Texts: Leo Thompson is a 54-year-old African-American man admitted to the hospital with a diagnosis of acute CVA. The following data are collected by the nurse during an interview and examination.
Interview data:
Mr. Thompson’s wife tells the nurse that he was fine until this morning when he suddenly had a headache, fell to the floor, and could not get up. Mrs. Thompson adds that her husband made only mumbling noises and she could not understand him. He has type 2 diabetes mellitus and hypertension. He stopped smoking last year.
Examination data:
- Neurologic examination: Awake, alert man. Unable to talk but able to follow requests. Cries and avoids eye contact with his wife and nurse. Cranial nerves III, IV, V, VI, and VIII are intact bilaterally. The patient has asymmetry and unequal movements of his face, with a drooping of the left side of his face. He has asymmetric shoulder shrug, with weakness noticed on his left side. He has supination and pronation of his right hand but is unable to perform with his left hand. Light touch with sharp and dull sensation is present on his right arm and leg; there is no sensation on his left arm or leg. Right arm and leg muscle strength is 5, left arm muscle tone 0, and left leg 1. He is unable to move around in bed unassisted at this time. Assessment of balance is deferred.
Clinical judgment:
1. What cues do you recognize that suggest deviations from expected findings, suggesting a need for further investigation?
2. For which additional information should the nurse ask or assess?
3. Based on the data, which risk factors for CVA does Mr. Thompson have?
4. With which team member would the nurse collaborate to meet this patient’s needs?