Concepts of Neurological and Musculoskeletal Disorders – Part 2

Concepts of Neurological and Musculoskeletal Disorders – Part 2

Week 8 case study is about a 72-year-old female brought in by the daughter with acute onset slurred speech that lasted an hour, followed by lethargy and speechlessness. She had a stroke two years ago. On examination, she has reduced power (4/5) in all four limbs. Laboratory investigations revealed elevated total cholesterol (300), elevated LDL (140), and low HDL (36).

Her blood pressure during this visit is 134/81 mmHg. Imaging studies revealed a left-sided temporals region infarct, 40% blockage of the right carotid artery, and 35% blockage of the left carotid artery. This paper aims to describe the pathophysiology presentation, racial and ethine variables that could impact physiological functioning, and processes that interact to affect the patient.

Pathophysiology

The clinical information given suggests that the patient had a left-sided stroke. Her stroke is ischemic, as shown by the infarct on the CT scan. Ischemic stroke results from occlusion of blood flow into certain regions of the brain. Risk factors for this occlusion include but are not limited to hypertension, thromboembolism, atherosclerosis, diabetes mellitus, and race. Arterial occlusion leads to ischemia and infarction of the regions supplied by the affected artery (Kuriakose & Xiao, 2020).

The motor and sensory functions of the body controlled by the infarcted regions are lost. As the occlusion progresses without intervention, the infarction leads to permanent damage of the brain cells from severe stress and untimely cell death. Processes such as inflammation, energy failure, and oxidative stress can complicate stroke leading to brain edema and lateralizing symptoms (Hui et al., 2022). In this patient, key risk factors were elevated blood pressure, narrowing of carotid blood supply, and dyslipidemia.

Racial/Ethnic Variables Impacting Phycological Functioning

Stroke is a multifactorial disease, and race is just one of the factors. African Americans are most affected by stroke and stroke-related deaths (Lekoubou et al., 2021). Ischemic stroke, especially embolic stroke, is associated with underlying cardiovascular diseases. Cardiovascular disease and diabetes are more common among African Americans as compared with other races.

Other variables among races leading to health disparities, such as access to care, socioeconomic status, and religion, must be accounted for when comparing races (Howard et al., 2019). Advancing ages and male gender are other risk factors constant among all races (Lekoubou et al., 2021). Lekoubou et al. (2021) found that the risk of ischemic stroke is threefold among African Americans, holding other confounding factors constant.

Interaction of Pathophysiologic Processes to Affect

According to Chugh (2019), stroke is the second leading cause of mortality worldwide. It is the third leading cause of morbidity as well. Pathologic process in ischemia stroke can lead to permanent loss of motor, sensory, and autonomic function of the parts of the body being controlled by the stroke-affected area.

Loss of speech, difficulties in swallowing, and immobility are sperm of the effects of stroke on the patient (Prasanna & Forshing, 2022). Complications such as pneumonia, venous thromboembolism, and urinary tract infections arise from the process after the stroke.

Conclusion

The patient in this discussion had an ischemic stroke. Ischemic stroke arises from arterial occlusion of blood supply to certain parts of the brain. Ischemia and necrosis of the affected area result, and if not treated in time, mortality and disability may ensue. African Americans are the most affected race. However, consideration should be given to other confounding factors such as comorbidities and health disparities.

References

Chugh, C. (2019). Acute ischemic stroke: Management approach. Indian Journal of Critical Care Medicine: Peer-Reviewed, Official Publication of Indian Society of Critical Care Medicine23(Suppl 2), S140–S146. https://doi.org/10.5005/jp-journals-10071-23192

Howard, V. J., Madsen, T. E., Kleindorfer, D. O., Judd, S. E., Rhodes, J. D., Soliman, E. Z., Kissela, B. M., Safford, M. M., Moy, C. S., McClure, L. A., Howard, G., & Cushman, M. (2019). Sex and race differences in the association of incident ischemic stroke with risk factors. JAMA Neurology76(2), 179–186. https://doi.org/10.1001/jamaneurol.2018.3862

Hui, C., Tadi, P., & Patti, L. (2022). Ischemic Stroke. In StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK499997/

Kuriakose, D., & Xiao, Z. (2020). Pathophysiology and treatment of stroke: Present status and future perspectives. International Journal of Molecular Sciences21(20). https://doi.org/10.3390/ijms21207609

Lekoubou, A., Pelton, M., Ba, D. M., & Ssentongo, P. (2021). Racial disparities in ischemic stroke among patients with COVID-19 in the United States. Journal of Stroke and Cerebrovascular Diseases: The Official Journal of National Stroke Association30(8), 105877. https://doi.org/10.1016/j.jstrokecerebrovasdis.2021.105877

Prasanna, T., & Forshing, L. (2022). Acute Stroke. In StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK535369/

Concepts of Neurological and Musculoskeletal Disorders – Part 2 Instructions

Week 8: Concepts of Neurological and Musculoskeletal Disorders – Part 2
As homeowners know all too well, there is a continuous need for maintenance and repair. Some efforts are precautionary in nature, while others are the result of issues that surface over time.
Similarly, musculoskeletal disorders can develop over time. For some disorders, such as osteoporosis, precautionary treatments are a potential option. But much like issues that surface in a home over time, many musculoskeletal issues can be very serious concerns, and they can have a significant impact on patients’ lives.
This week, you continue to examine fundamental concepts of neurological and musculoskeletal disorders. You explore common disorders that impact these systems and you apply the key terms and concepts that help communicate the pathophysiological nature of these issues to patients. 
Module 5 Assignment: Case Study Analysis
An understanding of the neurological and musculoskeletal systems is a critically important component of disease and disorder diagnosis and treatment. This importance is magnified by the impact that that these two systems can have on each other. A variety of factors and circumstances affecting the emergence and severity of issues in one system can also have a role in the performance of the other.
Effective analysis often requires an understanding that goes beyond these systems and their mutual impact. For example, patient characteristics such as, racial and ethnic variables can play a role.
An understanding of the symptoms of alterations in neurological and musculoskeletal systems is a critical step in diagnosis and treatment. For APRNs this understanding can also help educate patients and guide them through their treatment plans.
In this Assignment, you examine a case study and analyze the symptoms presented. You identify the elements that may be factors in the diagnosis, and you explain the implications to patient health.
Learning Objectives
Students will:
•	Analyze processes related to neurological and musculoskeletal disorders
•	Identify racial/ethnic variables that may impact physiological functioning
•	Evaluate the impact of patient characteristics on disorders and altered physiology 
Coming up in Week 8: Module 5 Assignment, Case Study Analysis.    

Scenario: A 58-year-old obese white male presents to ED with chief complaint of fever, chills, pain, and swelling in the right great toe. He states the symptoms came on very suddenly and he cannot put any weight on his foot. Physical exam reveals exquisite pain on any attempt to assess the right first metatarsophalangeal (MTP) joint. Past medical history positive for hypertension and Type II diabetes mellitus. Current medications include hydrochlorothiazide 50 mg po q am, and metformin 500 mg po bid. CBC normal except for elevated sedimentation rate (ESR) of 33 mm/hr and C-reactive protein (CRP) 24 mg/L. Metabolic panel normal. Uric acid level 7.2 mg/dl.
In this Assignment, you examine a case study and analyze the symptoms presented. You identify the elements that may be factors in the diagnosis, and you explain the implications to patient health.
To prepare:
By Day 1 of this week, you will be assigned to a specific case study scenario for this Case Study Assignment. Please see the “Course Announcements” section of the classroom for your assignment from your Instructor.
Assignment (1- to 2-page case study analysis)
In your Case Study Analysis related to the scenario provided, explain the following:
•	Both the neurological and musculoskeletal pathophysiologic processes that would account for the patient presenting these symptoms.
•	Any racial/ethnic variables that may impact physiological functioning.
•	How these processes interact to affect the patient.