Case Exemplar Patient Explained for Students (Easy Guide)

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Original Question

CASE EXEMPLAR: Patient With Face Drooping and Slurred Speech JS is a 62 -year -old male brought urgently into clinic by his wife who reports “something is just not right with J.” She says he is walking and leaning to one side, his face looks odd, and his words are slurred. She thinks he is having a stroke. Past Medical History • Hypertension • Hypercholesteremia • Anemia Medications • Spironolactone, 50 mg daily • Losartan, 50 mg daily • Simvastatin, 40 mg daily • Ibuprofen for pain Family History • Father deceased, liver failure due to alcoholism • Mother alive, hypertension Social History • Smoker • Plays poker at a senior citizens’ center • Little physical activity Physical Examination • Height: 70 inches; weight: 250 lb; blood pressure: 188/94; pulse: 110; respiration rate: 24 • Obesity • Droop to right side of face • Difficulty forming words • Sluggish mental response Labs and Imaging • Electrocardiogram: Atrial fibrillation with slowed ventricular response • Potassium: 4.5 mEq/L • Sodium: 142 mEq/L • Liver function: Normal Discussion Questions 1. What factors in JS’s history place him at risk for stroke? 2. The clinician determines that JS needs additional intervention that is beyond the scope of the clinic, so he is transferred by ambulance to the nearest emergency department. After initial tests, an ischemic stroke is confirmed. Treatment will begin with alteplase. Why is time important in the administration of alteplase? What is the intended outcome of this intervention and what short- and long-term side effects may JS experience? 3. What pharmacological and nonpharmacological treatments will JS continue at home?

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