just like to get different insights/ways of explaining things on here because it really helps me. The following is a short clinical scenario:
A 68 year old white female comes to the complains of a "funny feeling on my left side" which she describes as a kind of numbness and tingling. With furthur questioning, she has says that she has a history of DVT (severe variscosities) with embolization to the lungs, emphysema, DM2 (controlled with diet) and is hard of hearing.
My instructor told us this would be a neurological problem (and therefore you would focus on neurological checks). I understand that tingling on the left side would prompt you to think this is neurological. But, because of the past DVTs and everything, I was originally thinking this was a cardiac problem. Then I figured out that vein clots go to the lungs while arterial clots go to the heart, brain or feet. My question is: How would you know this is neurological and not cardiovascular? The one other thing the teahcer mentioned is a TIA (transient ischemic attack) that something in the brain (a clot?) caused ischemia in a small part of the brain. If this is true,then the reason for her numbness/tingling on left side, I am assuming, would be an arterial clot to the bran. Which brings me back to my original question of why this is not a cardiac problem (clot i nartery), but rather in considered neurological? Is a "mini stroke" in the brain considered neurological (I always thought strokes were cardiovascular in nature). I haven't had a ptho class yet, so I'm sure this will be clarified eventually, but I'm still curious and I know it will bother me all weekend if I can't figure it out.
I'm not looking for anyone to have to go through and answer/detangle all of my questions (I know I talked in circles, but I just wanted to paint a clear picture of my thought process). But if someone could explain how you'd go about assessing this patient and why it is a neurological proble, or really provide any feedback at all, it would really help me out!
Thanks again so much everyone!
Apr 8, '05
It would be a cardiological problem if the clot wound up in the heart, causing a heart attack.
Since the clot is in the brain, evidenced by numbness/tingling on one side, it's a neuro problem. The term for it is "Ischemic Stroke."
You would assess the patient with a NIHSS, or National Institute of Health Stroke Scale. You would do a swallow screen to assess the patient's gag and swallow reflexes. You would also do neuro checks q2h with vital signs for 24 hours, then q4h X 24, then qs.
If there was any deterioration, you would call the MD, repeat the CT head w/o contrast (rules out hemorrhagic stroke), and begin the NIHSS and neuro checks over again.
This is only a portion of the nursing interventions that would be performed, but you get the drift.
For more information on stroke, the American Stroke Association has a wonderful video teaching online that shows real patients with ischemic stroke in varying severity, and teaches how to assess for the NIHSS.
Last edit by UM Review RN on Apr 8, '05