NURS 6501 Module 5 Advanced Pathophysiology Case Study

NURS 6501 Module 5 Advanced Pathophysiology Case Study

NURS 6501 Module 5 Advanced Pathophysiology Case Study

Case overview

A 74-year-old male with a history of hypertension and smoking is having dinner with his wife when he develops sudden onset of difficulty speaking, with drooling from the left side of his mouth, and weakness in his left hand. His wife asks him if he is all right and the patient denies any difficulty. His symptoms progress over the next 10 minutes until he cannot lift his arm and has trouble standing. The patient continues to deny any problems. The wife sits the man in a chair and calls 911. The EMS squad arrives within 5 minutes. Upon arrival in the ED, the patient’s blood pressure was 178/94, pulse 78 and regular, PaO2 97% on room air. Neuro exam – Cranial nerves- Mild left facial droop. Motor- Right arm and leg extremity with 5/5 strength. Left-arm cannot resist gravity, left leg with mild drift. The sensation is intact. Neglect- Mild neglect to the left side of the body. Language- Expressive and receptive language intact. Mild to moderate dysarthria. Able to protect the airway

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 Neurological and Musculoskeletal Pathophysiologic Processes That Would Account For the Patient Presenting These Symptoms

Cerebro-vascular accidents also known as stroke, is when the brain is deprived of blood supply either by blockage or by rapture of a blood vessel. These can be further be classified as ischemic stroke, hemorrhagic stroke, and cryptogenic stroke. In this particular case, the patient presents with signs and symptoms indicating an ischemic stroke. Arba et al (2017) highlights brain ischemia or cerebral ischemia’s as other names used to refer to ischemic stroke, a condition that results from blockage in the blood vessel supplying the brain with blood and oxygen.  This can result from thromboembolism or hypo perfusion .brain ischemia can further be classified as transient ischemic stroke, lacunars strokes, embolic strokes, thrombotic strokes and hemodynamic strokes. According to the presenting symptoms the patient may classified under transient ischemic stroke. The major pointer to my diagnosis is that the patient had a very sudden onset of neurological abnormalities; these are cranial nerves which are causing the droop on the left side. History of hypertension, smoking, in advanced age are predisposing factors to transient ischemic stroke, this is also major predisposing factor to full blown celebralvascular accident

According to the neurologic exam, it indicates that the stroke is left side as the patient has mild facial droop, the strength on the left arm is diminished, and cannot resist gravity. Neurological exam is also used to define the position of the affected part in this particular case the artery affected is the middle carotid artery (Arba et al., 2017). This because the patient is presenting with mild dysarthria and mild hemiparesis

Racial/Ethnic Variables That May Impact Physiological Functioning and How These Processes Interact To Affect the Patient

Seventy five percent of individuals aged 70years or older are hypertensive and this predisposes them to cerebral vascular accidents. The American Heart Association categorizes stroke as a leading cause of death in the United States among the elderly (Benjamin et al., 2017).The risk of cerebral vascular accident varies with race and ethnicity, in blacks the risk increases two fold when compared to whites. This indicates that genetic composition in different individuals will determine the chances of developing stroke and even causing death. Besides, there has been reported decline in stroke incidences in both whites and blacks but a sharp increase in Hispanics which explains the reason of high incidences of strokes among Hispanics (Hachiya et al., 2017). Blacks have also reported high numbers of hypertensive and diabetic patients in reference to their white counterparts. 

References

Arba, F., Quinn, T., Hankey, G. J., Ali, M., Lees, K. R., Inzitari, D., & Weir, C. J. (2017). Cerebral small vessel disease, medial temporal lobe atrophy and cognitive status in patients with ischaemic stroke and transient ischaemic attack. European journal of neurology, 24(2), 276-282.

Benjamin, E. J., Blaha, M. J., Chiuve, S. E., Cushman, M., Das, S. R., Deo, R., & Muntner, P. (2017). Heart disease and stroke statistics—2017 update: a report from the American Heart Association. circulation, 135(10), e146-e603.

Hachiya, T., Kamatani, Y., Takahashi, A., Hata, J., Furukawa, R., Shiwa, Y., … & Shimizu, A. (2017). Genetic predisposition to ischemic stroke: a polygenic risk score. Stroke, 48(2), 253-258.

Case 1:
74-year-old male with a history of hypertension and smoking, is having dinner with his wife when he develops sudden onset of difficulty speaking, with drooling from the left side of his mouth, and weakness in his left hand. His wife asks him if he is all right and the patient denies any difficulty. His symptoms progress over the next 10 minutes until he cannot lift his arm and has trouble standing. The patient continues to deny any problems. The wife sits the man in a chair and calls 911. The EMS squad arrives within 5 minutes. Upon arrival in the ED, patient‘s blood pressure was 178/94, pulse 78 and regular, PaO2 97% on room air. Neuro exam – Cranial nerves- Mild left facial droop. Motor- Right arm and leg extremity with 5/5 strength. Left arm cannot resist gravity, left leg with mild drift. Sensation intact. Neglect- Mild neglect to left side of body. Language- Expressive and receptive language intact. Mild to moderate dysarthria. Able to protect airway.

Assignment (1- to 2-page case study analysis)
In your Case Study Analysis related to the scenario provided, explain the following:

Both the neurological and musculoskeletal pathophysiologic processes that would account for the patient presenting these symptoms.
Any racial/ethnic variables that may impact physiological functioning.
How these processes interact to affect the patient.

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Develop a 1- to 2-page case study analysis, examining the patient symptoms presented in the case study. Be sure to address the following:

Explain both the neurological and musculoskeletal pathophysiologic processes of why the patient presents these symptoms.
28 (28%) – 30 (30%)
The response accurately and thoroughly describes the patient symptoms.

The response includes accurate, clear, and detailed explanations of both the neurological and musculoskeletal pathophysiologic processes of patients who present these symptoms and is supported by evidence and/or research, as appropriate, to support the explanation.
25 (25%) – 27 (27%)
The response describes the patient symptoms.

The response includes accurate, explanations of both the neurological and musculoskeletal pathophysiologic processes of patients who present these symptoms and is supported by evidence and/or research, as appropriate, to support the explanation.
23 (23%) – 24 (24%)
The response describes the patient symptoms in a manner that is vague or inaccurate.

The response includes explanations of both the neurological and musculoskeletal pathophysiologic processes of patients who present these symptoms and is supported by explanations that are vague or based on inappropriate evidence/research.
0 (0%) – 22 (22%)
The response describes the patient symptoms in a manner that is vague and inaccurate, or the description is missing.

The response does not include explanations of both the neurological and musculoskeletal pathophysiologic processes of patients who present these symptoms, or the explanations are vague or based on inappropriate evidence/research.
Explain how the highlighted processes interact to affect the patient.
28 (28%) – 30 (30%)
The response includes an accurate, complete, detailed, and specific explanation of how the highlighted processes interact to affect the patient and is supported by evidence and/or research, as appropriate, to support the explanation.
25 (25%) – 27 (27%)
The response includes an accurate explanation of how the highlighted processes interact to affect the patient and is supported by evidence and/or research, as appropriate, to support the explanation.
23 (23%) – 24 (24%)
The response includes a vague or inaccurate explanation of how the highlighted processes interact to affect the patient, with explanations that are based on inappropriate evidence/research.
0 (0%) – 22 (22%)
The response includes a vague or inaccurate explanation of how the highlighted processes interact to affect the patient, with explanations that are based on inappropriate or missing evidence/research.
Explain any racial/ethnic variables that may impact physiological functioning.
23 (23%) – 25 (25%)
The response includes an accurate, complete, detailed, and specific explanation of racial/ethnic variables that may impact physiological functioning and is supported by evidence and/or research, as appropriate, to support the explanation.
20 (20%) – 22 (22%)
The response includes an accurate explanation of racial/ethnic variables that may impact physiological functioning and is supported by evidence and/or research, as appropriate, to support the explanation.
18 (18%) – 19 (19%)
The response includes a vague or inaccurate explanation of racial/ethnic variables that may impact physiological functioning, and/or explanations that are based on inappropriate evidence/research.
0 (0%) – 17 (17%)
The response includes a vague or inaccurate explanation of racial/ethnic variables that may impact physiological functioning, or the explanations are based on inappropriate or no evidence/research.
Written Expression and Formatting – Paragraph Development and Organization:
Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria.
5 (5%) – 5 (5%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity.

A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria.
4 (4%) – 4 (4%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time.

The purpose, introduction, and conclusion of the assignment are stated, yet they are brief and not descriptive.
3.5 (3.5%) – 3.5 (3.5%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time.

The purpose, introduction, and conclusion of the assignment are vague or off topic.
0 (0%) – 3 (3%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time.

No purpose statement, introduction, or conclusion were provided.
Written Expression and Formatting – English Writing Standards:
Correct grammar, mechanics, and proper punctuation
5 (5%) – 5 (5%)
Uses correct grammar, spelling, and punctuation with no errors.
4 (4%) – 4 (4%)
Contains a few (1 or 2) grammar, spelling, and punctuation errors.
3.5 (3.5%) – 3.5 (3.5%)
Contains several (3 or 4) grammar, spelling, and punctuation errors.
0 (0%) – 3 (3%)
Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.
Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, parenthetical/in-text citations, and reference list.
5 (5%) – 5 (5%)
Uses correct APA format with no errors.
4 (4%) – 4 (4%)
Contains a few (1 or 2) APA format errors.
3 (3%) – 3 (3%)
Contains several (3 or 4) APA format errors.
0 (0%) – 3 (3%)
Contains many (≥ 5) APA format errors.
Total Points: 100