Sample Answer for NURS 6501 Week 8 Module 5 Assignment: Case Study Analysis Included After Question
An understanding of the neurological and musculoskeletal systems is a critically important component of disease and disorder diagnosis and treatment. This importance is magnified by the impact that that these two systems can have on each other. A variety of factors and circumstances affecting the emergence and severity of issues in one system can also have a role in the performance of the other.
Effective analysis often requires an understanding that goes beyond these systems and their mutual impact. For example, patient characteristics such as, racial and ethnic variables can play a role.
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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:
By Day 1 of this week, you will be assigned to a specific case study scenario for this Case Study Assignment. Please see the “Course Announcements” section of the classroom for your assignment from your Instructor.
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.
Day 7 of Week 8
Submit your Case Study Analysis Assignment by Day 7 of Week 8.
Reminder: The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The sample paper provided at the Walden Writing Center provides an example of those required elements (available at https://academicguides.waldenu.edu/writingcenter/templates). All papers submitted must use this formatting.
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Module 5 Assignment
A Sample Answer For the Assignment: NURS 6501 Week 8 Module 5 Assignment: Case Study Analysis
Title: NURS 6501 Week 8 Module 5 Assignment: Case Study Analysis
The scenario concerns a 74-year-old hypertensive patient who suddenly experienced difficulty speaking, drooling on the left side of the mouth, and left-hand weakness. The symptoms worsen within 10 minutes to the point that he cannot raise his arm and cannot stand. However, he persistently denies his problems. The patient’s vital statistics include BP-178/94, HR-78, as well as PaO2 97% on room air. Slight left facial droop, left arm inability to resist gravity, mild left leg drift, as well as mild neglect of the left side of the body are the abnormal neurological exam findings on the patient. The client’s dysarthria is modest to severe, but the airway is protected. The objective of this paper is to describe the pathophysiologic processes that cause the patient’s symptoms and the racial/ethnic characteristics that can influence physiological functioning.
Pathophysiologic Processes That Would Account for the Symptoms
The patient’s symptoms can be attributed to a neurological pathophysiologic process, Intracerebral hemorrhage (ICH). ICH is caused by bleeding within the brain due to a rupture of a blood vessel resulting in hemorrhagic stroke. Hypertension is the most important cause of hemorrhage, and it mostly occurs during activity. The patient’s symptoms could be due to an elevated BP, which caused changes within the arterial wall, increasing its risk of rupture. The brain then got damaged due to bleeding, resulting in edema, distortion, and displacement, which directly irritated the brain tissue (McGurgan et al., 2020). The patient likely has right-brain damage, which has led to left-sided hemiplegia, left-sided neglect, and denying symptoms.
Musculoskeletal pathophysiologic processes that may have led to the symptoms include a combination of muscle disuse, denervation, remodeling, and spasticity. Defects in the descending neural pathways cause impaired neuromotor control and structural and functional changes in the muscle tissue (McGurgan et al., 2020). The processes lead to muscle hypotrophy, weakness, fatigue, and altered motor control. This explains the patient’s inability to stand, lift his arm, or resist gravity, as well as muscle weakness and leg drift.
How the Processes Interact to Affect the Patient
The pathophysiological processes in the patient’s hemorrhagic stroke interacted causing the abrupt onset of symptoms that worsened over ten minutes possibly due to ongoing bleeding. The musculoskeletal and neurological pathophysiological processes affected the patient by causing motor and neurological deficits (Morais Filho et al., 2021). Consequently, the patients experienced a loss of voluntary movement like inability to stand, lift arm, and resist gravity. He also experienced neurological deficits like drooling, muscle weakness, and leg drift.
Racial/Ethnic Factors That May Affect Physiological Functioning
Like many health conditions, the causes of hemorrhagic stroke are presumed to be a combination of genetic and environmental risk factors. Kittner et al. (2021) explain that Blacks and Hispanics have a higher risk of ICH), than their White counterparts, especially at a younger age. The study established that more than half of all ICH cases among Black and Hispanic populations were attributed to hypertension. Besides, among Blacks and Hispanics, APOE was not associated with lobar ICH, while hypertension remained a strong risk factor for this subtype (Kittner et al., 2021). Furthermore, compared with White persons, Black and Hispanic patients had Intracerebral hemorrhage at a much younger age and had a higher population attributable risk (PAR) percentage for treated and untreated hypertension and lack of health insurance, which affects physiological functioning.
Conclusion
The patient’s symptoms were due to hemorrhagic stroke secondary to ICH, which is caused by bleeding to the brain. He has left-sided muscle weakness, neglect to the left side of the body, left facial droop, and dysarthria can be attributed to a stroke on the right side of the brain. Inadequately managed hypertension and lack of health insurance among minority ethnic/racial groups and the early onset of ICH in Black and Hispanic populations puts them at risk of hemorrhagic stroke.
References
Kittner, S. J., Sekar, P., Comeau, M. E., Anderson, C. D., Parikh, G. Y., Tavarez, T., … & Woo, D. (2021). Ethnic and racial variation in intracerebral hemorrhage risk factors and risk factor burden. JAMA Network Open, 4(8), e2121921-e2121921. https://doi.org/10.1001/jamanetworkopen.2021.21921
McGurgan, I. J., Ziai, W. C., Werring, D. J., Al-Shahi Salman, R., & Parry-Jones, A. R. (2020). Acute intracerebral hemorrhage: Diagnosis and management. Practical Neurology, 21(2), 128–136. Advance online publication. https://doi.org/10.1136/practneurol-2020-002763
Morais Filho, A. B., Rego, T., Mendonça, L. L., Almeida, S. S., Nóbrega, M., Palmieri, T. O., Giustina, G., Melo, J. P., Pinheiro, F. I., & Guzen, F. P. (2021). The physiopathology of spontaneous hemorrhagic stroke: a systematic review. Reviews In The Neurosciences, 32(6), 631–658. https://doi.org/10.1515/revneuro-2020-0131
A Sample Answer 2 For the Assignment: NURS 6501 Week 8 Module 5 Assignment: Case Study Analysis
Title: NURS 6501 Week 8 Module 5 Assignment: Case Study Analysis
The case study concerns a 72-year-old female who developed an acute onset of slurred speech that abated within an hour. Head CT shows an old left-sided infarct in the temporal region, while CT of the carotids shows a 35% blockage on the left and 40% on the right. The purpose of the paper will be to explain the neurological and musculoskeletal pathophysiological processes contributing to the patient’s clinical features.
The Neurological and Musculoskeletal Pathophysiologic Processes Accounting For These Symptoms
The patient’s symptoms can be attributed to Transient ischemic attack (TIA). TIA is characterized by transient neurologic symptoms without evidence of acute infarction. The patient had a TIA attack associated with a focal neurologic deficit and speech disturbance in a vascular territory because of an underlying cerebrovascular disease (Ortiz-Garcia et al., 2022). In this case, the patient has a history of stroke, which likely contributed to the symptoms. The neurological pathophysiology causing the patient’s symptoms is the transient disruption of arterial blood flow due to the narrowing of the carotid artery. Blockage of the carotids with a 35% blockage on the left and 40% on the right indicates carotid stenosis.
Plaque or fatty deposits along the inner arterial wall cause the narrowing of the carotids, which results in decreased blood flow to the brain (Perry et al., 2022). The insufficient blood flow to the brain contributed to the patient’s slurred speech, weakness on one side of the body with temporary paralysis, and gait disturbance. The patient’s motor impairment can be attributed to musculoskeletal Pathophysiological changes. The typical motor impairments in TIA include unilateral motor weakness, gait disturbance, limb paralysis, and loss of coordination (Kuriakose & Xiao, 2020). This explains why the patient slumped over to the right side and could not get to an upright position or stand.
Racial/Ethnic Variables That May Impact Physiological Functioning
TIA incidence is higher in Blacks than Whites in the US. Kamel et al. (2020) found that among US participants in the study, blacks faced a higher risk of early stroke recurrence following a minor ischemic stroke or TIA. This is even after adjusting demographics, comorbidities, and medication adherence. It has been found that Black and Mexican American persons have higher TIA incidence rates than non-Hispanic Whites (Kamel et al., 2020). Therefore, the patient has a high risk of recurring TIAs or stroke if she is Black or Mexican.
How These Processes Interact To Affect the Patient
TIA cause temporary neurologic dysfunction because of a brief disruption in cerebral blood flow. Cerebral vasospasm or systemic arterial hypertension can interact to cause neurologic dysfunction. Besides, the processes affect the patient by causing visual, sensory, motor, and speech deficits. Visual deficits include blurred/ double vision, one-eye blindness, and tunnel vision (Simmatis et al., 2019). Sensory deficits include numbness in the face, arm, or hand and vertigo. Motor deficits include weakness in the upper or lower limbs and gait disturbance, while speech deficits include aphasia and slurred speech.
Conclusion
The patient’s symptoms are due to a TIA attack, which causes a focal neurologic deficit and speech disturbance due to insufficient blood flow to the brain. TIAs are more common and have a higher recurrence in Blacks. The pathophysiologic processes in TIA interact to cause visual, sensory, motor, and speech deficits.
References
Kamel, H., Zhang, C., Kleindorfer, D. O., Levitan, E. B., Howard, V. J., Howard, G., Soliman, E. Z., & Johnston, S. C. (2020). Association of Black Race With Early Recurrence After Minor Ischemic Stroke or Transient Ischemic Attack: Secondary Analysis of the POINT Randomized Clinical Trial. JAMA neurology, 77(5), 601–605. https://doi.org/10.1001/jamaneurol.2020.0010
Kuriakose, D., & Xiao, Z. (2020). Pathophysiology and Treatment of Stroke: Present Status and Future Perspectives. International journal of molecular sciences, 21(20), 7609. https://doi.org/10.3390/ijms21207609
Lioutas, V. A., Ivan, C. S., Himali, J. J., Aparicio, H. J., Leveille, T., Romero, J. R., Beiser, A. S., & Seshadri, S. (2021). Incidence of Transient Ischemic Attack and Association With Long-term Risk of Stroke. JAMA, 325(4), 373–381. https://doi.org/10.1001/jama.2020.25071
Ortiz-Garcia, J., Gomez, C. R., Schneck, M. J., & Biller, J. (2022). Recent advances in the management of transient ischemic attacks. Faculty reviews, 11, 19. https://doi.org/10.12703/r/11-19
Perry, J. J., Yadav, K., Syed, S., & Shamy, M. (2022). Transient ischemic attack and minor stroke: diagnosis, risk stratification and management. CMAJ : Canadian Medical Association journal = journal de l’Association medicale canadienne, 194(39), E1344–E1349. https://doi.org/10.1503/cmaj.220344
Simmatis, L. E. R., Scott, S. H., & Jin, A. Y. (2019). The Impact of Transient Ischemic Attack (TIA) on Brain and Behavior. Frontiers in behavioral neuroscience, 13, 44. https://doi.org/10.3389/fnbeh.2019.00044