Unit 8 Case Study

Case Study The wife of a 67-year-old man called the office and reported that her husband awoke this morning with weakness and numbness of the right side. He had difficulty getting out of bed and complained of intermittent episodes of dizziness. He also was experiencing difficulty speaking. The patient has a history of hypertension and is taking enalapril maleate (Vasotec) and propranolol hydrochloride (Inderal). The wife was advised that her husband should be seen in an emergency care facility, and an ambulance was called for transport.On examination in the emergency facility, the patient was found to have diminished strength in the right hand and foot, diminished movement in the right arm and leg, and had slurred speech. Vitals signs were the following: temperature, 98.6º F; pulse, 106 and irregular; respirations, 22; and blood pressure, 172/96 mm Hg. Oxygen therapy was started. Reflexes were diminished, as was pain response on the right side, including the extremities.

What is the diagnosis?

Transient Ischemic Attack (TIA) A cerebral MRI scan, CT scans, an EEG, skull radiographs, and an ECG were ordered. The ECG showed atrial fibrillation. After approximately 6 hours after onset, the symptoms began to resolve, with improvement in feeling and movement of the right extremities. Speech slowly became less slurred. The patient was diagnosed as having a TIA and was scheduled for follow-up evaluation. He was prescribed anticoagulant therapy.

Case Study #2

The wife of a 48-year-old man complains she cannot sleep as a result of the loud snoring of her husband. Questioning reveals she has noticed he has periods during which he appears to stop breathing for about 30 seconds when sleeping. The patient has a history of mild alcohol consumption and is also a smoker. He is approximately 30 pounds overweight.

What is the diagnosis?

Sleep Apnea