Temperature 99.8, O2 sat is 97% on room air.
· -pupils are equal and reactive, and the ocular movements are intact, he is unable to turn his eyes voluntarily toward the left side.
· -neck is supple, there is no jugular vein distension, and there are no bruits
· -The limbs are not well perfused distally.
· The neurologic examination reveals that he is alert and oriented, although he does not recognize he is sick.
· He shows loss of awareness and attention with respect to objects or stimuli on his left side.
· He has mild dysarthria but, his speech is fluent, and he understands and follows commands very well.
· There is mild weakness on the left side of the face and left sided homonymous hemaianopsia, but there is no nystagmus or ptosis, and no tongue or uvula deviation.
· He is not able to move his left arm and leg, has hyperreflexia, and the left great toe is upgoing.
Health determinant applicable for the patient is education. The patient displays history of conditions that leads to the readmission of the patient. This only implies that the patient lacks knowledge that leads to poor health seeking behaviour.
Step-by-step explanation
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KN WEEK 5 DISCUSSION 1
Two questions to ask the patient:
1. Have any observable alterations in your breast's physical attributes or consistency, such as indentation, wrinkling, or dermal modifications, come to your attention?
2. Have you encountered any instances of nipple discharge, pain, or tenderness?
These two questions aim to acquire supplementary data regarding the mass and any related indications, thereby facilitating subsequent assessment and identification.
Two risk factors in assessing for:
1. A medical practitioner needs to investigate whether any first-degree relatives have been diagnosed with breast cancer. A family history of the disease can increase the patient’s susceptibility.
2. Assessing a patient's history of breast conditions or previous breast biopsies can help determine their overall risk profile. This includes evaluating any prior instances of benign breast lumps or abnormal biopsies.
Through evaluating these risk factors, healthcare professionals can gain a more comprehensive understanding of a patient's susceptibility to the development of breast cancer and customize suitable preventative interventions and monitoring strategies.
Levels of prevention for this patient:
Primary prevention: It is recommended to motivate the patient to embrace a healthful way of life that encompasses the upkeep of a well-balanced diet, participation in routine physical exercise, and restriction of alcohol intake. According to Gardezi et al. (2019), certain lifestyle choices have been linked to a decreased likelihood of developing breast cancer.
Secondary prevention: It is recommended that individuals perform routine breast self-examinations and seek clinical breast examinations by a qualified healthcare professional. Furthermore, considering the patient's age and risk factors, it is pertinent to deliberate on the feasibility of commencing mammographic screenings at a suitable frequency per established protocols (Tsilidis et al., 2023).
Notably, these prevention measures are broad-based suggestions, and a personalized evaluation and direction from a medical practitioner are imperative for formulating a holistic prevention strategy.
References
Gardezi, S. J. S., Elazab, A., Lei, B., & Wang, T. (2019). Breast cancer detection and diagnosis using mammographic data: Systematic review. Journal of medical Internet research, 21(7), e14464.
Tsilidis, K. K., Cariolou, M., Becerra‐Tomás, N., Balducci, K., Vieira, R., Abar, L., ... & Chan, D. S. (2023). Postdiagnosis body fatness, recreational physical activity, dietary factors and breast cancer prognosis: Global Cancer Update Programme (CUP Global) summary of evidence grading. International Journal of Cancer, 152(4), 635-644.