Patient Data

Exhibits

For each focused assessment area, click to specify which findings indicate early interventions for an ischemic stroke were effective.

Each focused assessment area may support more than one clinical finding. Each category must have at least one response option selected.

 

Focused Assessment Area	Clinical Finding
Musculoskeletal	Ambulates with a walker Flaccidity of left arm Passive range of motion of the left leg
Psychosocial	Fits of laughter Angry outbursts Tearful sharing of stories
Neurological	Drinks with repetitive cough Decorticate posturing Speaks in short sentences

Rationale:
A. Elevated liver function tests: Oral antivirals such as acyclovir or valacyclovir are metabolized by the liver, and elevated liver enzymes may indicate hepatotoxicity. This finding is critical and may necessitate discontinuation or dose adjustment to prevent liver damage.

B. Vomiting and diarrhea: These are common side effects of oral antivirals and are usually self-limiting. They typically do not require discontinuation unless they lead to dehydration or are severe and persistent.

C. Decreased white blood cell count: A decreased white blood cell can be a side effect of some antiviral medications, and while it increases the risk of infection, it is usually monitored during long-term therapy. However, in the context of acute shingles treatment with an oral antiviral, elevated liver function tests often represent a more immediate concern.

D. Pruritus and muscle aches: These symptoms may occur with antiviral use but are usually mild and nonspecific. They should be monitored but are not as immediately concerning as signs of liver dysfunction.

Rationale for Correct Choices

• 4 to 8 weeks: Sertraline, an SSRI, typically requires 4 to 8 weeks to reach its full therapeutic effect. This time frame allows for sufficient serotonin modulation, necessary for symptom improvement in conditions like PTSD and depression.
• Eye movement desensitization: Eye Movement Desensitization and Reprocessing (EMDR) is specifically recommended for PTSD. It involves guided eye movements that help the brain reprocess traumatic events and reduce emotional disturbance.
• Deep breathing: Deep breathing promotes parasympathetic nervous system activation, helping reduce anxiety and hyperarousal. It is a simple, accessible coping strategy to complement therapy and medication.

Rationale for Incorrect Choices

• 1 to 2 days: This timeframe is too short for an SSRI to have significant therapeutic effects. Any changes in mood or anxiety within this period are typically not due to the medication’s primary mechanism of action.
• 10 to 14 days: Although some mild improvement may begin, full therapeutic benefits of sertraline are not typically seen within this period. Clients are advised to continue consistent use for several weeks.
• Cognitive behavioural therapy: CBT is effective for many mental health disorders, including PTSD, but it does not involve the “reprocessing” component referenced.
• Prolonged exposure therapy: Prolonged exposure is used for PTSD treatment but focuses on gradually confronting trauma-related memories. It lacks the reprocessing element emphasized in the question.
• Progressive muscle relaxation: While useful for anxiety reduction, it is more complex and less immediate than deep breathing. It also requires a quiet space and more time, which may limit spontaneous use.
• Guided imagery: Guided imagery can reduce anxiety but involves visualization, which may not be suitable for individuals with intrusive trauma-related images. Deep breathing is simpler and more universally applicable.