DB 6 case 1 Pathophysiology

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Herzing University *

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621

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Health Science

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Jan 9, 2024

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Pathophysiology DB 6 Case # 2: Mr. Smith is a new patient with a history of a recent stroke approximately 3 months ago. He was hospitalized in another state, but you don't have his records now. The patient's wife is extremely anxious and worried about him because he hasn’t been “acting right”. She wants him checked out. She does not think he had hypertension but adds "he does not like to go to doctors." Regarding the patient's available history, create a detailed plan of care for this patient. Based on the few pieces of information given about Mr. Smith, it is obvious that he is having an early cerebrovascular accident (CVA), known as a stroke. CVA is the leading cause of disability, the third cause of death in women, and the fifth leading cause of death in men in the United States (Poupore et al., 2020). About 75% of CVAs occur among the population older than 65 years. The yearly incidence of new and recurrent strokes is 795,000; approximately 185,000 of these are recurrent and there are about 128,932 deaths each year, a decline of 18.2% from 2003 to 2013. Risk factors of CVA include genetics, smoking, uncontrolled hypertension, high- density lipoprotein (HDL) cholesterol, congestive heart disease, peripheral vascular disease, atrial fibrillation, physical inactivity, obesity, and depression (McCance & Huether 2019). Henceforth, the plan of care for Mr. Smith will include monitoring his blood pressure, checking what blood pressure medication he takes, including blood thinner and diabetes medications, and will determine if the patient is hypertensive. Performing the head to toes assessment will help in evaluating the patient’s condition. Asking family members about the patient will help in implementing the appropriate plan of care. For example, asking the spouse about the recent falls, what safety precaution is implanted in the house, or any recent trauma will help determine the plan of care. In recognition of the morbidity of recurrent brain ischemia, the evidence-based recommendations for the prevention of future stroke among survivors of ischemic stroke or TIA can be found in the current AHA/ASA Recommendations for Antithrombotic Therapy for Noncardioembolic Stroke or TIA https://www.ahajournals.org/doi/pdf/10.1161/str.0000000000000024 Links to an external site. Based on these current guidelines what goals would you recommend for this patient to ensure prevention of another brain ischemic event? Transient Ischemic Attack (TIA) patients with focal lesions may appear normal on computed tomography (CT), thus they are at higher risk for hemorrhage post-thrombolysis treatment following the onset of ischemic stroke (Poupore et al., 2020). TIA are episodes of neurologic dysfunction lasting no more than 1 hour and resulting from focal cerebral ischemia. Signs and symptoms of TIA include weakness, numbness, sudden confusion, loss of balance, loss of vision, or sudden severe headache resulting from focal cerebral ischemia. About 3% to 17% of individuals experiencing a TIA will have a stroke within 90 days (McCance & Huether 2019). American Heart Association (2022) emphasizes educating patients with heart disease, stroke, or any cardiovascular diseases to live a healthy lifestyle, like avoiding smoking, drinking alcohol, and being physically active. Therefore, for the patient not to be readmitted back to the hospital, the patient must constantly monitor his cholesterol level, blood pressure [BP], and blood sugar/glucose control. Additionally, ordering lab works like CBC, CMP, and lipid tests will reveal any abnormality in the patient and will help in the treatment plan.

References American Heart Association. AHA. (2022). Heart Disease and Stroke Statistics https://www.ahajournals.org/doi/pdf/10.1161 Baraness L, Baker AM. Acute Headache. (2022). Stat Pearls, Treasure Island (FL): Stat Pearls https://www.ncbi.nlm.nih.gov/books/NBK554510/ Bhoi, S. K., Jha, M., & Chowdhury, D. (2021). Advances in the Understanding of Pathophysiology of TTH and its Management. Neurology India , 69 , S116–S123. https://doi.org/10.4103/0028- 3886.315986 Kathryn L. McCance, Sue E. Huether. (2019). Pathophysiology: the biologic basis for disease in adults and children. St. Louis: Mosby National Headache Foundation. (2022). Acute Kidney Injury: Definition, Pathophysiology and Clinical Phenotypes. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5198510/ Poupore, N., Strat, D., Mackey, T., Snell, A., & Nathaniel, T. (2020). Ischemic stroke with a preceding Trans ischemic attack (TIA) less than 24 hours and thrombolytic therapy. BMC Neurology , 20 (1), 1–12. https://doi.org/10.1186/s12883-020-01782-5 Rapoport, A. M., & Edvinsson, L. (2019). Some aspects on the pathophysiology of migraine and a review of device therapies for migraine and cluster headache. Neurological Sciences , 40 (1), 75– 80. https://doi.org/10.1007/s10072-019-03828-0

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