Pathophysiology Case Study

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Scenario:

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.

An understanding of the symptoms of alterations in neurological and musculoskeletal systems is a critical step in diagnosis and treatment. For APRNs this understanding can also help educate patients and guide them through their treatment plans.


In this Assignment, you examine a case study and analyze the symptoms presented. You identify the elements that may be factors in the diagnosis, and you explain the implications to patient health.


To prepare:

You will be assigned to a specific case study scenario for this Case Study Assignment. 

Assignment (1- to 2-page case study analysis)In your Case Study Analysis related to the scenario provided, explain the following:
1.  Both the neurological and musculoskeletal pathophysiologic processes that would account for the patient presenting these symptoms.

2.  Any racial/ethnic variables that may impact physiological functioning.

3.  How these processes interact to affect the patient.

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. Pathophysiology Case Study. 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.

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Neurologic and Musculoskeletal Pathophysiologic Processes

Concerning the patient’s presenting symptoms, it is highly likely that he has a stroke. The purpose of this paper is to identify the neurological and musculoskeletal pathophysiological processes and ethnic/racial variables that may impact the patient’s physiological functioning.  A stroke occurs when blood supply to the brain is cut probably by a blood clot or atherosclerosis. Disruption in bod flow initiates a cascade of cellular metabolic events. The cascade begins when the cerebral blood flow falls to below 25mL/100g/min (Coupland et al., 2017). At this point, the neurons in the brains can no longer maintain aerobic metabolic respiration. Pathophysiology Case Study.  The mitochondria then switch to anaerobic respiration hence generating lactic acid. Lactic acid reduces the pH level. The less efficient anaerobic respiration renders neurons incapable of producing enough ATP to fuel depolarization processes. Membrane pumps, which maintain electrolyte balance, begin to cease to function.

Low cerebral blood flow causes an infarction area, which triggers the increase of intracellular calcium and the release of glutamate. Increased calcium and glutamate activate damaging pathways including vasoconstriction and more infarction hence extending the stroke features. Stroke can cause neurologic deficits depending on the lesion’s location, the amount of collateral blood flow and size inadequately perfused area. Weakness or numbness in the face and extremities is a result of stroke effects on the respective nerves. Drooling from side of the mouth signifies nerve involvement in the stroke.  Additional neurologic deficits include difficulty in speaking, understanding speech, walking and loss of coordination or balance.

Motor loss occurs when a lesion of the upper motor is affected by the reduced blood flow and infarction. Loss of voluntary control over movements can occur. Paralysis of one side of the body (hemiplegia) due to a lesion on the opposite side of the brain may occur and loss of deep tendon reflexes. When deep reflexes reappear, increased muscle tone may occur with abnormally increased tone spasticity) of the extremities. Following the stroke, skeletal muscles may be affected by the alteration in central neural activation and the developed spasticity (Asghari et al., 2018). The weakness and spasticity influence the muscles by causing reduced motor unit contraction and an overactive stretch reflex.

Racial and Ethnic Variables That May Impact Physiological Functioning

The risk of developing stroke among the non-Hispanic African-Americans and Hispanics is 2-3 times higher than the non-Hispanic American population. The preventive measures of stroke and early access to appropriate treatment for stroke patients are crucial determinants of the disease’s prognosis. Studies show that the delay in seeking medical attention after a stroke incidence increases the pathophysiology of stroke (Howard et al., 2016). The delay can occur in a population who have to travel to a far health facility for medical attention. Pathophysiology Case Study.  The availability and accessibility of Emergency Medical Services minimize the ill effects of stroke because of prompt medical attention. The higher risk of developing other cardiovascular diseases such as hypertension among African-Americans also predisposes them to acquire stroke. Cardiovascular diseases increase the risk of developing stroke the 74-year-old male patient is a known hypertensive client. Hypertension is a significant risk factor for stroke – it contributes to damage f blood vessels. Uncontrolled hypertension can cause stroke from ruptured aneurysm, hemorrhage or damaged blood vessels.

Additionally, smoking could affect the pathophysiology of stroke. Prolonged cigarette smoking reduces the blood’s oxygen-carrying capacity and raises blood pressure because of its nicotine content. Some studies show that smoking doubles one’s risk of developing stroke, especially ischemic type (Ojaghihaghighi et al., 2017). The danger of developing stroke increased in the older man because he smoked while living with hypertension. Pathophysiology Case Study. 

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References

Asghari, M., Behzadipour, S., & Taghizadeh, G. (2018). A planar neuro-musculoskeletal arm model in post-stroke patients. Biological cybernetics, 112(5), 483-494.

Coupland, A. P., Thapar, A., Qureshi, M. I., Jenkins, H., & Davies, A. H. (2017). The definition of stroke. Journal of the Royal Society of Medicine, 110(1), 9-12.

Howard, G., Kissela, B. M., Kleindorfer, D. O., McClure, L. A., Soliman, E. Z., Judd, S. E., … & Howard, V. J. (2016). Differences in the role of black race and stroke risk factors for first vs recurrent stroke. Neurology, 86(7), 637-642.

Ojaghihaghighi, S., Vahdati, S. S., Mikaeilpour, A., & Ramouz, A. (2017). Comparison of neurological clinical manifestation in patients with hemorrhagic and ischemic stroke. World journal of emergency medicine, 8(1), 34. Pathophysiology Case Study.