NRS 455 Case Study Mrs. T.

Sample Answer

Critical Thinking Table

Clinical Manifestations

Describe the clinical manifestations present in Mrs. T., focusing on what is normal and abnormal and how this relates to her current condition.
Subjective Nurses working with patients should obtain subjective and objective data to guide them in decision-making.

Subjective data refers to the information the patient or others give about the health problem. The abnormal subjective manifestations in the case study include Mrs. T not acting like herself and the information that the symptoms were sudden and lasted 5 minutes.

The symptoms developed from changes in brain tissue perfusion, mimicking those seen in patients with a transient ischemia attack (Panuganti et al., 2024).

Objective Healthcare providers obtain objective information. Some of the abnormal objective manifestations include elevated blood pressure, pulse, blood glucose, NIHSS score, and cholesterol level. It also includes the inspection findings by the nurse such as mumbling something, her right arm appearing limp, slackening the right side of her face, not making sense when talking, and denying pain.

These symptoms arise from the impaired blood supply to a brain region. For example, the slacking of the night side of her face implies that the left side of the brain is involved in the disease process.

Symptoms such as elevated blood pressure and glucose are physiological responses to ensure adequate brain tissue oxygenation and supply of essential nutrients (Panuganti et al., 2024). The cholesterol levels are elevated because of hyperlipidemia.

Primary and Secondary Diagnoses

Discuss the primary and secondary medical diagnoses that should be considered for Mrs. T., and why you chose this diagnosis.
Primary medical diagnosis and why you chose this diagnosis. Transient ischemic attack is the primary diagnosis for Mrs. T.

Transient ischemic attack is a sudden episode of neurologic dysfunction because of focal brain, retinal, or spinal cord ischemia without tissue injury or acute infarction. The symptoms of transient ischemic attack last less than an hour and are minutes in most cases.

The risk of stroke is high following a transient ischemia attack. Patients experience symptoms such as speech disturbance and focal neurological deficits (Mendelson & Prabhakaran, 2021). Mrs. T developed symptoms of neurological deficits such as facial paralysis, speech disturbances, and arm weakness with normal brain CT scan findings. The symptom duration was five minutes. This means that transient ischemic attack is the primary diagnosis for her.

Secondary medical diagnosis and why you chose this diagnosis. The secondary medical diagnosis I would consider for Mrs. T is a stroke. A stroke is a medical emergency that develops from the occlusion of blood supply to the brain or bleeding to the brain.

There is impaired tissue oxygenation in the brain, which causes cell death and loss of function in the affected brain areas. Patients with stroke present to the hospital with symptoms such as paralysis, facial drooping, speech impairment, difficulty coordinating movements, and numbness and weakness among others. They also have abnormal CT and MRI scans of the brain (Amarenco, 2020).

Despite Mrs. T having symptoms seen in stroke, stroke is the least likely diagnosis because of the normal brain imaging results.
Formulate a nursing diagnosis from the medical diagnoses One of the nursing diagnoses that can be developed from the medical diagnoses is ineffective brain tissue perfusion related to the interrupted blood supply to the brain as evidenced by speech difficulty.

Pathophysiological Changes

Explain the pathophysiological changes in Mrs. T.
What pathophysiological changes would you expect to be happening to Mrs. T.? Mrs. T experienced a transient interruption of arterial blood supply to the brain. The interruption affected the functioning of the brain area supplied by the artery.

The sources of interruption could be due to ischemia or mild bleeding in the artery to the brain. Besides, cardiac embolism could have caused an interrupted blood supply to the brain. The emboli in the cardiac chamber could impede the normal blood supply to the brain, leading to ischemia (Grotta et al., 2021).

The cessation in blood supply affects the functioning of the brain supplied by the artery, hence, symptoms such as paralysis, speech difficulty, and inability to move.

How will pathophysiological changes transition in the subacute phase after diagnosis and initial treatment? Diagnosis and initial treatment will prevent the progression of transient ischemic attack to a stroke. Early treatment will reduce the risk of early stroke.

Studies show that the risk of patients developing stroke within 3 months of a transient ischemic attack is 20% with at least 50% of them occurring within 2 days of a transient ischemic attack.

Diagnosis and treatment of other comorbidities such as atrial fibrillation and hyperlipidemia significantly reduce the risk of disease progression to stroke (Ortiz-Garcia et al., 2022). Treatments such as the use of aspirin and clopidogrel provide the appropriate antiplatelet therapy that prevents blood clot formation and subsequently stroke development.

Health Status Effect

Describe the effects Mrs. T.’s current health status may have on her.
Describe the physical, psychological, and emotional effects Mrs. T.’s current health status may have on her. Mrs. T’s current health status might be associated with considerable physical, psychological, and emotional health effects.

One of the physical effects of transient ischemic attack is the increased risk of subsequent attacks and progression to a stroke. Such risks predispose her to premature disability, decreased functioning, poor quality of life, and premature death. Mrs. T is also likely to suffer from increased care demands. Patients with transient ischemic attacks incur high healthcare costs due to frequent hospitalizations and hospital visits.

Some patients diagnosed with transient ischemic attacks have to make changes such as reducing the number of hours worked and avoiding driving for long distances, which affect their financial status and overall functioning. The transient ischemic attack also affects social relationships (Katzan et al., 2021). The diagnosis increases anxiety in others and lowers intimate relationships since the suitability for different contraceptive methods changes.

A diagnosis of a transient ischemic attack also has considerable psychological and emotional health impacts. For example, the diagnosis brings significant uncertainty and anxiety for patients and their significant others. The increased risk of stroke makes patients anxious and at times depressed, which affects the overall treatment outcomes.

The risk of stress among patients with transient ischemic attack is also high due to decreased functioning, poor quality of life, and fear of unknown outcomes (Prost et al., 2021). Therefore, strategies to minimize the impacts of the diagnosis on health should be adopted.

Discuss the impact it can have on her role in the family. The diagnosis of a transient ischemic attack affects Mrs. T’s role in the family. Firstly, it affects her contribution to her family’s financial status. A diagnosis of a transient ischemic attack might imply that Mrs. T has to work fewer hours than usual to prevent the risk of complications due to stress.

This would reduce her financial status and contribution to the family. Mrs. T’s diagnosis is also likely to act as a source of financial strain for the family. Patients with transient ischemic attack can develop stroke and require frequent hospital visits and hospitalization. The changes can have a considerable financial toll on the family.

The diagnosis also affects the social and emotional well-being of the family. Mrs. T’s family members are anxious and fearful of unknown outcomes associated with the diagnosis. The fact that a transient ischemic attack could progress to a stroke acts as a stressor for the family members (ANDERSSON et al., 2021; Tsalta-Mladenov & Andonova, 2021).

The diagnosis also affects Mrs. T’s intimate relationships. In this case, she has to consider the suitability of different contraceptive options, which would affect her sexual life with her partner.

Treatments and Support

Discuss treatments and support that can be completed for Mrs. T.
Discuss the immediate treatments that can be completed for Mrs. T. Immediate medical therapy should be implemented for Mrs. T. Firstly, antiplatelet therapy should be initiated for Mrs. T. Antiplatelets effectively prevent stroke in high-risk patients.

The therapy has positive outcomes on vascular death, nonfatal stroke, and non-fatal myocardial infarction. Some of the antiplatelet medications that might be prescribed include aspirin, ticlopidine, and dipyridamole. Combined or dual antiplatelet therapy should also be considered for Mrs. T. This includes combining drugs such as clopidogrel and aspirin to improve outcomes.

Underlying etiologies should also be treated. This includes hypertension, hyperlipidemia, and hyperglycemia. Revascularization might be considered if Mrs. T is diagnosed with symptomatic cervical internal carotid artery stenosis. Oral anticoagulation should be considered if Mrs. T is diagnosed with atrial fibrillation (Mendelson & Prabhakaran, 2021).

Describe the long-term support she may need to return to the baseline activity level. Mrs. T requires a range of long-term support services for her to return to her baseline activity level. One of them is rehabilitation services. Mrs. T might suffer impaired normal functioning such as difficulty with speech and movement after the treatment.

As a result, she might require long-term rehabilitation services such as occupational, speech, and physical therapy to help her achieve the desired functioning level. The second aspect of long-term support that Mrs. T requires is psychological support. Decreased functioning and poor quality of life predispose Mrs. T to adverse psychological outcomes such as depression and anxiety disorders.

The nurse must ensure that Mrs. T accesses psychological support services, including support groups and counseling to help her cope with changes brought by the disease. Mrs. T also required medical management as part of the long-term support for her to return to baseline functioning (Ali et al., 2021). She should be actively followed and supported to ensure treatment adherence and compliance for optimum outcomes and prevention of stroke and other complications.

Explain how the interdisciplinary team is utilized to help her family support and cope with her diagnosis. The interdisciplinary team is utilized to help Mrs. And her family support and cope with her diagnosis. Interdisciplinary team members such as counselors will equip Mrs. T and her family knowledge and skills needed to overcome the psychological impacts of the diagnosis.

The counselor will also link them to social support services, which would improve their coping with the increasing demands of the diagnosis. Interdisciplinary team members such as nurses will support the coping with the diagnosis by providing close follow-up, continuous health education, and ensuring adherence to treatment adherence, lifestyle, and behavioral modifications.

They will also implement nurse-led interventions for self-management of transient ischemic attacks to prevent complications and worsening health status. Interdisciplinary team members such as physicians will evaluate the effectiveness of the adopted treatments and recommend changes or improvements in the treatment plans (Nardai et al., 2021).

They will also recommend rehabilitation services such as speech and occupational therapy, which will help the patient and family cope with the diagnosis and its demands.

References

• Ali, A., Tabassum, D., Baig, S. S., Moyle, B., Redgrave, J., Nichols, S., McGregor, G., Evans, K., Totton, N., Cooper, C., & Majid, A. (2021). Effect of Exercise Interventions on Health-Related Quality of Life After Stroke and Transient Ischemic Attack. Stroke, 52(7), 2445–2455. https //doi.org/10.1161/STROKEAHA.120.032979
  
• Amarenco, P. (2020). Transient Ischemic Attack. New England Journal of Medicine, 382(20), 1933–1941. https //doi.org/10.1056/NEJMcp1908837
  ANDERSSON, J., STÅLNACKE, B.-M., SÖRLIN, A., MAGAARD, G., & HU, X. (2021). LONG-TERM PERCEIVED DISABILITIES UP TO 10 YEARS AFTER TRANSIENT ISCHAEMIC ATTACK. Journal of Rehabilitation Medicine, 53(3), 2767. https //doi.org/10.2340/16501977-2808
  
• Grotta, J. C., Albers, G. W., Broderick, J. P., Kasner, S. E., Lo, E. H., Sacco, R. L., Wong, L. K., & Day, A. L. (2021). Stroke E-Book Pathophysiology, Diagnosis, and Management. Elsevier Health Sciences.
  Katzan, I. L., Schuster, A., Daboul, L., Doherty, C., Speaker, S., Uchino, K., & Lapin, B. (2021). Changes in Health-Related Quality of Life After Transient Ischemic Attack. JAMA Network Open, 4(7), e2117403. https //doi.org/10.1001/jamanetworkopen.2021.17403
  
• Mendelson, S. J., & Prabhakaran, S. (2021). Diagnosis and Management of Transient Ischemic Attack and Acute Ischemic Stroke A Review. JAMA, 325(11), 1088–1098. https //doi.org/10.1001/jama.2020.26867
  
• Nardai, S., Lanzer, P., Abelson, M., Baumbach, A., Doehner, W., Hopkins, L. N., Kovac, J., Meuwissen, M., Roffi, M., Sievert, H., Skrypnik, D., Sulzenko, J., van Zwam, W., Gruber, A., Ribo, M., Cognard, C., Szikora, I., Flodmark, O., & Widimsky, P. (2021). Interdisciplinary management of acute ischaemic stroke Current evidence training requirements for endovascular stroke treatment Position Paper from the ESC Council on Stroke and the European Association for Percutaneous Cardiovascular Interventions with the support of the European Board of Neurointervention. European Heart Journal, 42(4), 298–307. https //doi.org/10.1093/eurheartj/ehaa833
  
• Ortiz-Garcia, J., Gomez, C. R., Schneck, M. J., & Biller, J. (2022). Recent advances in the management of transient ischemic attacks. Faculty Reviews, 11, 19. https //doi.org/10.12703/r/11-19
  
• Panuganti, K. K., Tadi, P., & Lui, F. (2024). Transient Ischemic Attack. In StatPearls. StatPearls Publishing. http //www.ncbi.nlm.nih.gov/books/NBK459143/
  
• Prost, A., Kubitz, K., Pelz, J., Hobohm, C., Hinz, A., & Michalski, D. (2021). Acute and long-term impairments regarding emotional symptoms and quality of life in patients suffering from transient ischemic attack and stroke. Neurological Research, 43(5), 396–405. https //doi.org/10.1080/01616412.2020.1866370
  
• Tsalta-Mladenov, M., & Andonova, S. (2021). Health-related quality of life after ischemic stroke Impact of sociodemographic and clinical factors. Neurological Research, 43(7), 553–561. https //doi.org/10.1080/01616412.2021.1893563