You are working in a 15-bed rural hospital with an emergency department. You are the only adult-geriatric provi

 THIS IS A GRADUATE NURSE PRATRITIONER PROGRAM.  REPORT MUST BE OF GRADUATE LEVEL AND STANDARD WITH APPROPRIATE REFERENCE WITHIN 5 YEARS AND 7TH EDITION APA STYLE . MINIMUM OF 350 WORDS WITH AT LEAST 2 PEER REVIEW REFERENCE. 

 You are working in a 15-bed rural hospital with an emergency department. You are the only adult-geriatric provider on this shift, and you are presented with the following case.

A distraught older female brings by personal vehicle her husband of 60 years. This is an 81-year-old male farmer/rancher who was out branding cattle when he experienced new onset headache and difficulty using his right hand. He tried to call his wife on his cell phone, but was unable to speak. Instead he blew into the phone and tried to make noises with his mouth. She went to the branding site and transported him to the emergency department.

He is somnolent, but will awaken with stimulation. When awake, he is frustrated and tearful. His right hand is flaccid, and he is aphasic. Your facility has a full lab, full x-ray, and CT machine, but no MRI and no neurology consultation service. You are contractually connected with a tertiary care center that is also a stroke center.

Choose one of the options below and outline your initial assessment, diagnostic orders, anticipated clinical manifestations, exam findings, and your plan.

1. CT (noncontrast), no acute findings. It has been 4 hours since onset of symptoms.
2. CT (noncontrast), no acute findings. It has been 1 hour since onset of symptoms.
3. CT (noncontrast), no acute findings. It has been 4 hours since onset of symptoms.
4. CT (noncontrast), a small intracerebral bleed, no mass effect. 
5. CT (noncontrast), a moderate intracerebral bleed, 3mm of shift, and mass effect.