Below is a summary of Maya’s EHR activity during her four hours in the ED. As a health coach, your job is to recommend changes to decrease the need for future emergency care or hospitalization. You will also provide the resources she needs to understand her diagnosis and what may have caused her condition. Answer the questions and be prepared to discuss the responses with the rest of Maya’s healthcare team.

1. Internet Research: As a health coach, you want everyone to know the warning signs of a stroke. From the list below, designate which are the 4 signs of a major stroke (M) and which are other (O) possible symptoms of a stroke.

______ “pins and needles” sensation	______ face drooping
______ blurred vision	______ arm weakness
______ severe headache	______ paralysis
______ speech difficulty	______ time to call 9-1-1




2. Review Maya’s VPE: As Maya is being cared for in the ED, you begin to plan for her recovery. You review her National Institute of Health Stroke Scale (NIHSS) in VPE and notice several issues that are of concern. Select all of the areas that are of high concern.

   A. LOC question: Month and age

   B. LOC question: Open and close eyes

   C. Gaze

   D. Visual field

   E. Facial palsy


Internet Research: From the list below, select all of the following issues Maya might need for rehabilitation after she leaves the hospital. (Consider the issues from the question above that were high concern areas when she entered the hospital.)

A. Stroke rehabilitation facility or in-home care

B. Speaking and communicating

C. Thinking and memory

D. Bladder and bowel problems

E. Swallowing and eating




3. Review Maya’s ED EHR and story: In reviewing Maya’s EHR and medical history, you discover several areas she can improve to decrease her risk of having another stroke. From the list below, select all of the issues she can immediately change.

A. Decrease her salt intake

B. Lower her blood pressure

C. Decrease her total calorie intake

D. Choose better options for snacking

E. Lower her cholesterol levels

F. Begin a walking / exercise program