Case Study

A 66-year-old woman who arrives in the emergency department after falling in the middle of the night when she tried to get up to go
to the bathroom. She states that she fell because she, could not control her left leg. Her husband brought her to the hospital, but
states that he had a really hard time getting her to the car.
1. What are the possible causes for her acute leg weakness?
2. What type of assessment would be most appropriate for A.J.: comprehensive, focused, or emergency? What would be your priority
assessment?
3. What questions would you ask A.J.?
4. What should be included in the physical assessment? What would you be looking for?
5. What diagnostic studies might you expect to be ordered?
1.

What are the possible causes of A.Js acute leg weakness?

Transient ischemic attack

Hemorrhagic stroke

Ischemic stroke

Brain tumor

Spinal cord tumor

2.

What type of assessment would be most appropriate for A.J: comprehensive, focused, or emergency? What would be your
priority assessment?

Because time is brain, it is imperative to perform an emergent assessment on A.J. in order to quickly identify if his
symptoms are caused by a stroke, for which treatment within a 3-hour time frame can prevent and/or minimize permanent
damage.

3.

What questions would you ask A.J.?

Do you have a history of cardiovascular or neurologic disease, high cholesterol, or high blood pressure?

What medications are you currently taking, including over-the-counter medications? Are you taking your medications on a
regular basis?

Do you smoke or drink alcohol?

What is your height and weight?

Have you noticed any previous difficulty with walking?

Do you have any numbness or tingling of your extremities?

Have these symptoms occurred before?

4.

What should be included in the physical assessment? What would you be looking for?

Vital signs

Assess mental status, cranial nerves, motor function, and sensory function

Would be looking for symptoms of stroke, such as motor weakness or paralysis, loss of sensation, loss of visual fields, or
impaired communication

5.

What diagnostic studies might you expect to be ordered?

CT scan of the head

Blood glucose

PT/IINR

A subjective assessment of A.J. revealed the following information:

PMH: Hyperlipidemia, hypertension.
Medications: pravastatin 40 mg/day PO; lisinopril
10 mg/day PO.
Health PerceptionHealth Management: Smokes one pack of cigarettes per day since she was 28 yr old. Drinks alcohol
occasionally. Hypertension controlled when on medication but has not taken her lisinopril for a few weeks because she did not have
enough money for the refill and was waiting for her next Social Security check. Has never been hospitalized for a neurologic problem.
Nutritional-Metabolic: A.J. is 5 ft, 3 in tall and weighs 160 lb.
Activity-Exercise: States that up until tonight she was able to walk slowly, but her knees and hips hurt.
Cognitive-Perceptual: States had a brief episode of left-sided weakness and tingling of the face, arm, and hand 3 mo ago. The
symptoms totally resolved and she did not seek treatment. Denies dizziness, change in hearing, or memory deficits.
CopingStress Tolerance: Is depressed and fearful. Concerned she is having a stroke and she does not know if she has enough
money to cover the copay for coming to the emergency department.
A physical assessment of A.J. reveals the following:
BP 180/110, HR 94, RR 22, T 37 C
Alert, oriented, and able to answer questions appropriately but mild slowness in responding
Left-sided arm weakness (3/5) and leg weakness (4/5)
NIH Stroke score is 3
As you continue to read this chapter, consider diagnostic studies you would anticipate being performed for A.J.