left side tingling pain...assessment, please help!

[sweetieann]

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! :)

[UM Review RN, ASN, RN]

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.

http://asa.trainingcampus.net/UAS/Modules/TREES/index.aspx

http://www.strokeassociation.org/presenter.jhtml?identifier=1200037