The risk factor that contribute to Bertie 57, (overweight, hypertensive and diabetic). His BMI(body max index) could contribute to risk of stroke though not mentioned in PMx according to BNF candesartan of treatment for hypertension, which also is a risk factor.
Other stressful situation is the burden of children still in full time education. As temperature is 37.8(degree centigrade), it could be symptom of infection as evidence has shown.(Grau et al, 1999).
Mr Botts is nil by mouth, concern will be that he is unable to take his antihypertensive medication and his metformin. I will keep closely eye on his blood sugar/blood pressure. I will inquire from medical team if there is a deferent route for antihypertensive medication. Sugar will be reviewed at regular intervals with the view to change IVI to Hartman, if he becomes hypoglycaemic. My big concern is the lack of urine output(although current news of 6 is not part of it). It is e red flag for sepsis with low grade fever and heart rate increase. I will be wary of putting low grade fever down to stroke alone as noted. As the cause is also noted to be from infection through evidence, I will ask my Botts for his consent to catharize and start a strict fluid checks and balances.
Grau AJ, Buggle F, Schnitzler P, Spiel M, Lichy C, Hacke W. Fever and infection early after ischemic stroke. J Neurol Sci. 1999 Dec 15;171(2):115-20. doi: 10.1016/s0022-510x(99)00261-0. PMID: 10581377.
