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Case Research: Disorders of Brain Function

Ting Lin

Question #1

The health care provider needs to get yourself a complete medical history, medication history, life history, cultural and genealogy, to assess for just about any risk factors for stroke, such as hypertension, hyperlipidemia, diabetes, heart and soul diseases (e. g. , atrial fibrillation), serious kidney disease, earlier stroke assault or transient ischemic assault (TIA), family history of stroke, obesity, smoking, inactivity, stress, use of anticoagulants, etc. . (Porth, 2011, p. 933). Furthermore, the nurse must make inquiries about any neurological deficits the individual is exhibiting, followed by a thorough physical, concentrating on neurological exam, to evaluate patient's mental status, motor and sensory function, cranial nerve function, as well as to examine the patient's cognitive level (terms, memory, wisdom, problem-solving abilities, etc. ). Radiologic studies are essential tools to provide diagnostic information and guide treatment regiments. For instance, a noncontrast brain Computed tomography (CT) and brain Magnetic resonance imaging (MRI) can identify hemorrhage from ischemia and exclude intracranial lesions that mimic stroke medically (Porth, 2011, p. 935). Furthermore, brain CT angiogram and carotid Doppler allow visualization of blood vessels and blood circulation to the mind, which end up being valuable diagnostic strategies in stroke management.

Question 2

Onset of heart stroke is unexpected. Patients can manifest generalized symptoms as disorientation, distress, dizziness, seizure, throwing up or severe throbbing headache. Medical presentations are usually accompanied by focal neurologic deficits (depending on the location of vessel included and the amount of harm), such as aphasia, visible field damage, contralateral sensory /electric motor loss, apraxia, agnosia, ataxia, cranial nerve deficits, etc. (Porth, 2011, p. 934).

Question 3

There are two types of strokes: ischemic and hemorrhagic. An ischemic heart stroke occurs consequently of vascular blockage within cerebral flow induced by thrombus or embolus with succeeding infarction and lack of neurologic function. Hemorrhage stroke results from a weakened vessel that ruptures and bleeds in to the surrounding structure. The blood accumulates and compresses the encompassing brain substance causing brain bloating. Strokes can be major or minor depending on the affected area. The results can range from complete restoration to fatality. Mr. J's scientific manifestations seem to be long-term global deterioration of cognitive function that interferes with memory, intellect, terminology, learning and judgment, which are not consistent with stroke but probably indicate Alzheimer's dementia. A neurologist would need to be consulted.

Question 4:

Alzheimer's disease frequently presents with a delicate onset of short memory loss followed by slowly progressive dementia that has a course of many years (Porth, 2011, p. 949). As the condition progresses, long-term memory can be impaired as well with an increase of global impairment of cognitive working. Patients may exhibit confusion, disorientation, lack of insight, and lack of ability to carry out the actions of everyday living (Porth, 2011, p. 950). Personal cleanliness is often neglected. Patients sometimes have problems realizing relatives and buddies member, organizing thoughts or learning new things. Other medical indications include: language troubles, disturbed sleep style and loss of impulse control. They may also undergo personality changes and behavioral changes (e. g. , agitation, hallucination, questioning, aggression, decreased awareness of environments and lowered self-care, etc. ) which is often very distressing (Anderson, 2016).

Question 5

Based on Mr. J's presenting symptoms, the nurse would suspect that he's experiencing Alzheimer dementia because Mr. J's memory reduction and cognitive impairment is continuous in nature and also have been gradually getting worse. On the other hand, a stroke event is often abrupt onset and combined with focal neurological deficit such as limited movements on one aspect of the body, cosmetic droop, aphasia or visual field deficit, etc. Medical provider can obtain a complete background and physical, including a detained neuro exam to exclude other possible causes of dementia. A mini-mental status exam (MMSE) (Snyderman, 2009) little cog (Borson, 2003) or other verification tests can be performed to look for the severity and progression of cognitive drop. Mind CT and MRI can produce highly thorough images to rule out other brain disorders with dementia-like symptoms. However, definite medical diagnosis of Alzheimer's can only just be proved at autopsy when pathological exam of the brain reveals the quality deposition of amyloid in plaques and tau necessary protein in neurofibrillary tangles (Hardy, 2002). Research workers (Small, 2006) have found that Positron-emission tomography (Dog or cat) scan by using amyloid-binding radiotracer to have the ability to detect brain degree of plaques (amyloid) and tangles (tau) in living things, which are characteristic of Alzheimer's disease. Way of measuring of key health proteins biomarkers in blood and in cerebrospinal liquid (CSF) can also be employed to indicate the probability of Alzheimer's disease (Blennow, 2010), which provide perspectives for new diagnostic tools for Alzheimer's disease.

References

Anderson, H. S. (2016, September 28). Alzheimer disease. Retrieved from http://emedicine. medscape. com/article/1134817-overview

Blennow, K. , Hampel, H. , Weiner, M. , & Zetterberg, H. (2010). Cerebrospinal liquid and plasma biomarkers in Alzheimer disease. Nature Reviews Neurology, 6(3), 131-144.

Borson, S. , Scanlan, J. M. , Chen, P. , & Ganguli, M. (2003). The MiniCog as a display for dementia: validation in a societybased test. Journal of the American Geriatrics Society, 51(10), 1451-1454.

Hardy, J. , & Selkoe, D. J. (2002). The amyloid hypothesis of Alzheimer's disease: improvement and problems on the path to therapeutics. Science, 297(5580), 353-356.

Porth, C. (2011). Basics of pathophysiology:(4th. Ed. ). Philadelphia: Lippincott Williams & Wilkins.

Small, G. W. , Kepe, V. , Ercoli, L. M. , Siddarth, P. , Bookheimer, S. Y. , Miller, K. J. , . . . & Thompson, P. M. (2006). Family pet of brain amyloid and tau in light cognitive impairment. New Britain Journal of Medicine, 355(25), 2652-2663.

Snyderman, D. , & Rovner, B. W. (2009). Mental Position Examination in Key Care: AN ASSESSMENT. American family physician, 80(8).


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