Mr. H is a 61-year-old male carpenter

Mr. H is a 61-year-old male carpenter with a large building firm who is admitted to the Rehabilitation Institute with a diagnosis of right hemiplegia and aphasia following a stroke (CVA) 4 weeks PTA. Subjective Because of J.T.’s speech dysfunction, history provided by wife. 4 weeks PTA—Complaint of severe headache; then sudden onset of collapse and loss of consciousness while at work. Did not strike head as he fell. Transported by ambulance to Memorial Hospital where admitting physician said J.T. “probably had a stroke.” Right arm and leg were limp, and he remained unconscious. Admitted to critical care unit. Regained consciousness day 3 after admission, unable to move right side, unable to speak clearly or write. Remained in ICU 4 more days until “doctors were sure heart and breathing were steady.” 3 weeks PTA—Transferred to medical floor where care included physical therapy 2 ×/day and passive ROM 4 ×/day. Now—Some improvement in right motor function. Bowel control achieved with use of commode same time each day (after breakfast). Bladder control improved. Some occasional incontinence, usually when he cannot tell people he needs to urinate. Objective Mental status: Dressed in jogging suit, sitting in wheelchair, appears alert with appropriate eye contact, listening intently to history. Speech is slow, requires great effort, able to give one-word answers that are appropriate but lack normal tone. Seems to understand all language spoken to him. Follows requests appropriately, within limits of motor weakness. Cranial nerves: II: Acuity normal; fields by confrontation—right homonymous hemianopsia; fundi normal. III, IV, VI: EOMs intact, no ptosis or nystagmus, PERRLA. V: Sensation intact to pinprick and light touch. Jaw strength weak on right. VII: Flat nasolabial fold on right, motor weakness on right lower face. Able to wrinkle forehead bilaterally but unable to smile or bare teeth on right. VIII: Hearing intact. IX, X: Swallowing intact, uvula rises midline on phonation. XI: Shoulder shrug, head movement weaker on right. XII: Tongue protrudes midline; no tremors. Sensory: Sharp and dull, light touch present but diminished on right arm and leg. Vibration intact. Position sense impaired on right side. Stereognosis intact. Motor: Right hand grip weak, right arm drifts, right leg weak, unable to support weight. Spasticity in right arm and leg muscles, limited range of motion on passive motion. Unable to stand up and walk unassisted. Unable to perform finger-to-nose or heel-to-shin on right side; left side smoothly intact. Reflexes: Hyperactive 4+ with clonus, and upgoing toes in right leg. READ THE SCENARIOS 1. WHAT ARE THE QUESTIONS YOU WILL ASK TO A CLIENT WHO PRESENTED TO THE CLINIC WITH CONFUSED MENTAL STATUS? 2. WHAT ARE THE NORMAL AND ABNORMAL FINDINGS YOU COULD THINK FROM THE CLIENT’S CRANIAL NERVES EXAMINATION? SCIENCE HEALTH SCIENCE NURSING NURS 110

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