CASE STUDY Clinical Scenarios, Assessment of Neurologic

CASE STUDY Clinical Scenarios, Assessment of Neurologic Function 1. Leah Smith, an 87-year-old patient, is at the clinic receiving an annual physical checkup. The patient is wearing a sweater, but complains that the room is cold. The thermostat reads 70°F. The patient has a slow, wide-based gait, and she is flexed forward slightly when she walks. She opens her purse and tries to find the bottle of herbals she bought to make sure it is alright to take the supplement and has problems locating it by feeling for the bottle. She states that she is all thumbs. She complains that food does not smell or taste like she remembered it smelling and tasting 10 years ago. She wonders if it is because she used to grow her food and that is why it had a better taste and smell. She also stated that her family is concerned because she does not seem to have enough peripheral vision to drive, and she wiped out the mailbox yesterday when backing out of the driveway. The nurse performs a neurologic exam. a. Explain the changes in the patient’s neurologic function that are related to aging and what risks the patient has related to age-related changes. b. Because age-related changes have an impact on the neurologic assessment, for what additional areas should the nurse assess the patient, and what findings reflect normal aging? c. What neurologic assessment findings do not change with aging? 2. Joe Carpenter, a 70-year-old patient, presents to the emergency department 4 hours after experiencing an ischemic brain attack confirmed on the CT of the head without contrast. The patient is a candidate for intra-arterial thrombolytic therapy to dissolve the blood clot causing the significant stroke symptoms. The patient is scheduled for the emergent cerebral angiogram with possible intra-arterial thrombolytic therapy. The nurse provided patient and family education and received the informed written consent from the patient’s spouse. The patient has IV normal saline at 100 mL/hr infusing into the right forearm with an 18-gauge angiocath, which is patent. a. What labs should the nurse assess before the procedure and why? b. What additional preparation should the nurse provide before the patient goes to the procedure?

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