Neurological examination Pupils equal – 2mm and reactive to light Right facial droop Paralysis of right arm and weakness of the right leg Normal strength in the left arm and leg Decreased sensation on right side of the body Right knee and ankle reflexes moderately brisk compared with those on the left Plantar response is extensor on the right and flexor on the left Difficulty with speech ? repeats yes to all questions
Laboratory tests Full blood count ? all values within normal range Blood glucose level ? 6.5 mmol/L Electrolytes, urea and creatinine ? all values within normal range ECG ? normal sinus rhythm
CT brain scan (2hours from symptom onset) No intracranial haemorrhage or mass lesions. Suggestion of early ischaemic changes in left hemisphere.
Diagnosis Mr Black is diagnosed with a left middle cerebral artery distribution stroke. He is assessed as being eligible for thrombolytic therapy.
Management IV Alteplase (8.1mL bolus over minute; 72.9 mL added to 50mL sodium chloride infused over 60 minutes via a volumetric control pump). Continue antihypertensive medication 24 hours after completion of alteplase follow-up CT brain scan ? if bleeding excluded commence Assasantin? SR capsule twice a day.
400815 ? Alterations in Breathing, Work/Leisure and Mobility Learning Guide ? Spring 2013
?School of Nursing and Midwifery Page 11 of 22 University of Western Sydney
PART 1 ? Pathophysiology template Complete a pathophysiology template for an ischaemic stroke that affects the dominant left cerebral hemisphere (400 words).
PART 2- Questions related to the case study Question 1 (450 words) Explain the pathogenesis that leads to the structural and functional changes resulting from Mr Black?s stroke. Question 2 (150 words) Explain how two of Mr Black?s clinical manifestations are related to the structural and functional changes caused by the stroke. Question 3 (250 words) Relating your discussion to the pathogenesis of Mr Black?s condition, explain the mode of action of Alteplase and Assasantin?. Resources ? Examples may be available on the vUWS site. ? There are a number of textbooks and resources available through the UWS Library that may assist you.