rotation 4; stares 3: assessment

Situation:
79 y.o female adm on the 6/7/10 for an elective St Jude’s (mechanical) atrial valve replacement for severe aortic stenosis. She had been experiencing increasing shortness of breath on exertion over the past year. Her pre admission exercise tolerance was 50m with a frame. She has a past medical history of severe aortic stenosis, tachy-brady syndrome, paroxysmal atrial fibrillation, hypertension, increased cholesterol, reflux, obese. She stayed in surgical ICU overnight and was transferred to the ward I was on the next day. On arrival to the ward she seemed to be showing some neurological signs of stroke.

Task:
Assess whether this patient was demonstrating neurological signs of stroke.

Action:
As discreetly as possible I did a quick neuro assessment on this patient as not to worry the patient’s family before more conclusive tests could be done plus have the medical team talk to the family.

Result:
Through general observation, visual tracking/field, volitional movement, reflexes and gross sensation I was able to give the medical team fairly concise findings which demonstrated a clinical picture fitting with a R CVA.

Evaluation:
As this patient was quite drowsy some aspects of the neurological assessment where more difficult to assess like proprioception and sensation. It was very important to prioritise the assessments in this case as she was fatiguing quickly so I tried to use as much observation as I could and then moved to the tasks that I thought she was most likely to able to follow commands for and that were important from a physiotherapy point of view like volitional movement. As I was not on a neuro ward but a post cardiothoracic surgical ward I didn’t have some equipment like reflex hammers and toothpicks/ objects for sharp blunt test so I had to make do with what I had, if I had been more organised I could have gone and collected this equipment before seeing the patient.

Strategies:
• Prioritise
• Use observational skills as much as possible
• Be prepared with all equipment required
• Be resourceful when equipment is not available
• Prepare findings in a concise well organised way to the medical team