Pathogenesis that leads to the structural and functional changes

Review the case study: Mr Black (detailed below) Complete the pathophysiological template (Part 1) for an ischaemic stroke that has affected the left dominant cerebral hemisphere and answer three questions. To complete the template you must summarize the relevant information for each component. This summary may consist of a combination of sentences, flow diagrams and dot points where relevant. The information in the template must be accurately referenced using the APA referencing style.

Part 2. Three questions are to be answered using correct sentence structure, paragraphs, grammar and spelling. Your answers must be accurately referenced using the APA referencing style

Length: Pathophysiology template 400 words Answers to questions 850 words Date due: Friday 30th August, 2013 at 5pm


CASE STUDY Mr Black, a 61 year old businessman was watching the 7pm television news when he developed sudden onset of difficulty in speaking and drooping of the right side of his mouth. He was not able to lift his right arm or stand up. His wife immediately called the ambulance. The paramedics, using the FAST protocol assessed Mr Black as having had a stroke and transported him to a hospital with an acute stroke thrombolysis centre. He was admitted to the Emergency Department at 8pm.

History obtained from wife. Mr Black was diagnosed with hypertension 10 years ago for which he takes Metopropol daily. He smokes about one packet of cigarettes/day and drinks alcohol socially. There is no history of serious illnesses or allergies. His father died of a heart attack at the age of 60.

400815 ? Alterations in Breathing, Work/Leisure and Mobility Learning Guide ? Spring 2013

?School of Nursing and Midwifery Page 10 of 22 University of Western Sydney

Vital signs BP 150/80 mmHg Pulse 90bpm and regular Respirations 20 breaths/minute Temperature 36.5? C SaO2 95%

Neurological examination Pupils equal – 2mm and reactive to light Right facial droop Paralysis of right arm and weakness of the right leg Normal strength in the left arm and leg Decreased sensation on right side of the body Right knee and ankle reflexes moderately brisk compared with those on the left Plantar response is extensor on the right and flexor on the left Difficulty with speech ? repeats yes to all questions

Laboratory tests Full blood count ? all values within normal range Blood glucose level ? 6.5 mmol/L Electrolytes, urea and creatinine ? all values within normal range ECG ? normal sinus rhythm

CT brain scan (2hours from symptom onset) No intracranial haemorrhage or mass lesions. Suggestion of early ischaemic changes in left hemisphere.

Diagnosis Mr Black is diagnosed with a left middle cerebral artery distribution stroke. He is assessed as being eligible for thrombolytic therapy.

Management IV Alteplase (8.1mL bolus over minute; 72.9 mL added to 50mL sodium chloride infused over 60 minutes via a volumetric control pump). Continue antihypertensive medication 24 hours after completion of alteplase follow-up CT brain scan ? if bleeding excluded commence Assasantin? SR capsule twice a day.

400815 ? Alterations in Breathing, Work/Leisure and Mobility Learning Guide ? Spring 2013

?School of Nursing and Midwifery Page 11 of 22 University of Western Sydney

PART 1 ? Pathophysiology template Complete a pathophysiology template for an ischaemic stroke that affects the dominant left cerebral hemisphere (400 words).

PART 2- Questions related to the case study Question 1 (450 words) Explain the pathogenesis that leads to the structural and functional changes resulting from Mr Black?s stroke. Question 2 (150 words) Explain how two of Mr Black?s clinical manifestations are related to the structural and functional changes caused by the stroke. Question 3 (250 words) Relating your discussion to the pathogenesis of Mr Black?s condition, explain the mode of action of Alteplase and Assasantin?. Resources ? Examples may be available on the vUWS site. ? There are a number of textbooks and resources available through the UWS Library that may assist you.

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