Aim of assessment
The purpose of this assessment is for the student, by analysing information from a case study, demonstrate knowledge of the pathophysiological processes involved in health breakdown affecting alterations in work/leisure specifically resulting from a stroke. The student will also discuss pharmacological concepts related to the case study.
Details
Review the case study: Mr Black (detailed below)
Complete the pathophysiological template (Part 1) for an ischaemic stroke that has affected the left dominant cerebral hemisphere and answer three questions.
To complete the template you must summarise the relevant information for each component. This summary may consist of a combination of sentences, flow diagrams and dot points where relevant.
The information in the template must be accurately referenced using the APA referencing style.
Part 2. Three questions are to be answered using correct sentence structure, paragraphs, grammar and spelling. Your answers must be accurately referenced using the APA referencing style
Length: Pathophysiology template 400 words
Answers to questions 850 words
CASE STUDY
Mr Black, a 61 year old businessman was watching the 7pm television news when he developed sudden onset of difficulty in speaking and drooping of the right side of his mouth. He was not able to lift his right arm or stand up. His wife immediately called the ambulance. The paramedics, using the FAST protocol assessed Mr Black as having had a stroke and transported him to a hospital with an acute stroke thrombolysis centre. He was admitted to the Emergency Department at 8pm.
History obtained from wife.
Mr Black was diagnosed with hypertension 10 years ago for which he takes Metopropol daily. He smokes about one packet of cigarettes/day and drinks alcohol socially. There is no history of serious illnesses or allergies. His father died of a heart attack at the age of 60
Vital signs
BP 150/80 mmHg
Pulse 90bpm and regular
Respirations 20 breaths/minute
Temperature 36.5° C
SaO2 95%
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.
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 to use
Essential texts Jenkins, G. W., Kemnitz, C. P., & Tortora, G. J. (2010). Anatomy and
physiology from science to life (2nd ed.). Hoboken, NJ: John Wiley &
Sons.
Lehne, R. A., (2010). Pharmacology for nursing care (7th ed.). St. Louis,
Mo: Saunders/Elsevier.
Porth, C. M., & Matfin, G. (Eds.). (2009). Pathophysiology: Concepts of
altered health states (8th ed.). Philadelphia, PA: Wolters Kluwer
Health/Lippincott Williams & Wilkins.
• Question 1
• CRITERIA/20 HD 17 – 20 D 15 – 16.5 C 13.5 – 14.5 P 10 – 13 F = 9.5
• Demonstrates comprehensive and detailed knowledge of the pathogenesis of an ischaemic stroke related to a case study.
• Demonstrates the links between the pathogenesis of chronic obstructive pulmonary disease and the resulting structural and functional changes. Analyses information from a discerning selection of sources and synthesises in own words an accurate and clear explanation of the pathogenesis of an ischaemic stroke. The discussion is relevant to the case study. (8.5-10)
Within the discussion the relationships between the pathogenesis of an ischaemic stroke and all structural and functional
Changes are clearly and logically explained (8.5-10) Analyses information from a discerning selection of sources and accurately explains the pathogenesis of an ischaemic stroke with discussion related to the case study. Some synthesis evident, but much of the discussion is paraphrased from single sources. (7.5-8.25)
Within the discussion the relationships between the pathogenesis of an ischaemic stroke and most of the structural and functional changes are accurately and clearly explained. (7.5-8.25). Analyses information from relevant references. Describes the pathogenesis of an ischaemic stroke accurately with discussion mainly consisting of paraphrased information. Information may be incomplete.The discussion is generally related to the case study. (6.5-7.25)
The structural and functional changes are described in the discussion but are not always clearly linked to the pathogenesis, or not all structural and functional changes are included in the discussion. (6.5-7.25). Using information from relevant references provides a basic description of the pathogenesis of an ischaemic stroke. There may be minor inaccuracies, omissions or repetition of information, lack of clarity or logical flow of the process. The discussion may be generalised rather than related to the case study. (5-6.25)
A number of structural Using one or two relevant references gives a superficial description of the pathogenesis of an ischaemic stroke with a number of significant inaccuracies, repetition or lack of clarity. (2.5-4.5)
Information predominantly copied or quoted from inappropriate sources such as non-authoritative web sites, Wikipedia, encyclopaedias or dictionaries, with little evidence of understanding. (0-2)
Pathogenesis of ischaemis stroke not explained or explanation mostly inaccurate and lacking clarity. (0-2)
Lists some structural and functional changes but most not accurately related to the pathogenic process. (1-4.5)
Question 2
Demonstrates comprehensive and detailed knowledge of the reasons for two clinical manifestations presented by the patient in the case study with clear links to the structural and functional changes identified. Analyses information from the case study and a discerning selection of sources and synthesises a response in own words explaining the reasons, with clear links to the structural and functional changes, for two clinical manifestations presented by the patient in the case study. Analyses information from the case study and a discerning selection of sources and provides clear and accurate reasons for two clinical manifestations presented by the patient in the case study. Evidence of some synthesis but information mostly paraphrased. Links to the structural and functional changes are mostly evident in the discussion. Analyses information from the case study and relevant references. Explains the reasons for two clinical manifestations presented by the patient in the case study with links to the structural changes generally being evident but at times may be incomplete. Provides a basic explanation for two clinical manifestations presented by the patient in the case study. Links to the structural and functional changes may lack clarity, contain minor errors or be incomplete. Provides a superficial description of two clinical manifestations but there are many significant inaccuracies and the links to the structural and functional changes are minimal and lack clarity. (3-7)
Identifies clinical manifestations but the links to the structural and functional changes lack clarity, are mostly inaccurate or omitted. (1-2.5)
Does not identify clinical manifestations presented by the patient in the case study. (0)
QUESTION 3
Demonstrates comprehensive and detailed knowledge of the action of alteplase and Assasantin? used in the treatment of the patient in the case study with clear links between the drug action and pathogenesis identified. Analyses information from the case study and a discerning selection of references and in own words synthesises a response explaining the rationales for the administration of alteplase and Assasantin? to the patient with clear links to the pathogenesis discussed. Analyses information from the case study and a discerning selection of references and provides clear and accurate rationales for the administration of alteplase and Assasantin?. Links between the action of the drugs and pathogenesis of ischaemic stroke are mostly evident. Analyses information from the case study and relevant references and explains the rationales for the administration alteplase and Assasantin?. Drug actions are accurate but links to the pathogenesis of ischaemic stroke contain minor inaccuracies or are incomplete. Analysing information from relevant references provides basic rationales for the administration alteplase and Assasantin?. Drug actions are accurate but links to the pathogenesis of ischaemic stroke lack clarity, contain inaccuracies or are only partially discussed. Reasons for the administration of alteplase and Assasantin? are superficial or lack clarity with few or no links to the pathogenesis of ischaemic stroke. Information about drug action is mostly from a relevant source. (3-7)
Drug actions have been mostly paraphrased or copied from non-authoritative sources with little evidence of understanding the reasons for their administration to the patient in the case study. There are no links between the drug action and pathogenesis of ischaemic stroke. (0-
What is the distinction between practical significance and statistical significance?
