Case Study Analysis
When trying to determine the nature of the patient’s health condition, the advanced practice nurse uses different methods of assessment to gain a comprehensive view of the patient. This process starts with the formation of a differential diagnosis that filters the possibilities and offers the best shot at getting the right diagnosis to begin with in an attempt at getting the right treatment. This essay focuses on the diagnostic assessment of a 92-year-old African American man with particularly slurred speech and severely high blood pressure; the emergency department BP reading was 210/100mmHg: Case Study Analysis.
Chief Complaint
The primary report is about slurred speech, which is clear evidence of neurological deficit; the patient is old and hypertensive. While slurred speech is often related to a stroke, which means a neurological event, it is necessary to provide the patient with primary care and begin a diagnostic examination as soon as possible.
Physical Exams and Diagnostic Tests
To obtain more patient-specific information about the patient’s condition, certain physical examinations and diagnostic tests need to be performed. A thorough neurological exam is mandatory, including cranial nerve examination and assessment of the sensory system, motor system, and reflexes. This involves examination of the cranial nerves, muscle power assessment, sensory examination, and examination of reflexes to identify any abnormality that may indicate a stroke or any neuropathies.
Also, the patient’s blood pressure needs to be repeated to ensure a hypertensive crisis is confirmed and to track the disease’s progression. High blood pressure readings are not only crucial in the treatment of the patient’s current state but also an outstanding signal of the pathophysiology.
Depending on the patient’s stroke risk factors, specific laboratory tests should be performed before the procedure. These include a complete blood count to check for infection or anemia, a metabolic panel to evaluate kidney function and electrolyte levels, and a lipid level to determine hyperlipidemia. Blood glucose levels are critical to rule out hypoglycemia because the signs are often similar to those of a stroke. Investigations done by medical members show that imaging studies are the most critical aspect of diagnosis.
The non-contrast CT head is the initial imaging to diagnose hemorrhagic stroke or other structural abnormality of the brain. If the CT scan does not give sufficient information, an MRI of the brain gives better extensive imaging, especially for ischemic stroke. Ernstmeyer and Christman (2021) recommend an ECG and carotid Doppler ultrasound as they help check for atrial fibrillation that may cause embolic stroke or carotid artery stenosis that may lead to the same.
Utilizing Results for Diagnosis
The results of these tests would be instrumental in formulating an accurate diagnosis. Neurological examination would determine the areas of the brain involved and distinguish between the ischemic and hemorrhagic events. Diagnostic imaging would establish or rule out stroke, its type, and the extent to decide on the appropriateness of thrombolytic therapy in desire for the ischemic forms or controlling blood pressure in the hemorrhagic forms. Metabolic and coagulation profiles would reveal features suggesting that the stroke was secondary to some other condition, so investigations such as myocardial and carotid imaging would point to the potential source of thromboembolism and further management (Shafaat & Sotoudeh, 2023).
Differential Diagnosis
Based on the patient’s presentation and initial findings, several conditions must be considered in the differential diagnosis. A more probable diagnosis is an ischemic stroke due to the presence of the symptom of slurred speech and a history of hypertension. An ischemic stroke takes place due to the blockage of the cerebral blood flow that can result from embolism or thrombosis (Nogles & Galuska, 2023). Another possible explanation is hemorrhagic stroke in those with high blood pressure to critical levels, resulting in vessel and intracranial hemorrhage (Unnithan et al., 2023).
It also makes sense to consider transient ischemic attack (TIA) as that is a stroke-like condition where blood flow is temporarily interrupted, but no tissue is lost. Moreover, hypertensive encephalopathy should be considered because increased ICP may cause cerebral edema and neurological manifestations when blood pressure rises sharply. Finally, hypoglycemia should be excluded during the diagnosis of stroke since it may cause neurological symptoms indistinguishable from those of a stroke.
References
Ernstmeyer, K., & Christman, E. (2021). Chapter 6 neurological assessment. Www.ncbi.nlm.nih.gov; Chippewa Valley Technical College. https://www.ncbi.nlm.nih.gov/books/NBK593206/
Nogles, T. E., & Galuska, M. A. (2023, April 3). Middle cerebral artery stroke. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK556132/
Shafaat, O., & Sotoudeh, H. (2023, May 1). Stroke imaging. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK546635/
Unnithan, A. K. A., Mehta, P., & Das, J. M. (2023, May 8). Hemorrhagic stroke. National Library of Medicine; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK559173/
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Question 
When seeking to identify a patient’s health condition, advanced practice nurses can use a diverse selection of diagnostic tests and
For this Case Study Assignment, you will determine the physical exams a
- Review the details of the patient case study.
- Case study: 92 y/o African American male is brought to the Emergency Department by his daughter. The patient has slurred speech. His blood pressure is 210/100.
- Consider what physical exams and diagnostic tests would be most appropriate to gather more information about the patient’s condition.
- Reflect on how the results would be used to make a diagnosis.
- Identify three to five (3–5) possible conditions that may be considered in a differential diagnosis for the patient.
Case Study Analysis
Assignment: Diagnostic Reasoning
Include the following:
- Identify the patient’s chief complaint.
- Identify what physical exams and diagnostic tests would be most appropriate to gather more information about the patient’s condition. Be specific and explain your reasoning.
- Explain how the results would be used to make a diagnosis.
- Identify three to five (3–5) possible conditions that may be considered in a differential diagnosis for the patient. Explain your thinking.
- Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2023). Seidel’s guide to physical examination: An interprofessional approach (10th ed.). Elsevier Mosby.
- Chapter 3, “Examination Techniques and Equipment” This chapter explains the physical
examination techniques of inspection, palpation, percussion, and auscultation. This chapter also explores special issues and equipment relevant to the physical exam process.
- Chapter 3, “Examination Techniques and Equipment” This chapter explains the physical
- Sullivan, D. D. (2019). Guide to clinical documentation (3rd ed.). F. A. Davis Company.
- Chapter 2, “The Comprehensive History and Physical Exam”
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