Tia Lauren, a 95 year-old female, presents to the Emergency Department (ED) with, what daughter thought, were stroke-like symptoms that began approximately 6 hours ago. She is brought in by her daughter who she lives with. Her daughter states the symptoms are starting to go away. The daughter also states that maybe she made a mistake thinking her mom may have had a stroke since the symptoms are resolving.

 

Exhibits

What type of stroke is the patient most likely experiencing and which of the following are common symptoms? (Select all that apply)

• Heart rate: 92/min: Improved from 109/min on Day 1, showing better autonomic control.
  A heart rate within normal range indicates reduced stress or inflammation. This suggests pain management and fluid status have improved.

• Respiratory rate: 20/min: Improved from 26/min, now within normal limits. This reflects decreased respiratory effort and better oxygenation. The labored breathing on Day 1 has also resolved.

• Oxygen saturation: 96% on room air: Increased from 93% on Day 1, indicating improved gas exchange. No supplemental oxygen was required, suggesting stable pulmonary function.
  This is a positive sign especially given the initial diminished breath sounds.

• Client rates pain as 3/10 after medication: The pain is down from 8/10 on Day 1, showing effective analgesia. Pain control improves patient comfort and respiratory status. The pain was likely contributing to tachypnea and lethargy on Day 1.

• Respirations even and unlabored; chest clear on auscultation: Improved from "rapid, labored" with "diminished" breath sounds on day 1 which suggests resolution of respiratory compromise and pain-related restriction. Likely associated with improved oxygen saturation and decreased fatigue..

• Passing flatus: This indicates return of peristalsis and some bowel activity. These findings were not present on Day 1, showing progress. Flatus passage often precedes return to full bowel function.

• Urinating without difficulty; urine clear yellow: These findings indicate stable renal function, no hematuria or concentration issues. The findings were maintained across both days, with no signs of obstruction or dehydration which uggests effective fluid balance and kidney perfusion.

Rationale for Incorrect Findings:

• Bowel sounds hypoactive in all quadrants: No change from Day 1, suggests slow GI recovery. Hypoactivity may reflect paralytic ileus or continued inflammation.
  Despite passage of flatus, bowel function remains impaired.

• Client vomiting brown liquid and reports continuing nausea: This is a new symptom on Day 2, worsening GI symptoms despite earlier improvement. Brown emesis may suggest delayed gastric emptying or possible GI bleeding.

• Reports extreme fatigue: Fatigue is more severe than Day 1's lethargy and may reflect nutritional deficits, systemic inflammation, or sleep disruption. Despite improved pain and respiratory status, overall energy is low.

A. Primary disorders affect hormone receptors, while secondary disorders affect hormone production: While receptor sensitivity may play a role in some conditions, the main distinction between primary and secondary endocrine disorders is based on the location of dysfunction, not receptor or hormone function alone.

B. Primary disorders originate in the target organ, while secondary disorders originate in the pituitary gland or hypothalamus: In primary disorders, the problem lies in the endocrine gland itself (e.g., the thyroid gland in primary hypothyroidism), while secondary disorders result from dysfunction in regulatory centers like the pituitary or hypothalamus.

C. Primary disorders involve the hypothalamus, while secondary disorders involve the target organ: This reverses the correct relationship. Secondary disorders typically involve the hypothalamus or pituitary, not primary disorders.

D. Primary disorders are caused by external factors, while secondary disorders are caused by genetic mutations: While both external and genetic factors can contribute to endocrine disorders, this distinction does not define the difference between primary and secondary types. The classification is based on the anatomical source of dysfunction.