Aim of assessment
The purpose of this assessment is for the student, by analysing information from a case study, demonstrate knowledge of the pathophysiological processes involved in health breakdown affecting alterations in work/leisure specifically resulting from a stroke.
The student will also discuss pharmacological concepts related to the case study.
Details
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 summarise 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
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
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.
Vital signs BP 150180 mmHg Pulse 90bpm and regular Respirations 20 breaths/minute Temperature 36.5 C
Sa0295% 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 haemorrtiage 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 .1 mL bolus over minute: 729 mL added to 5OmL sodium chloride infused over 60 minutes via a volumetric control pump).
Continue antihypertensive medication 24 hours after completion of alt eplase
follow-up CT brain scan — if bleeding excluded commence Assasantin SR capsule twice a day.
PART 1 — Pat hophysiology template
Complete a pathophysiology template for an ischaemic stroke that affects the dominant left cerebral hemisphere (400 words)
CRITERIA PART 1.
Accurately, concisely and clearly summarises all of the most important information for each component of the template with all information supported by a discerning selection of authoritative sources. The information is relevant to an ischaemic stroke of the left dominant cerebral hemisphere. (20 MARKS)
PART 2 (450 words) Explain the pat hogenesis that leads to the structural and functional changes resulting from Mr Black’s stroke.
CRITERIA PART 2:
Analyses information from a discerning selection of sources and synthesises in own words an accurate and clear explanation of the pathogenesis of an ischaemic stroke. The discussion is relevant to the case study. Within the discussion the relationships between the pathogenesis of an ischaemic stroke and all structural and functional changes are clearly and logically explained.( 10 MARKS)
PART 3 (150 words) Explain how two of Mr Blacks clinical manifestations are related to the structural and functional changes caused by the stroke.
CRITERIA PART 3:Analyses information from the case study and a discerning selection of sources and synthesises a response in own words explaining the reasons, with clear links to the structural and
functional changes, for two clinical manifestations presented by the patient in the case study. (15MARKS).
PART 4 (250 words) Relating your discussion to the pathogenesis of Mr Blacks condition, explain the mode of action of Alteplase and Assasantin.
CRITERIA PART
Analyses information from the case study and a discerning selection of references and in own words synthesises a response explaining me rationales for the administration of alteplase and Assasantin to the patient with clear links to the pathogenesis discussed.
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