NURS 2003 - Steven’s CVA - Steven Case Study - Nursing Assignment Help

Assignment Task

Steven is a 61 year old man who lives with his wife Marie in suburban Adelaide. Steven is a Senior Partner in a Law firm and recently reduced his working hours to 30 hours per week, from 60 hours.
This morning while eating breakfast, Steven experienced sudden onset slurring of speech, had facial droop on his left hand side with weakness in left side upper and lower limbs. Marie spotted these sudden onset of symptoms and immediately called for an ambulance, which arrived within 15 minutes.
Steven was taken to ED where on arrival he had a BP of 165/90 mmHg, HR 95, RR 25, SpO2 94% on room air and a temperature of 37.2. He was diagnosed with an ischaemic CVA.
PMHx:
Asthma - Dx Aged 8
Hypertension – Dx 5 years ago
Prediabetes – Dx 3 years ago

Medication Hx:
Seretide Accuhaler
Ventolin (As Required - Not Required for over 1 Year)
Thiazide

Social Hx notes:
Planning on retirement in 1 - 2 years.
Lives in a Bungalow with his wife Marie, who is a recently Retired Teacher. 2 Adult Children, both married with their own children - 1 lives close by, the other lives
overseas. Lifestyle Changes implemented over past 2 - 3 Years following Dx Prediabetes.
Outside work he enjoys golf, usually playing at least 2-3 per week. Also enjoys playing Bridge with Friends.
Took up walking 3 Years ago following Dx Prediabetes. Walks 5 - 6 days per week for between 30 - 45 mins.
Ex-Smoker - Hx Smoking 30 Years x 10 - 15/day - Quit 3 Years ago following Dx Prediabetes.
Social Beer Drinker 10 - 15 Standard Drinks per week with 3 - 4 per session, although sometimes after Golf may be more.

Steven is transferred to the neurological ward. On assessment he is FAST +ve, has left facial droop, left motor weakness (upper limb 0/5, lower limb 2/5) and slurred speech. He is scheduled to see the speech pathologist and the physiotherapist later today.

The doctors have ordered the following medications for discharge:
Apixaban 5 mg PO daily
Atorvastatin 40 mg PO daily
Ezetimibe 10 mg PO daily
Perindopril 2 mg PO daily
Amlodipine 10 mg PO daily

Assignment Instructions:

1. Identify the most likely type and cause of Steve’s CVA

• Your answer must include a rationale for this selection and explain how and why this cause can lead to a CVA from a pathophysiological perspective.
• Include in your answer the pathophysiology of Steven’s CVA.
• In other words, discuss the pathogenesis of the most likely cause and how it can lead to CVA. Consider his past medical history.

2. Identify two (2) other risk factors that Steven has for CVA

• For each of these risk factors explain how & why they can increase the risk of & lead to CVA.

3. Select two (2) signs and/or symptoms that Steven had as a result of his CVA

• For each sign/symptom explain how & why it can occur after a CVA, again from a pathophysiological perspective.

4. Select three (3) of Steven’s discharge medications and explain why each of the three (3) medications was ordered for Steven

• Your discussion should include the pharmacodynamics and pharmacokinetics of each medication, including relevant adverse effects and contraindications.

5. Each of Steven’s discharge medications is to be administered orally. This means they will all undergo the first pass effect. Explain what first pass is and the implications this has for a drug’s bioavailability.

This assessment focuses on the clinical knowledge and critical thinking you have gained in the topic and your ability to apply it using critical thinking. You need to demonstrate that you understand the concepts of Pathophysiology and Pharmacology and their effects on the human body.

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