92 y/o African American male is brought to the Emergency Department by his daughter.9

Case study: Diagnostic Reasoning

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.

For this Case Study Assignment, you will determine the physical exams and diagnostic tests that would be most appropriate for gaining information and better understanding of your patient’s condition. Then, based on your analysis, you will formulate a differential diagnosis for the patient.

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.

References page

Assignment 1_Rubric

 

NURS_6512_Week 3_Assignment 1_Rubric
Criteria	Ratings	Pts
This criterion is linked to a Learning OutcomeIdentify the patient’s chief complaint.	15 to >12.0 pts Excellent The response clearly, accurately, and in detail explains the assigned patient’s chief complaint. 12 to >9.0 pts Good The response accurately explains the assigned patient’s chief complaint. 9 to >6.0 pts Fair The response vaguely and with some inaccuracy explains the assigned patient’s chief complaint. 6 to >0 pts Poor The response is inaccurate and/or missing an explanation of the assigned patient’s chief complaint.	15 pts
This criterion is linked to a Learning OutcomeIdentify 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.	20 to >17.0 pts Excellent The response clearly, accurately, and in detail Identifies physical exams and diagnostic tests that are most appropriate to gather more information about the patient’s condition; reasoning for the exams/tests is clear, accurate, and detailed. 17 to >14.0 pts Good The response accurately Identifies physical exams and diagnostic tests that are most appropriate to gather more information about the patient’s condition; reasoning for the exams/tests is specific and accurate. 14 to >13.0 pts Fair The response vaguely and with some inaccuracy Identifies physical exams and diagnostic tests that are appropriate to gather more information about the patient’s condition; reasoning for the exams/tests is vague and somewhat accurate. 13 to >0 pts Poor The response is inaccurate and/or missing identification of physical exams and diagnostic tests that are appropriate to gather more information about the patient’s condition; reasoning for the exams/tests is inaccurate or missing.	20 pts
This criterion is linked to a Learning OutcomeExplain how the results would be used to make a diagnosis.	15 to >12.0 pts Excellent The response clearly, accurately, and in detail explains how the results would be used to make a diagnosis. 12 to >9.0 pts Good The response accurately explains how the results would be used to make a diagnosis. 9 to >6.0 pts Fair The response vaguely and with some inaccuracy explains how the results would be used to make a diagnosis. 6 to >0 pts Poor The response explains inaccurately and/or is missing how the results would be used to make a diagnosis.	15 pts
This criterion is linked to a Learning OutcomeIdentify three to five (3–5) possible conditions that may be considered in a differential diagnosis for the patient. Explain your thinking.	35 to >29.0 pts Excellent The response clearly, accurately, and in detail identifies four or five possible conditions that may be considered in a differential diagnosis for the patient; with clear, accurate, and detailed reasoning for each possible condition. 29 to >23.0 pts Good The response accurately identifies three to five possible conditions that may be considered in a differential diagnosis for the patient; with accurate reasoning for each possible condition. 23 to >17.0 pts Fair The response vaguely and lacking specificity identifies three possible conditions that may be considered in a differential diagnosis for the patient; with vague reasoning for each possible condition. 17 to >0 pts Poor The response inadequately identifies fewer than three possible conditions that may be considered in a differential diagnosis for the patient; with inadequate or missing reasoning for each possible condition.	35 pts
This criterion is linked to a Learning OutcomeWritten Expression and Formatting: Paragraph Development and Organization — Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused and neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria.	5 to >4.0 pts Excellent Paragraphs and sentences follow writing standards for flow, continuity, and clarity. A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria. 4 to >3.0 pts Good Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time. Purpose, introduction, and conclusion of the assignment are stated, yet are brief and not descriptive. 3 to >2.0 pts Fair Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time. Purpose, introduction, and conclusion of the assignment are vague or off topic. 2 to >0 pts Poor Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time. No purpose statement, introduction, or conclusion were provided.	5 pts
This criterion is linked to a Learning OutcomeWritten Expression and Formatting: English Writing Standards — Correct grammar, mechanics, and proper punctuation	5 to >4.0 pts Excellent Uses correct grammar, spelling, and punctuation with no errors. 4 to >3.0 pts Good Contains a few (1 or 2) grammar, spelling, and punctuation errors. 3 to >2.0 pts Fair Contains several (3 or 4) grammar, spelling, and punctuation errors. 2 to >0 pts Poor Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.	5 pts
This criterion is linked to a Learning OutcomeWritten Expression and Formatting: APA The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running heads, parenthetical/in-text citations, and reference list.	5 to >4.0 pts Excellent Uses correct APA format with no errors. 4 to >3.0 pts Good Contains a few (1 or 2) APA format errors. 3 to >2.0 pts Fair Contains several (3 or 4) APA format errors. 2 to >0 pts Poor Contains many (≥ 5) APA format errors.	5 pts
Total Points: 100

92 y/o African American male is brought to the Emergency Department by his daughter.9

### Case Study: Diagnostic Reasoning

 

#### Chief Complaint

The patient, a 92-year-old African American male, presents with slurred speech and a blood pressure of 210/100 mmHg.

 

#### Physical Exams and Diagnostic Tests

1. **Physical Exams:**

– **Neurological Examination:** Assess for signs of focal neurological deficits, including cranial nerve examination, motor and sensory function, coordination, and gait.

– **Cardiovascular Examination:** Focus on blood pressure measurement, auscultation of the heart for murmurs, and assessment of peripheral pulses.

 

2. **Diagnostic Tests:**

– **CT Scan of the Head:** To rule out acute intracranial hemorrhage or ischemic stroke.

– **MRI Brain:** If CT scan is inconclusive or for detailed evaluation.

– **Electrocardiogram (ECG):** To evaluate for cardiac arrhythmias or evidence of acute myocardial infarction.

– **Lab Tests:** Including complete blood count (CBC), basic metabolic panel (BMP), and coagulation studies to assess for metabolic abnormalities and coagulopathy.

 

#### Use of Results for Diagnosis

– **Neurological Findings:** Abnormalities such as unilateral weakness or sensory deficits would suggest a focal neurological lesion indicative of stroke.

– **Imaging Studies:** CT or MRI findings of acute ischemic changes or hemorrhage would confirm a stroke diagnosis.

– **Cardiac Evaluation:** ECG and cardiac enzymes (if indicated) would assess for underlying cardiac causes contributing to the neurological symptoms.

 

#### Differential Diagnosis

1. **Ischemic Stroke:** Given the acute onset of slurred speech and elevated blood pressure.
2. **Hemorrhagic Stroke:** Especially considering the significantly elevated blood pressure.
3. **Transient Ischemic Attack (TIA):** Temporary neurological deficits without infarction.
4. **Hypertensive Crisis:** Elevated blood pressure leading to neurological symptoms.
5. **Subdural Hematoma:** Especially if there is history of trauma or anticoagulant use.

 

#### References

– American Heart Association/American Stroke Association. (2018). Guidelines for the early management of patients with acute ischemic stroke: A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 49(3), e46-e99.

– Powers, W. J., et al. (2018). Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 50(12), e344-e418.

 

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### References

 

American Heart Association/American Stroke Association. (2018). Guidelines for the early management of patients with acute ischemic stroke: A guideline for healthcare professionals from the American Heart Association/American Stroke Association. *Stroke, 49*(3), e46-e99. https://doi.org/10.1161/STR.0000000000000158

 

Powers, W. J., et al. (2018). Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: A guideline for healthcare professionals from the American Heart Association/American Stroke Association. *Stroke, 50*(12), e344-e418. https://doi.org/10.1161/STR.0000000000000211

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