Question:After conducting a physical assessment and obtaining the patient’s medical history, what diagnosis do you suspect and explain why.

Answer:After a quick assessment, the patient is noted to have a BP of 160/100, EKG shows atrial fibrillation, facial drooping, right-sided paralysis, aphasia, and dysarthria. The NIH Stroke Scale score is 17. The wife reports that the patient had complaints of chest fluttering, dizziness, and syncope. A review of his medications includes Avodart for BPH, Lisinopril for HTN, indomethacin for gout pain, colchicine for gout, ASA as needed for pain, Zocor and Niaspan for high cholesterol, and Metformin for DM. The wife also reports that he does not take the prescribed Lisinopril. Additionally, the patient smokes, has a poor diet, and leads a sedentary lifestyle. Considering the above symptoms, medical history, and the patient’s race, a stroke can be suspected.

What teaching point were you trying to make, which incorporated one or more of the three Ps? (pathophysiology, physical exam, pharmacology):All three Ps are addressed in this question. From the start, a quick physical assessment can guide the nurse toward thinking about the possibility of a stroke. After learning of his medical history and lifestyle, the nurse can further relate the likelihood of a stroke. Additionally, understanding pharmacology and why a patient takes certain medications can provide crucial information to anticipate further tests ordered by the physician to rule out a stroke.

Question:What indicators are present that demonstrate tPa is the appropriate treatment option?

Answer:Upon assessment, the patient presents with facial drooping, severe weakness in the right limbs, sensory loss, severe aphasia, and dysarthria. The NIH Stroke Scale score is 17. Analyzing the patient’s assessment…

What teaching point were you trying to make, which incorporated one or more of the three Ps? (pathophysiology, physical exam, pharmacology):With this question, I aimed to address all three Ps. The physical exam teaching occurs by asking the student to assess the patient and recognize key signs and symptoms indicative of a stroke. Pathophysiology is addressed by helping the patient understand what predisposes them to having a stroke. Pharmacology is also incorporated by discussing the appropriate use of tPa based on the clinical presentation.