Nursing Pathophysiology Case Study 2022

Running Head: Nursing
Case Study Analysis
Name of the Student
Name of the University
Authors Note

Case Study Analysis1
Pathophysiology
Stroke is occurred in the brain due to poor blood circulation to the brain. Different
factors are responsible for stroke such as high blood pressure, hypoglycaemia, cardiac
abnormalities and high level of cholesterol. Primarily hypertension, atherosclerosis related to
coronary artery disease, hyperlipidaemia and dyslipidaemia are factors for the ischemic
stroke. Stroke might be happened in brain as the passage in the artery becomes narrow for
different reasons for example hypertension, atherosclerosis, high level of cholesterol and
blood clots. Cerebro-arterial system is damaged due to the lipid deposition and blockages in
the artery. Blood clots in heart often travel to the brain and block the blood circulation
pathways. Due to hypertension, some blood vessels are ruptured in brain and as a result entire
blood circulation of brain gets disturbed. The ischemic attack in brain is dependent upon
the ischemic cascade pathway. The brain tissues stop the functions if they do not get
oxygen for at least 60 to 90 seconds due to infractions and emboli. The infraction occurs
due to death of the tissues by de-oxygenation(Li, & Yang, 2017). On the other hand,
atherosclerosis disrupts the blood flow to the brain as the depositions and parts of the
deposition narrow down the space in lumen following the reduction in the blood flow. The
embolic infraction occurs due to formation of emboli in the circulatory system. emboli
influence the anaerobic metabolism in the region of brain tissues(Khoshnamet al., 2017).
Due to the anaerobic metabolism, ATP production get disrupted and lactic acid production
get increased. This lactic acid destroysthe acid-base balance in the body, specially in the
circulatory systems of brain and as a result ischemia occurs. The part of brain where
ischemia occurs is called penumbra. Due to depletion of oxygen and glucose in brain, ATP
cannot execute the energy production processes (such as ion pumping) which are important
for the survival of the tissues(Samaryet al., 2016).ATP reduction leads to the release
ofglutamate in the extra-cellular space. This condition lower the ion gradient and process a

Case Study Analysis2
calcium influx which destroys the functionalities of mitochondria by the process of
programmed cell death. Due to ischemia, the oxygen levels gets disturbed and the free
oxygen radicals are produced. The radicals react to the elements in the extracellular or
cellular elements of the blood vessels. The antioxidants neuroprotectants ( uric
acid and NXY-059) do not act on the brain cells but in the endothelium. The free radicals
affect the cells and initiate the cell death cascades with the reference of redox signalling. In
this case study the patient had chronic hyperglycemia or high blood glucose level. High
blood glucose level leads to elevated cell apoptosis due to the calcium imbalance and
aggravates cytochrome c outflow into the cytosol. Hyperglycaemia will lead to pentose
phosphate pathway which produces NADPH(Chenet al., 2016). The hyperglycaemia
increase vasoconstriction with the decreased level of nitric oxide production and induced
level of NO elimination. High blood sugar level increases ROS(Reactive Oxygen Species)
which interact with the Nitrogen oxides to generate peroxy-nitrite and this interaction
reduces bioavailability of NO(Reshiet al.,2017). The reduced bioavailability of NO leads to
vasoconstriction and poor condition of perfusion. Thus ischemia occurs in the brain cells.
Different parts of body become impaired due to the occurrence of the ischemic stroke for
an example aphasia, dysphagia, cognitive impairment and paralysis.
Assessment and the priorities of nursing care
In this case study ,Mrs Sue Jackson is a 51 year old lady and was suspected to be
affected by ischemic stroke or attack. The lady collapsed after feeling light headed and
having headache. Her husband thought that the headache was due to not taking Metformin for
blood glucose level control. The person who is suspected to have an ischemic stroke
should be assessed with the help of FAST assessment tool. Full form of “FAST” is Facial
drooping , Arm weakness, Speech impairment, and Time. The term Facial drooping denotes
if any deformities (any side of the face is deformed or hard to move) can be observed in the

Case Study Analysis3
face of the patient(Wolterset al., 2018). Arm weakness means if the patient feels
difficulties in moving hands and limbs, the patient will have the arm weakness as per
FAST.If the patient’s speech is become slurry or she/ he cannot talk properly , the patient
is having difficulties in the producing speech. At last “Time” means if the patient is showing
any of the above-discussed symptoms , emergency services should be called and the
patient should be hospitalised immediately. It is not clear whether the paramedics or Mrs
Jackson assessed her with the help of FAST assessment.
A-airway airway clear
B-breathing Resp =28, oxygen sats 94% on air
C-circulation Pulse 54-irregular pattern BP -170/100
D-disability Disoriented
Speech- slurring
facial weakness
cannot move her left arm and leg
pupils are unequal
Blood glucose -9.2-mmol.
E-Exposure Temperature 37.2