Module 7 Assignment: Case Study Analysis.

Introduction

This paper discusses the case study of a 74-year-old male with a history of hypertension and smoking and was having dinner with his wife when she developed left-sided drooling, difficulty speaking, and left-hand weakness. The author will describe the musculoskeletal and neurological pathophysiologic processes that account for the patient’s presenting symptoms, the ethnic/racial variables that can impact physiological functioning, and how processes interact to affect the patient.Module 7 Assignment: Case Study Analysis.

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Neurological and Musculoskeletal Pathophysiologic Processes

The patient is this case scenario presented with drooping(left-sided), and dysarthria (slurred speaking and speech), which are signs of damage to the motor cortex caused by either a thrombus or ischemia. Besides, the changes were central and affected the contralateral lower half of the face, were acute as they became severe within ten minutes. On examination, there was the involvement of multiple cranial nerves of the left leg and arm with not resistance and strength. His PO2 was less than 100 % and BP was 178/94mmHg (elevated), which according to O’Donnell & Yuan (2018), are potential risk factors of acute ischemic stroke, the most likely primary diagnosis of the patient in this case scenario.Module 7 Assignment: Case Study Analysis.

The primary characteristic of stroke is a sudden occlusion of a blood vessel (caused either by an embolus or thrombus) decreasing the circulation of blood in specific areas in the brain. As a result, some regions in the brain can die (death can be temporary in case there’s an abrupt resumption of blood flow) (O’Donnell & Yuan, 2018). However, in instances where there’s no immediate resumption of blood circulation, signals can no longer be transmitted to other body parts. From a cognitive perspective, the impulses are presented but cannot be sent to specific body parts to execute specific functions required to perform a task. Similarly, the musculoskeletal system components are present but there are no impulses to utilize them.Module 7 Assignment: Case Study Analysis.

Racial/Ethnic Variables That May Impact Physiological Functioning

Although the assigned case scenario does not indicate the patient’s ethnicity/race, generally, African Americans are at a high risk of strokes when compared with White Americans and other minority ethnic groups.  According to Sharrief et al (2016), although stroke-related mortalities have decreased over time, the mortality is twice higher among African Americans. Besides, the incidence and mortality of strokes have decreased in potentially slower rates for African Americans increasing stroke disparities with time.  The differences in the incidence of stroke based on race/ethnicity are influenced by risk factors such as diabetes and hypertension.  (Sharrief et al, 2016). Low stroke literacy (knowledge of risk factors, management, and stroke-related behavior), and lack of awareness are additional risk factors that influence high incidences of stroke among African Americans. For the patient in this case scenario, additional variables that may impact physiological functioning are hypertension (178/94mmHg), and a history of smoking.Module 7 Assignment: Case Study Analysis.

How Processes Interact to Affect the Patient

African Americans are at high risk of acute ischemic stroke when compared to other ethnicities since they have more predisposing risk factors. These risk factors include obesity, hypertension, type 2DM, and smoking. For the patient in this case scenario, smoking increases the amount of inhaled nicotine and carbon monoxide in the blood (Larsson, Burgess & Michaëlsson, 2019). The carbon monoxide further reduces the amount of oxygen in blood and nicotine increases the pulse rate and blood pressure(hypertension). Collectively, these mechanisms increase the risk of a stroke. This implies that, in the management plan of this patient, the nurse must include lifestyle modification to prevent future risks of a stroke.Module 7 Assignment: Case Study Analysis.

Introduction

This paper discusses an 11-year-old boy who presented with complaints of difficulty “getting enough air” and wheezing. The symptoms are reportedly noticeable when playing baseball and improve when the exercise activity stops. The symptoms continue to worsen and occur even at rest. The child is reportedly allergic to cat dander yet his next-door neighbor in the apartment started to shelter cats recently for the local humane society. On auscultation, there were wheezes on forced expiration in all lung fields.Module 7 Assignment: Case Study Analysis.

Cardiovascular and Cardiopulmonary Pathophysiologic Processes

Asthma is a respiratory illness involving the inflammation of the bronchioles lining with subsequent narrowing and hypersensitivity of the airways with reversible airway obstruction. Asthma can develop at any age. Currently, in the US, there are more than six million cases among children and 17 million cases among adults. It has a genetic tendency, significant morbidity, a lower QoL, and excess utilization of healthcare resources (Zahran et al., 2018). The development of asthma usually begins in childhood with increased sensitivity to inhaled allergens. Common allergen examples include dust mite, fungi, pollen, and cockroaches. During exposure, there is an immediate and delayed response.Module 7 Assignment: Case Study Analysis.

The immediate early exposure involves bronchoconstriction within the initial thirty minutes after exposure and can last up to three hours of post-intervention. The delayed response often starts between four to eight hours post-exposure with increased responsiveness of the airways (Selman et al., 2019).  In both responses, after the stimulation of inhaled allergens, there is a proliferation of type two T helper cells with subsequent production and release of interleukin IL-3, IL- 4, IL-5, IL- 6, IL- 9, IL-10, and IL-13, and Th2 cytokines. Antigen-processing dendritic cells take the allergens involved in sensitization and present it to T helper cells. These processes activate allergen-specific Th-2 cells that influence the development and progression of asthma.Module 7 Assignment: Case Study Analysis.

Racial/ Ethnic Variables That May Influence Physiological Functioning

The highest asthma-related mortality rates are among adult African American females aged 65 years or older. The primary predictors and contributors to acute asthma exacerbations in most populations are race, socio-economic status, geography, and access to preventive care. For instance, in New York, children who dwell in neighborhoods with a low income have a high likelihood to be admitted for asthma and asthma-related incidences as compared to their counterparts living in affluent regions (Assari & Moghani, 2018). Similarly, ethnicity influences the development of asthma such that, its severity is higher in people with an African American and Puerto Rican descent. It is for this reason that African Americans account for most asthma-related admissions, ED visits, and mortalities in comparison to their white counterparts. Similarly, based on the statistics provided by the (CDC, 2016), Black adults and their children are twice likely to be diagnosed with asthma than whites.Module 7 Assignment: Case Study Analysis.

Lack of income or health insurance negatively impacts the management of asthma by placing barriers to prompt diagnosis and management. The current advances made in the stepwise management of asthma in the short term and long term can worsen these inequalities since only those with affordable income or insurance coverage can access healthcare services. Besides, even for those who can seek professional assistance, they are less likely to afford drugs prescribed for management (CDC, 2016). For early intervention, patients should avoid allergens that influence hypersensitivity reactions such as pollutants from industries and dust mites. Initial management with corticosteroids and short-acting bronchodilators is also necessary to prevent exacerbations.Module 7 Assignment: Case Study Analysis.

How Processes Interact To Affect the Patient

Gould (2018) highlights exercise-induced asthma is a common presentation for many pediatric patients and is an indicator of poor disease control associated with a poor QoL due to poor symptom control. During physical activity, the child inhaled and exhaled cold and dry air. According to Selman et al. (2019), the airway muscles become more sensitive to the changes in humidity and temperature thus contract causing the airways to narrow.Module 7 Assignment: Case Study Analysis.