case study analysis; 74-year-old male with a history of hypertension and smoking…

Week 8 Assignment
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.
Please do a 1 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
Osmosis.org. (2019, June 12). Osteoporosis – causes, symptoms, diagnosis, treatment, pathologyLinks to an external site. [Video file]. Retrieved from https://www.youtube.com/watch?v=jUQ_tt_zJDo Note: The approximate length of the media program is 9 minutes.
Khan Academy. (2019b). Ischemic strokeLinks to an external site.. Retrieved from https://www.khanacademy.org/science/health-and-medicine/circulatory-system-diseases/stroke/v/ischemic-stroke Note: The approximate length of the media program is 8 minutes.
ANSWER
**Case Study Analysis**
In the presented scenario, a 74-year-old male with a history of hypertension and smoking experiences sudden-onset symptoms, including difficulty speaking, drooling from the left side of his mouth, and weakness in his left hand. These symptoms progress, eventually affecting his ability to stand. The analysis of this case involves understanding the neurological and musculoskeletal pathophysiologic processes, considering potential racial/ethnic variables, and how these processes interact to affect the patient.
**Neurological Pathophysiology:**
1. **Ischemic Stroke:** The patient’s sudden onset of symptoms, including difficulty speaking, facial droop, and weakness, is indicative of an ischemic stroke. Ischemic strokes occur when blood flow to a part of the brain is blocked. In this case, the patient’s history of hypertension and smoking likely contributed to atherosclerosis, leading to the formation of a clot in a cerebral artery, causing the stroke. The affected area of the brain leads to the development of specific neurological deficits, such as difficulty speaking and weakness (Khan Academy, 2019b).
**Musculoskeletal Pathophysiology:**
1. **Hemiparesis:** The patient’s weakness in his left hand and leg, with the left arm unable to resist gravity, suggests hemiparesis. Hemiparesis results from damage to the motor areas of the brain, causing muscle weakness on one side of the body. In this case, the patient’s left-sided weakness is likely due to the impact of the ischemic stroke on the motor cortex.
**Racial/Ethnic Variables:**
While the scenario does not specify the patient’s racial or ethnic background, it is essential to consider that certain racial/ethnic groups may have a higher risk for stroke due to various factors, including genetics, lifestyle, and access to healthcare. African Americans, for example, have been shown to be at a higher risk of stroke due to higher rates of hypertension, which may be influenced by genetic factors (Ovbiagele, 2020). Understanding these variables can help tailor the treatment and preventive strategies to the patient’s specific needs.
**Interactions and Effects:**
The neurological and musculoskeletal pathophysiological processes in this case interact to affect the patient significantly. The ischemic stroke causes damage to specific areas of the brain, resulting in neurological deficits such as facial droop, difficulty speaking, and hemiparesis. The left-sided weakness and neglect are direct consequences of the brain’s reduced blood supply. The patient’s ability to communicate is impaired due to the damage to language centers, leading to mild to moderate dysarthria.
In summary, the patient’s presentation of symptoms, including difficulty speaking, drooling, and left-sided weakness, is consistent with an ischemic stroke, likely related to his history of hypertension and smoking. Understanding the pathophysiological processes and potential racial/ethnic variables is crucial for effective management and tailored care for the patient.
References:
Khan Academy. (2019b). Ischemic stroke. Retrieved from https://www.khanacademy.org/science/health-and-medicine/circulatory-system-diseases/stroke/v/ischemic-stroke
Ovbiagele, B. (2020). Stroke in African Americans: A more aggressive and recurrent form of cerebrovascular disease. Current Cardiology Reports, 22(7), 1-6.