What are two questions you would ask this patient?
Due to the patient’s past history of hypertension, hypercholesterolemia, coronary artery disease, and MI, one of the first questions I would ask is if the patient or his family has a history of stroke. Another question I will ask the patient is if he has a history of seizures and/or complex migraines which can mimic a stroke. According to Otlivanchik and Liberman (2019), approximately 2% of stroke emergencies result in a diagnosis of migraine, and 18% of those who were treated with IV thrombolysis also ended up with a final diagnosis of migraine.
Identify the subjective data for this patient.
The patient reports not being able to move his left arm and leg currently.
The patient reports an episode of amaurosis fugux (blindness) in the right eye a month ago that lasted 5 minutes.
The patient’s wife states that he had bilateral leg pain while on a walk that lasted about 15 minutes.
The patient reports that he takes a daily baby aspirin, an ACE inhibitor, and a statin.
The patient reports a history of alcohol use and smoking in the past but stopped after his heart attack.
The patient is right-handed with a history of coronary artery disease, hypertension hypercholesterolemia, and a heart attack at age 50.
Identify the objective data for this patient.
A 60-year-old patient with a blood pressure of 195/118, pulse of 106, respiratory rate of 18, temperature 99.8, Oâ‚‚ sat is 97% on room air.
Although his pupils are equal and reactive, and his eye movements are intact, he cannot voluntarily turn his eyes to the left side.
The neck is flexible, there is no distention of the jugular vein and there are no murmurs.
The lungs are clear, the heart sounds regular without murmurs, and the abdomen is normal.
The limbs are not well perfused distally.
Neurological examination reveals that he is alert and oriented, although he does not recognize that he is ill.
He shows a loss of awareness and attention to objects or stimuli on his left side.
He has mild dysarthria but speaks fluently understands and follows commands very well. There is mild weakness on the left side of the face and homonymous hemianopsia on the left side, but there is no nystagmus or ptosis, and no deviation of the tongue or uvula.
He can’t move his left arm and leg; he has hyperreflexia, and his left big toe is up.
What Social Determinants of Health would be relevant for this patient?
Although the patient’s financial status, educational level, work status, and living situation are unknown, what is known is the fact the patient is not in the most optimal health and may not be working full-time or at all. We also know the patient has a history of hypertension, coronary artery disease, hypercholesterolemia, and MI, therefore the patient may not be eating a healthy diet (or have access to healthy foods), the patient also has a history of tobacco and alcohol use thus increasing his risk of stroke and other comorbidities. Taking all these factors into consideration as well as not knowing the patient’s educational level and level of understanding of his condition, as healthcare providers, it is our job to screen for social determinants of health for each patient in order to provide patient-centered care that is holistic and all-encompassing. Healthcare providers can utilize different tools provided by different organizations such as the Health-Related Social Needs Screening Tool (AHC-HRSN) created by the Center for Medicare and Medicaid Services Accountable Health Communities, and the Protocol for Responding to and Assessing Patientsâ€™ Assets, Risk, and Experiences Tool created by the National Association of Community Health Center (Moen et al., 2020).