CNA 155: Clinical Reasoning Report

Added on - 12 Mar 2020

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Health Assessment 2NameUniversity
Health Assessment 22Transient Ischemic Attack is caused due to interruption in the supply of oxygen to thebrain. There are several symptoms that differentiate it from an ischemic stroke. The chancesof suffering from TIA increase with age, being a woman, having conditions like, diabetes,hypertension and dyslipidemia. Treatment can include medication for prevention of clotformation or even surgery. Life style modifications are important in preventing a recurrenceor a stroke. Angioplasty or stenting may be necessary in some patients. A neurological examhelps to assess the extent of damage that a TIA has caused in a patient.A Transient Ischemic Attack is caused due to a temporary interruption of blood flowto a part of the brain due to the presence of a clot. This disrupted blood flow causes lack ofoxygen in the brain which lead to stroke like symptoms, this is why an ischemic attack isreferred to as a mini stroke. Since it is a brief and reversible neurological deficit, it does notcause permanent damage to the brain. Whereas, a stroke causes permanent damage in thebrain. But several symptoms of a Transient Ischemic Attack are similar to those of a stroke.Disturbances in speech and vision of one or both eyes, feeling numb in the arms, legs andface occur in Transient Ischemic Attack and stroke. But these last for upto a few minutes to24 hours in case of a Transient Ischemic Attack[ CITATION Kha16 \l 16393 ]Incidence of TIA is more common in women. In a survey conducted on 46971patients with TIA, the mean age at the time of occurrence was 71 years. Among men andwomen aged 65 years or more the annual rates of TIA declined from 5.8/1000 to 4.8/1000among men and from 5.3/1000 to 4.2/1000 among women. The decrease was associated withbetter care received at public health hospitals, stroke unit care and reduction of vascular riskdue to medication and primary and secondary measure employed for prevention[ CITATIONSun14 \l 16393 ].In the US 200,000 to 500,000 persons are diagnosed by doctors to havesuffered from a TIA every year. But an additional 300,000 to 700,000 patients do not seektreatment and the incidence of TIA among them is not on records. The risk of suffering from
Health Assessment 23the debilitating effects of an ischemic stroke is higher in people who do not seek treatmentafter an episode of TIA. The risk is particularly highest in the first 24 hours, the first weekand lessens after a few weeks. So, TIA should be treated as an emergency so that, furthercomplications can be prevented[ CITATION Sor11 \l 16393 ]. In many cases a TIA occurs due toeither asymptomatic or symptomatic carotid stenosis,extracranial vertebral arteryatherosclerosis or intracranial atherosclerosis[ CITATION Col17 \l 16393 ].Imaging studies helpin the diagnosis of this set of diseases[ CITATION Ueh15 \l 16393 ].Carotid re-vascularilizationis often recommended or patients with severe stenosis[ CITATION Col17 \l 16393 ].Othertherapy may involve an anti-platelet therapy, blood pressure control, reduction of low densitylipoprotein, and extensive lifestyle modification that includes controlling blood glucose levelswithin the normal range.Symptoms experienced by TIA patients are often similar to the those experienced bypatients of ischemic stroke. But as the name suggests, these symptoms are of transientnature. Weakness in limb is usually unilateral, slurred speech, monocular blindness or evenbinocular blindness or blurred vision is experienced by some patients. Limb shaking occurs inTIA patients but does not occur in patients due to ischemic stroke. At times, patients mayreport hemivisual field vision defects or ataxia of the limbs, but these symptoms may be dueto some other underlying cause and are not caused due to Transient Ischemic Attack. Imagingtechniques may help understand the cause of such associated symptoms. How symptoms reperceived by patients and their physicians depends on their gender, education andrace[ CITATION Kim14 \l 16393 ].The propensity to suffer from TIA is greater in patients with hypertension, diabetes,dyslipidemias patients who have had a TIA before are advised to follow a prescribed diet,exercise regularly, limit intake of alcohol and cessation of tobacco use. Surgical proceduresmay have to be done on some patients for revascularisation of the carotid artery. At times
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