Clinical Reasoning: A Case Study on Transient Ischemic Attack


Added on  2019-09-23

3 Pages1473 Words224 Views
Case study1.0.BackgroundClinical reasoning is defined as thinking through the various aspects of patient care to arriveat a reasonable decision regarding the prevention, diagnosis, or treatment of a clinicalproblem in a specific patient (Masic et al., 2008). The present paper describes about MrsAmari, a 59 year old female patient. She had been brought to emergency department withparalyzing symptoms and undergone for diagnosis. The clinical reasoning of the patient interms of situation of the patient and her status at the time of admission in to emergencydepartment has been discussed in the paper.2.0.Situation of patientThe 59 year Amari was suffering from cardiovascular diseases. He was with past medicalhistory of hypertension and hypercholesterolemia. She had a habit of smoking for about 25years however she quit about 10 years ago. Being a New Zealand born lady, married anAustralian man. She was not doing a regular physical exercise but involving in occasionalwalk with friends. It appears the family is belonging to middle class socioeconomic state asher father was used to work at a construction site. She is having two daughters and herhusband is not having any kind of health issues. She complains of ‘numbness’ towards rightside from face and right arm, diverting the right side of mouth and slight facial drop. Theproblems are probably due to hypertension induced stroke (Iadecola & Davisson, 2008). Thetransient ischemic attack (TIA) is a transient scene of neurologic brokenness brought on byischemia (loss of blood stream) at central nervous system and/or spinal cord leading to anintense localized necrosis (Sorensen & Ay, 2011). TIA is characterized by weakness,numbness/paralysis at facial region, arm or leg, typically on one side of body, slurred speechor difficulty understanding others and blindness in one or both eyes or double vision. Thecauses of TIA includes smoking, high blood pressure, high cholesterol, diabetes, and familyhistory. As Amari does suffer from hypertension and high cholesterol, she was attacked fromTIA. TIAs occur due to the disruption of oxygen delivery in the brain leading to temporaryloss of consciousness without influencing the pulse. In contrast, CVA occurs due to death ofbrain tissues leading to the paralysis and death. In nutshell, TIA is not so harm to the health iftreatment is initiated early stages in comparison to CVA.3.0.Collect cues and information Upon admission in Emergency department, the vital parameters were recorded along with thephysical appearance. The data from preliminary investigations indicates that the bloodpressure is high (148/97 mm of Hg). The Glasgow Coma Scale values of 15 indicates that theeye opening, verbal and motor responses are quite well therefore the response was 15 (Reith,et al., 2016). Other vital parameters such as breathing rate, heart rate and pulse rate are innormal range. The major obstacle for the disease is hypertension. The hypertension was dueto narrowing of blood vessels as a result of cholesterol and lipids in the lumen of bloodvessels. This makes vessels to narrow lumen and also the elastic properties of vessels is goingto be lost leading to increase of pressure within the vessel. This reduces the blood flow andsupply of blood to brain tissue leading to delivery of in sufficient amount of oxygen andeventually to necrosis of tissue. Therefore the brain parts that supply to organs functions areexpected to collapse. Eventually it appears as the symptoms as numbness, alterations inmouth direction and speech and paralysis of arm. However there are no prominent evidencesin the CT scan and MRI scans indicating that there are no intracranial changes (CT scan) andno damages in nervous system (MRI scan). As she was brought to the emergency departmentat beginning stage, she was probably not shown any evidence of damage to brain tissue.1

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