What are two questions you would ask this patient?
Based on the symptoms the patient exhibits, he probably has a cardiovascular or neurological problem. Assessment questions can provide information for determining the diagnosis (Bickley, 2023). The first question I would ask the patient is: Do you have a history of seizures or epilepsy? The symptoms exhibited by the patient suggest that the health problem he has impairs brain function. The first question is important because it can help determine whether the impairment of brain function resulted from seizure or epilepsy. Seizures, epilepsy, and stroke share some symptoms because they affect brain function (Lee, 2019). The second question I would ask the patient is: Have you experienced dizziness or problems with balance and coordination within the last month? Before a stroke, patients usually experience warning signs such as numbness, blurred or loss of vision, dizziness, and balance and coordination problems (Syed et al., 2023). The occurrence of these warning signs indicates a mini-stroke. Therefore, asking the second question will help to validate stroke as the diagnosis for the patient.
Identify the subjective data for this patient.
Slurred speech and left side weakness
History of present illness:
The patient went to bed at 11pm and developed the symptoms during the night. His wife noticed the symptoms at 5am. He currently is unable to move his left arm and leg.
He is right-handed with a history of coronary artery disease, hypertension, and hypercholesterolemia and a heart attack at age 50.
He had an episode of amaurosis fugax (blindness) in his right eye one month ago that lasted for 5 minutes.
Around 3 months ago his wife states he had bilateral pain in his legs while they were on a walk that lasted about 15 minutes.
He does have a history of alcohol use and smoking in the past but stopped after his heart attack.
He is taking a baby aspirin a day an ACE inhibitor, and statin as well.
Identify the objective data for this patient.
Vital sings: blood pressure is 195/118, Pulse 106, Respiratory rate 18, Temperature 99.8, and O2 saturation is 97% on room air.
Physical Exam Findings
Although his pupils are equal and reactive, and the ocular movements are intact, he is unable to turn his eyes voluntarily towards the left side. The neck is supple, there is no jugular vein distension, and there are no bruits.
The lungs are clear, heart sounds regular without murmurs, and abdomen is normal.
He shows loss of awareness and attention with respect to objects or stimuli on his left side.
The neurologic examination reveals that he is alert and oriented, although he does not recognize he is sick.
He has mild dysarthria but, his speech is fluent, and he understands and follows commands very well.
There is mild weakness on the left side of the face and left sided homonymous hemianopsia, but there is no nystagmus or ptosis, and no tongue or uvula deviation.
He is not able to move his left arm and leg, has hyperreflexia, and the left great toe is upgoing.
The limbs are not well perfused distally.
What Social Determinants of Health would be relevant for this patient?
Social determinants of health influence the health outcomes of patients. De Mooij et al. (2019) describe social determinants of health as environmental conditions that define the place in which a person is born, grows, lives, and works. In the case of the 60-year-old patient, the social determinants of health that are likely to influence his well-being are socioeconomic status, social support, and neighborhood. Having stable social support and supportive relationships enable a patient to make decisions that promote their health (Lee & Waters, 2021). Social support also improves the ability of a patient to cope with the difficult realities of his health problem. Wang and Geng (2019) identify socioeconomic status as a factor influencing the health outcomes of patients because it determines their ability to afford the health care services they need. The neighborhood in which patients live influences their access to and availability of health services (Ginzberg, 2019). Living in a low-income neighborhood increases the risk of poor health outcomes due to low proximity to healthcare facilities.