Assignment Task: Joe Wright, a 78-year-old male client, was admitted to the hospital after a right-sided cerebral vascular accident (CVA), which is age indeterminate. He had a left-sided brain CVA 2 months earlier. The daughter had checked on her father before work at 7am. After working a 10-hour shift, she found that her father was displaying additional stroke symptoms. She called "911" when she noticed that her father had weakness of the left side of his face, left arm, and left leg. She said he was confused, had difficulty walking, kept bumping into objects, and also complained of having a severe headache. The nurse noticed that the client has difficulty understanding her when she asks him to perform tasks during a complete neurological examination. He needs frequent reminders to do the requested task, such as touch the nurse's finger and then touch his nose. The right-hand grasp is weak, but the left-hand grasp is absent. When the nurse had the client smile, the left side of the face droops. The tongue is deviated to the left side. The client does not see the nurse when approached from the left side. The client does not understand why he is in the hospital because he feels he is no different than when he had his stroke in the past. The nurse showed him an object that was upside down and he stated it was right-side up. The nurse asked him to touch both sides of his body and he only touches the right side of his body. The LPN/LVN asked the client to tell the meaning of the saying, "The early bird gets the worm," and the client states, "Birds eat worms." The nurse needs to determine what symptoms are residual from the previous stroke and which symptoms are from the new stroke.
Q1. What are the five manifestations of a CVA that can occur with either a right- or left-sided stroke?
Q2. Which manifestations are unique to a right-sided infarct, which is the new onset stroke? Which manifestations are unique to a left-sided infarct, which is the previous stroke?