Need to work something out in my head

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Hey ya'll. Happy Tuesday.

Let's see if I can explain this good enough, lol. I had a pt yesterday who had symptoms of a stroke. (Slurred speech, can't walk or stand, unable to tell me his age, DOB, can't hold things in his hand, involuntary jerks, was found Friday in his floor with tongue hanging out and eyes rolled back in head according to family, also has not urinated since then...). But he had some normals that struck me as odd for a stroke, hand grips were strong and equal, PERRLA, could follow commands, all vitals wnl, stroke assessment negative.

He refused to go to ER, but POA was called and demanded I call 911, so I did. EMS assessed and all of a sudden his speech was better and he was oriented 😳x3! It's like when he got mad, he got better? He refused transport. Could:

A: he had a Stroke, anger increased Bp which increased perfusion to brain?

B: renal failure present with these odd symptoms

C: does this sound more like drug/alcohol? No hx.

D: your advice

So my question, has anyone seen anything like this before?

Had stroke about 10 weeks ago, but fully recovered.

I'm trying to work this out: yes something is wrong which needed er visit, renal failure vs stroke. Can renal failure present with such strange symptoms?

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Specializes in Pedi.

Those symptoms don't sound like stroke symptoms to me. Being found on the floor with eyes rolled back and jerking sounds more like a seizure. It's possible he was post-ictal when he couldn't relate his age or DOB and recovered by the time EMS arrived. What makes you think renal failure? Does this patient have any renal history at all?

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Specializes in SICU, trauma, neuro.

Hard to know without a workup, but it sounds like it could have been a seizure or a TIA.

Was he bladder scanned to assess for urinary retention vs. anuria? Post stroke I'd wonder about neurogenic bladder. I'm not a renal nurse, but with any organ failure severe enough to cause CNS sx (e.g. hepatic encephalopathy), I wouldn't expect such a quick spontaneous reversal of those sx.

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That sounds like my son when he is having a seizure. All the scary looking neuro symptoms resolve and everything is back to normal.

I would have called 911 too. It is better to have them there and things resolve than not have them there and your patient gets worse.

Perhaps he needs to schedule a stat doctors appointment to have this checked out.

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Specializes in Critical Care and ED.

It might be a stroke, and it might not be. You can't be expected to know just by looking and guessing which is why it's always a good idea to call for help. Not all strokes are the same and just because there isn't any obvious weakness doesn't mean he isn't still having a stroke. It could be a TIA, a seizure, an MI or an aneurysm. You couldn't guess at it so calling 911 is always the right thing. A 10 week hx of a stroke is suspicious. He might be mad at you but you did your job. Imagine if suddenly he died and you didn't call! Older people often refuse help. My own parents do and it drives me mad! My mom refused an ambulance when she was lying on the floor with a temp of 104 and I'm so glad my dad listened to me and called the ambulance anyway! (I was 2000 miles away at the time and hysterical on the phone!). Call for help and let the EMS decide. Good call.

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Those symptoms don't sound like stroke symptoms to me. Being found on the floor with eyes rolled back and jerking sounds more like a seizure. It's possible he was post-ictal when he couldn't relate his age or DOB and recovered by the time EMS arrived. What makes you think renal failure? Does this patient have any renal history at all?

The no urine x3 days plus his bun creat were elevated week before. He has md appt today

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Specializes in Pedi.
The no urine x3 days plus his bun creat were elevated week before. He has md appt today

Ok, well if he's fluid overloaded he could be hyponatremic. Hyponatremia causes cerebral edema which can cause seizures. Do you know what his Na level was?

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Specializes in Psych, Addictions, SOL (Student of Life).

I have a resident who does this frequently minus the no urine output - he has been throughly worked up and no cause found - consensus is valsalva response as it usually happens in the bathroom. I am not sure why 911 was called in your case instead of just taking him into the ER. Paramedics in our area get pretty ****** with facilities that call 911 for alert and oriented patients.

hppy

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Specializes in Medical-Surgical/Float Pool/Stepdown.

What was his blood sugar just out of curiosity? Really don't see S&S of severe hypoglycemia (causing seizure activity) just resolve themselves without intervention but I wouldn't completely rule it out.

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I have a resident who does this frequently minus the no urine output - he has been throughly worked up and no cause found - consensus is valsalva response as it usually happens in the bathroom. I am not sure why 911 was called in your case instead of just taking him into the ER. Paramedics in our area get pretty ****** with facilities that call 911 for alert and oriented patients.

hppy

I'm a home health RN. I can't transport ppl, against policy. Plus he was pissed at me for wanting him to go to ER

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What was his blood sugar just out of curiosity? Really don't see S&S of severe hypoglycemia (causing seizure activity) just resolve themselves without intervention but I wouldn't completely rule it out.

Not a diabetic. Nothing to test it with. If he finally sees the doc I'll update

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