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Part B In this case, ischemic stroke is the immediate hypothesis to consider. The client presents significant and sudden symptoms like cognitive changes, body weakness, and speech difficulties that are associated with ischemic stroke. Although other hypotheses like systemic abnormalities, medication–related impacts, and neurological conditions are crucial to consider, they should be assessed with stroke evaluation. The client has a medical history of hypertension, hyperlipidemia, and type 2 diabetes, which are major risk factors for ischemic stroke (Wang et al., 2022). Specifically, diabetes and hypertension play a crucial role in the development of hemorrhage and cerebral ischemia. If the patient had not been assessed for ischemic stroke, several complications, including pulmonary embolism( PE), deep vein thrombosis( DVT), falls, bladder or bowel dysfunction, and urinary tract infection( UTI), could have occurred. These complications occur four days after the patient shows symptoms of ischemic stroke. PE is a common complication among patients with ischemic stroke and may cause death (Keller et al., 2020). DVT is a serious problem among patients diagnosed with ischemic stroke and, if not prevented earlier, leads to pulmonary emboli. Preventing DVT is one of the core measures in primary stroke centers (PSC). If earlier assessments were not conducted, the patient could experience falls, which results in injuries among stroke patients. For example, hip fractures appear seven days and have been associated with hemiplegia. UTI is a common infection linked to ischemic stroke. It is associated with adverse outcomes like disability and death (Mukapa et al., 2022). Additionally, the patient could have experienced long-term damage, making it difficult to engage in daily tasks and maintain independence. Undiagnosed strokes cause psychological and emotional impacts, including

anxiety and depression. Moreover, undiagnosed ischemic stroke increases brain damage. Time is an important factor to consider in treating ischemic stroke. Delayed diagnosis leads to long- lasting and severe neurological deficits. Physical assessment of ischemic stroke helps to determine the patient's complications, prognosis, and levels of neurological deficit. Assessment of mental and Conscious Level The assessment involves several neurological examinations and clinical scales. It helps healthcare providers to understand the severity of the condition and determine the most effective form of treatment. During this assessment, healthcare providers get critical data like verbal, motor, and eye-opening responses. Additionally, patients are monitored on alertness level by inquiring whether they are drowsy, awake, unresponsive, or confused. The observation provides critical information on their mental status. Patients are asked simple questions to evaluate their orientation to places, persons, and time, as they will likely experience varying degrees of confusion or disorientation. Magnetic resonance imaging (MRI) and Computed tomography (CT) brain scans are essential in the diagnosis of ischemic stroke and help evaluate brain damage (Provost et al.,2019). These scans also help nurses to identify the cause and location of the stroke. For example, MRI scans help to diagnose whether the stroke is hemorrhagic or ischemic and find abnormalities in the spinal cord and skull. Assessment of Speech Cognition The assessment entails a detailed investigation of attention, memory, praxis functions, and perception. The assessment provides critical data that helps healthcare providers to understand communication and cognitive deficits. During this assessment, healthcare providers monitor the patient's language impairment, including aphasia. Notably, aphasia is a primary

language impairment. In this case, the severity and type of aphasia can be assessed using standardized tests. Aphasia increases the risks of complications among stroke patients, including pneumonia and sepsis, and thus, the information can help healthcare providers provide further recommendations (Seo et al., 2020). The data collected include the ability of patients to name objects, write, and follow verbal commands. Data collected in this assessment helps healthcare providers plan treatment options, track progress, and set realistic goals. Besides treatment options, the assessment helps in improving patients recovery, quality of life, and the overall well- being. Moreover, the assessments help healthcare providers address specific problems patients experience and provide them with support and interventions. Assessment of Cardiac Rhythm Through this assessment, healthcare providers get detailed data about patients' history of heart diseases, arrhythmias, and prior strokes. The physical examinations involve assessing vital signs like heart rate and blood pressure. In this case, irregular heart rhythms will likely be detected during the examinations, including atrial fibrillation. Cardiac monitoring helps to identify atrial fibrillations for suspected patients with ischemic stroke (Bernstein et al.,2021). Additionally, during this assessment, monitoring of cardiac ultrasound provides critical information about the function and structure of the heart. It identifies conditions such as cardiomyopathy and valvular diseases, which lead to ischemic stroke. Assessment of cardiac rhythm is important in identifying the causes of ischemic stroke and how to minimize and manage the risk of future occurrence of strokes. Neurologic assessment

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During this assessment, some of the data healthcare providers collect include patients' level of orientation, consciousness, and general appearance. For example, using the Glasgow coma scale (GCS), care providers monitor patients' verbal response opening and motor response. Additionally, vital signs, including heart rate, blood pressure, and oxygen saturation, are monitored to provide critical information on the patient's overall condition. Moreover, patients are assessed on coordination, cranial nerves, and sensory function. Notably, detailed neurologic assessment is important as it guides treatment and management plans for patients. It also helps care providers decide on endovascular interventions and thrombolytic therapy. Moreover, the assessment provides the baseline for tracking patient progress during rehabilitation and recovery. Part C SBAR Report Situation, Background, Assessment, and Recommendation ( SBAR) is a validated and reliable tool that helps to reduce adverse events in hospitals, improve communication between healthcare providers, and promote patient safety(Shahid & Thomas,2018). Situation Hello, this is Elias Jones, a physician at the Mayo Clinic emergency department. I am calling about a patient in room 6, age 60, male, who presents signs and symptoms of ischemic stroke, including trouble speaking, confusion, sudden dizziness, loss of coordination and balance, and severe headaches. Background The patient's medical history of type 2 diabetes, hypertension, and hyperlipidemia. The patient experienced a transient ischemic attack two weeks ago. Patients report no allergies to iodine dye or medications. He weighs 82 kg and has no other medical problems. Despite the

medical history, the patient experiences symptoms like slurred speech and weak cognition problems. The patient was taking medications like Xarelto Metoprolol succinate and Pantoprazole. Assessment Based on neurological assessment, the patient shows expressive aphasia, facial droop, and right-sided hemiparesis. The GCS score is 5, indicating that patients need further medications. The patient has no sign of seizures or trauma. Additionally, the patient has no contrasted head CT scans. Lastly, a neurologist has been consulted to evaluate further thrombolytic therapy. Recommendation I would recommend a CT scan specifically for hemorrhagic breed in the brain. Drawing labs on Platelets and patient should stay on stroke precaution. Continuous collaboration with the stroke team on ongoing care. Regular communication with the family to provide updates. Management and control of hypertension to minimize risks of recurrent strokes. Weight management through a healthy diet and physical exercise.

References Bernstein, R. A., Kamel, H., Granger, C. B., Piccini, J. P., Sethi, P. P., Katz, J. M., ... & Ishida, K. (2021). Effect of long-term continuous cardiac monitoring vs usual care on detection of atrial fibrillation in patients with stroke attributed to large-or small-vessel disease: the STROKE-AF randomized clinical trial. Jama , 325 (21), 2169-2177. doi:10.1001/jama.2021.6470 Keller, K., Hobohm, L., Muenzel, T., Lankeit, M., & Ostad, M. A. (2020). Impact of pulmonary embolism on in-hospital mortality of patients with ischemic stroke. Journal of the Neurological Sciences , 419 , 117174. https://doi.org/10.1016/j.jns.2020.117174 Mukapa, N., Mataruse, A., Ngwende, G. W., & Robertson, V. (2022). Incidence, risk factors and microbiological aetiology of urinary tract infections in admitted stroke patients at a teaching hospital in Zimbabwe: A prospective cohort study. Infection prevention in practice , 4 (2), 100210. https://doi.org/10.1016/j.infpip.2022.100210 Provost, C., Soudant, M., Legrand, L., Ben Hassen, W., Xie, Y., Soize, S., ... & Oppenheim, C. (2019). Magnetic resonance imaging or computed tomography before treatment in acute ischemic stroke: effect on workflow and functional outcome. Stroke , 50 (3), 659-664. https://doi.org/10.1161/STROKEAHA.118.023882 Seo, K. C., Ko, J. Y., Kim, T. U., Lee, S. J., Hyun, J. K., & Kim, S. Y. (2020). Post-stroke aphasia as a prognostic factor for cognitive and functional changes in patients with stroke: Ischemic versus hemorrhagic. Annals of Rehabilitation Medicine , 44 (3), 171-180. https://doi.org/10.5535/arm.19096

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Shahid, S., & Thomas, S. (2018). Situation, background, assessment, recommendation (SBAR) communication tool for handoff in health care–a narrative review. Safety in Health , 4 (1), 1-9. https://doi.org/10.1186/s40886-018-0073-1 Wang, C., Du, Z., Ye, N., Shi, C., Liu, S., Geng, D., & Sun, Y. (2022). Hyperlipidemia and hypertension have synergistic interaction on ischemic stroke: insights from a general population survey in China. BMC cardiovascular disorders , 22 (1), 47. https://doi.org/10.1186/s12872-022-02491-2

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