Case Study 1 Mr. Sam Kwon

CaseStudy 1 Mr. Sam Kwon

CaseStudy 1 Mr. Sam Kwon

Question1: Patients History and Follow ups

Cerebrovascularaccident otherwise known as stroke is a major cause of death anddisability in the modern society. Due to changes in the modernlifestyles as well as an aging population, stroke is a major healthproblem in the modern society. It happened when blood vessels in thebrain are blocked on raptures leading to low oxygen and glucose inthe brain cells due to lack of blood supply. If the insufficientsupply is less than 3 minutes, the brain cells can recover from thestress. However, if the brain cells are deprived blood supply formore that 3 minutes, it may result into permanent brain damage ordeath. Additionally, in case stroke results into damage on some partsof the brain, other parts of the brain can learn to handle all taskswithout affecting the patient’s life.

Thereare several factors that put Mr. Kwon at the risk of cerebrovascularaccident. Mr. Kwon is male adult aged 74 years old. Statisticsindicates that males above the age of 55 years at a higher risk ofstroke. Therefore, the patient lies in this blanket. The medicalhistory of the patient indicates that he suffers from hypertension.Individuals with high blood pressure or hypertension are at a majorrisk of Cerebrovascular accident or stroke. A blood pressure readingof 140/90 or high is considered a major risk for stroke. The medicalobservation of Mr. Kwon indicated a blood pressure of 140/105. Due tothe high blood pressure in the arteries to the brain, they weakenresulting into rapture, a major cause of cerebrovascular accident.When combined with other risk factors, patients with high bloodpressure will most certainly suffer from stroke.

Diabetesmellitus increases the risk of cerebrovascular accident by up to 3times. Medical history of Mr. Kwon indicates that he suffers fromtype 2 diabetes mellitus. This is a major indication that he may besuffering from stroke. Diabetes mellitus is associated withcardiovascular diseases, high cholesterol levels and other riskfactors such as high blood pressure which predisposes an individualto stroke. History of other cardiovascular diseases is also a majorrisk factor for stroke. Coronary heart disease and heart attackpredisposes an individual to the risk of cerebrovascular accident.Mr. Kwon suffers from congestive heart failure is a major riskfactor. Mr. Kwon has also been a smoker for most of his life. He hassmoked a packet of cigarette every day for about 40 years, making hisa heavy smoker. Studies indicate that heavy smokers are twice aslikely to develop stroke and other cardiovascular diseases. This isbecause smoking reduces the level of oxygen in the blood which forcesthe heart to work harder. It also aggravates other risk factors suchas high blood pressure and diabetes.

Question2:Homonymousheminopia

Homonymousheminopiais a visual defect affecting the left or right half of both eyes. Inmany cases, it starts with one eye but eventually affects the othereye resulting into loss of visual fields. The main cause of thiscondition is cerebrovascularaccident which results inopt lesions in the optical pathways in lefthalf of the brain. This is indicated in the CT scan of Mr. Kwon’sbrain. The location of the lesions is on the left side of the brainand there he could be suffering from homonymous heminopia (Robert&amp Rafael, 2007).

Question3: Interventions

Likemajority of other cardiovascular diseases, cerebrovascularaccident is preventable. This is because majority of the risk factorscan be controlled. However, in the case of Mr. Kwon, management ofthe condition is the most viable option. The most important aspect ofacute stroke management is stabilizing the patient and clinicalevaluation of the patient through imaging and laboratory tests withinan hour after arrival in the medical facility. This is the mostimportant initial intervention that Mr. Kwon will require on arrivalat the facility. The management of acute cerebrovascular accident isguided by evidence based basic principles. These principles includemanagement of the airway, control of blood pressure and glucose andmanagement of seizure activity among others. The management of thecondition is guided by the nature of the cerebrovascular accidentsince some conditions may require specific interventions. Themanagement of the blood sugar is very essential since hypoglycemiaand hyperglycemia can produce symptoms that mimic certain types ofcerebrovascular accident, for example ischemic stroke. The managementof blood sugar includes administration of glucose in the case ofhypoglycemia and insulin in the case of hyperglycemia to maintain theblood glucose level between 3.8 and 10 mmols. It is also veryessential to maintain a stable blood pressure, especially if thepatient has a history of hypertension, as in the case of Mr. Kwon.However, it is important to note that sudden drop in the bloodpressure may worsen the conditions of the patient. Reducing the bloodpressure should be remitted to very necessary cases for example, toreduce bleeding in the case of hemorrhagic stroke. Cardiac monitoringis also essential since it identifies the cause of the stroke as wellas monitoring of the post stroke events. Swallow assessment whichinvolves a speech pathologist is also necessary. Bladder assessmentand intermittent catheter may be necessary in case of acute urinaryretention. Other parameters that need to be monitored and managementincludes respiratory patterns, heart rate and body temperature(Robert&amp Rafael, 2007).

Question4: Pathology results

Althoughthe blood glucose levels in the blood were high according to thebiochemistry report, no other pathology result had any value. Whilethe reference range was 3.5-6.0 mmol/L, results indicated that Mr.Kwon has 10.5 mmol/L. This is important because the patient had aprevious history of diabetes. Also the lesion in the CT scan alsogave useful information. It is important to note that while physicalexamination and medical history of the patient can suggest that apatient is suffering from cerebrovascular accident, it can only beconformed through neurological examination. Imaging technologies havebeen used in the confirmation of the condition as well asestablishing the likely cause by establishing the location and typeof infarction.

Question5: Types of Stroke

Thereare two main types of stroke, hemorrhage stroke and ischemic stroke. Ischemic stroke is as a result of inadequate supply of blood in aparticular part of the brain resulting into dysfunctional tissueswhile hemorrhage stroke is as a result of accumulation of blood. Based on the CT scan, Mr. Kwon could be suffering from hemorrhagestroke. The scan shows intracranial hemorrhage with possible edemasurrounding the affected area. Additionally, facial paralysis ismainly associated with hemorrhage stroke.

Ischemic stroke

Hemorrhagic stroke

Treatment

Mr. Kwon symptoms

Other symptoms

Mr. Kwon symptoms

Other symptoms

Medical treatment, surgical treatment,

Hemiparesis on one side (sudden numbness), aphasia and speech problem.

Sudden and intense headache, confusion, difficulties in walking, loss of balance, poor coordination.

Hemiparesis on one side (sudden numbness), aphasia and speech problem, drooping of the face.

Loss of consciousness, difficulties in swallowing, lack of balance, poor coordination, visual changes.

Question6: Treatment options

Medicaltreatment is of stroke is an emergency intervention when the injuryis identified as hemorrhagic. The treatment involves administrationof drugs that will reduce bleeding in the brain tissues, for example,warfarin and clopidogrel. However, the causes of the bleeding need tobe established before any treatment can be administered. Once thebleeding has been controlled, secondary care and bed rest isrecommended to avoid re-breeding. In the case of ischemic stroke,medications such as aspirin and plasminogen activities areadministered to prevent clotting and increase blood flow. On theother hand, stroke can be treated by surgical procedure where theraptured or abnormal blood vessel is repaired surgically. There areseveral surgical procedures that can be carried in the treatment ofhemorrhagic stroke. They include surgical clipping, coiling and AVMremoval among others. In the cases of ischemic stroke, a catheter isused to surgically remove the clot from the brain. Both types ofstroke result into disability. Rehabilitation of the patient afterrecovery is therefore very essential to enable the patient regainstrength and ability to live a normal life. For example, strokepatient require physical therapy to regain balance, vision,swallowing and sensation on affected parts of the body (Robert &ampRafael, 2007).

Reference

Robert,J. W. &amp Rafael, H. L. (2007).Stroke,Philadelphia: American College of Physicians.

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