Nursing - Greta Balodis - Cerebro Vascular Accident- Case Study Assessment Answer

Nursing Case Study Assignment

Case Scenario

One of Greta's close friends from the Latvian club has a daughter who is a second year student nurse. Greta has asked if you can explain the pathophysiology of a Cerebro Vascular Accident (stroke) and how it affects the central nervous system to her friend’s daughter, as she doesn’t

understand and has an exam approaching. Greta has given her permission for you to use her as an example. Please explain the pathophysiology of a Cerebro Vascular Accident (stroke) and how itaffects the central nervous system using the correct medical and nursing terminology.

Assignment Task

Following instructions are given by my tutor after my grading in the assignment which I failed:

Ensure that you read all of my comments within your paper and your rubric thoroughly and address all areas of concern

You need to demonstrate a clear understanding of the A and P, the pathophysiology and pharmacology involved within your case.

You need to provide a clear understanding of the 2 signs and symptoms and link them clearly with your case study

You also need to demonstrate appropriate clinical reasoning and rationale.

You may also like to consider consulting the Student learning centre to assist you in your grammar and spelling.sider consulting the Student learning centre to assist you in your grammar and spelling.

Introduction

Cerebral vascular accident or stroke is considered as the state, where the brain cells die suddenly due to the lack of the oxygen. The ischemic stroke is caused due to the blockage, while the hemorrhagicstroke is caused due to the rupture of the artery. Cerebral vascular accident is the medical term used for the stroke. There are always important signs and symptoms for the stroke that a person should be aware of, in order to seek medical attention on time. The paper is focused on the case study of Mrs Greta Balodis, who is suffering from right cerebral vascular accident (CVA) and atrial fibrillation. The paper also aims to present the anatomy and physiology, pathophysiology, definition, signs and symptoms and treatment of CVA.

Definition of Cerebrovascular Accident (Stroke)

The Cerebrovascular Accident is the medical term for stoke. The stroke is caused, when the flow of blood and oxygen is hindered in the brain due to the blockage or the rupture of the artery. Due to this condition oxygen could not be reached to all the parts of the brain. According to the case study, the patient suffers from right cerebral vascular accident. The brain cells from the right side of her brain died due to lack of oxygen. Cerebrovascular accident is the second leading cause of deaths in the world. There are two main kinds of cerebrovascular accidents:

• Ischemic Cerebrovascular Stroke: Caused due to the blockage in the brain artery.
• HemorrhagicCerebrovascular Stroke: Occurs due to the leakage or rupture of an artery in brain.

There are also three main causes of the Cerebrovascular accident or stroke. These are:

• Cerebral Thrombosis: Occurs due to the inflammation or the building up of plaque in the arteries. This deposition is called as Atherosclerosis. It narrows the arteries and hampers the blood flow. Such arteries are more likely to develop a clot and thus completely blocking the blood flow. Risk factors for such kind of blockage are hypertension, diabetes and high cholesterol.
• Cerebral Embolism: This condition occurs, when the clot is formed in some other part of the body and travels through blood stream and reaches to brain. This clot blocks the brain artery and stops the blood flow.
• Cerebral Hemorrhage: This condition occurs, when the brain artery breaks or leaks the blood on the surrounding brain tissues.

In CVA, the damaged part of the brain determines which cerebral artery is affected.

• CVA occurring in the anterior cerebral artery affects the motor and sensory cortex
• CVA occurring in the middle cerebral artery affects the speech and auditory functions
• CVA involving the posterior cerebral artery affects the visual cortex, and the limbic system
• Loss of blood supply via the basilar artery may partly be compensated for by blood passing through the circle of willis. Nevertheless, damage for the cerebellum and brainstem can be severe. Loss of brainstem functions will also affect the autonomic control (Clancy & McVicar 2009, p. 183).

Anatomy of Cerebral Circulation

The central nervous system is the part of the nervous system that regulates the entire bodily function. It comprises of brain, and spinal cord as the main organs that serves as the anatomical and functional centre which directly or indirectly controls, or at least influences, nearly every organ in the body (Thibodeau & Patton 2007, p. 505).

The central nervous system functions and coordinates the whole body system by bringing all the activities of the body system together and regulating them smoothly. It brings all the information together, makes decisions based on regarding the previously stored information making a proper sense of the information. It is responsible for performing the complex integrative functions of human language, consciousness, learning, perceiving, thinking and memory enabling us to adapt to situations that less complex organisms could not (Thibodeau & Patton 2007, p. 505).

• The main part of anatomy is the Blood Supply
• Anterior Blood Supply: Includes Carotid Arteries (middle and anterior cerebral arteries)

Frontal, parietal, temporal lobes; basal ganglion; part of the diencephalon (thalamus & hypothalamus) (Serlin, Shelef, Knyazer, and Friedman, 2015).

• Posterior: Vertebral Arteries– basilar artery

Mid and lower temporary & occipital lobes, cerebellum, brainstem, & part of the diencephalon

Circle of Willis– It connects the anterior & posterior cerebral circulation (Serlin, Shelef, Knyazer, and Friedman, 2015).

If the blood supply is interrupted for 30 seconds, it alters the neurologic metabolism. Metabolism stops in 2 minutes causing the death of the brain cells in 5 minutes.

Pathophysiology

The main pathophysiology of CVA is mainly linked with the diseases of heart and blood vessels. The presence of one or more such diseases increases the risk factors. The main pathologies include Atherosclerosis, hypertension leads to heart diseases, coronary artery diseases, hyperlipidemia and dyslipidemia (Go, et al, 2014). The two type of strokes caused due to these diseases are ischemic and hemorrhagic strokes, which are considered as Cerebrovascular accidents. Atherosclerosis is caused due to the development of plaque. The platelets and the fibrin sticks to the plaque, this result in narrowing or blockage of the artery. The blood supply cut off due to the blockage in the artery (Go, et al, 2014).

Anatomy and Pathophysiology in Case of Greta

The medical history of Greta explain that she had suffered from trans-ischaemic attack (TIA), and Hypertension. She is also suffering from atrial fibrillation. The Pathophysiology explains that Greta has shown significant signs and relevant symptoms for CVA. trans-ischaemic attack (TIA), and Hypertension are the vital cause for the stroke. According to De Reuck, J. (2011),“Stroke is not an accident but occurs in relation to a number of risk factors or antecedents,”“Hypertension is the most important modifiable risk factor for stroke.” The Ishemic strokes are often preceded by transient ischemic attacks (TIAs). This kind of situation occurs due to a temporary clot and results in mini strokes (Serlin, Shelef, Knyazer, & Friedman, 2015).

Signs and Symptoms of CVA

Stroke is a kind of medical emergency. If the patient had suffered from trans-ischaemic attack (TIA) then it is the sign that major stroke could happen. One of the simplest test for understanding the signs and symptoms of stroke is the FAST test. F stands for face, the patient should be asked to smile, and if the face drops from one side then it is the sign of stroke. A stands for Arms; the person should be asked to raise both arms; if one of the arm drifts downward then it is the second sign. S stands for the speech. The person should be asked to speak a simple phrase; if the speech is slurred or seems strange then it is the sign of stroke. T stands for Time, if all these signs are observed than that must be the time to call immediate help. FAST test is recommended by the Stroke Foundation of Australia (Stroke Association, 2015). The symptoms of stroke mainly appear suddenly. The patient may look pale and weak; they can also complaint about dizziness and regular headaches. Other symptoms of CVA are:

• Having trouble in walking, speaking and in vision.
• Having problems of concentration and memory.
• Sudden falls and unsteadiness.
• Having difficulty in keeping the balance and coordinating movements

Symptoms often depend on the size of the stroke and part of the brain, which is affected.

Signs and Symptoms in case of Greta

Greta has been diagnosed with right cerebral vascular accident and atrial fibrillation. The condition of fibrillation and trans-ischaemic attack explains that she had suffered Ischemic stroke. The signs, and symptoms observed in the case of Greta are the regular headaches, sudden falls and dizziness. Such condition occurs in the case of clot. The temporary clot could result in the stroke that could last for few seconds to 24 hours, if the stroke symptoms remain more than this period than it is a CVA (Van der Worp, & van Gijn, 2007). The condition of atrial Fibrillation explains that two small upper chambers of the heart do not beat in a normal pattern. The heart beat becomes irregular and too fast. This condition results in dizziness and fainting. The combined condition of atrial fibrillation and trans-ischaemic attack resulted in Cerebrovascular accident in case of Greta.

Critical Analysis

Greta has the history of being suffering from sudden falls, headache and dizziness. Atrial fibrillation and trans-ischaemic attack also explains that she had suffered temporary stroke (Go et al, 2014). The nervous system of a person is affected by the hampered blood flow and blockage. Greta’s condition clearly explains Ischemic stroke. The FAST test also explained drooping of face. According to the studies hypertension is also one of the major causes of the stroke. Greta also has the history of being suffered from hypertension. The blockage in the brain artery is the main reason behind the sudden falls and dizziness. Experiencing the symptoms of TIA explains that patient may suffer big stroke in near future (Van der Worp, & van Gijn, 2007). The pathogenesis of the disease in the case of Greta clearly explains the development of the problem of Ischemic stroke. The signs and symptoms are related to the stroke.