Answer

Pathophysiology I: Topic 5 Assignment 3

Case Study 1: Nate Greene 

In response to Mrs. Greene concern when she said “I cannot bear anymore!” she says. “First he get diabetes and now he has epilepsy!” insulin overdose resulted in severe hypoglycemia (46 mg/dl). Hypoglycemia is what is causing epileptic-like symptoms such as such as tonic and clonic seizures (Johansen & Christensen, 2018).  Insulin overdose causes severe hypoglycemic encephalopathy. If Nate Greene had not been rushed to the hospital and received urgent medical intervention he could have likely experienced permanent brain injury, gone to coma, or died as a result of complications of severe hypoglycemic encephalopathy (Barbara et al., 2017).

Mr. Greene experienced a generalized seizure characterized by tonic-clonic seizures, loss of consciousness, and aches in his leg and arm after the tonic-clonic seizures (Centers for Disease Control and Prevention (CDC), 2021). It is likely, that all the two cerebral hemispheres had been affected by the severe hypoglycemic encephalopathy (Barbara et al., 2017; CDC, 2021). On the other hand a focal seizure affects only one area of the brain and my manifest with symptoms such as change of sensation, twitching and confusion (CDC, 2021).

Mr. Greene presented with a tonic-clonic seizure. Tonic part of the seizure is characterized by stiffness of the muscles while clonic part of the seizure is characterized by periods of jerking of the parts of the body or shaking. Muscle spasms are also signs of a clonic seizure (CDC, 2021).

Insulin used in management of diabetes may be long-acting or short-acting in nature. Sinc, insulin overdose implies that at the moment of treatment, Mr. Greene still had significantly high levels of insulin in his system that counteracted the effect of intravenous glucose. Hence, it took some time for insulin levels to go down. This made hypoglycemia to persist for a while despite treatment (Barbara, 2017). 

Mr. Greene’s leg and arm was arching after recovery since he had experienced a tonic-clonic seizure. First of all, he may have fallen on one side of his body after experiencing the seizures plus he may have injured himself as he experienced muscle jerks or spasms (CDC, 2021).

Case Study II: Mrs. Czerny

The two classic pathological changes that contribute to neuronal death in persons who have Alzheimer’s disease include intracellular neurofibrillary lesions and extracellular Aβ plagues, which affect specific brain circuits and subclasses of neurons. The extracellular Aβ plagues form many years before the onset of dementia with a progressive and gradual pathology. Early extracellular Aβ plague formation results in brain changes including localized damage to axonal processes, dendrites, and synapses. Intracellular neurofibrillary include neuropil threads and tangles (Vickers et al., 2016). Neurofibrillary tangles are associated with unusual accumulations of the phosphyrylated tau in neurons (DeTure & Dickson, 2019).

            Clinical manifestations of Alzheimer’s disease arise after a number of years after the onset of pathologic changes in the brain.  For example, it may take years for signs and symptoms of dementia to manifest after the onset deposition of the extracellular Aβ plagues (Vickers et al., 2016).  Neuroimaging evidence indicates that neuropathological changes in the brain associated with Alzheimer’s disease begin much earlier before appearance of clinical symptoms as well as years before making of a clinical diagnosis. That is the rationale as to why the disease is most prevalent among people aged over 65 years (Coupe et al., 2019).

            Forgetfulness in the presentation of Alzheimer’s disease suggests memory loss. Memory loss among other associated clinical manifestations including apathy, and agitation develops as a result of the degeneration of the cholinergic neuron-rich regions in the brain include the frontal cortex, nucleus basalis of Meynert, posterior cingulate cortex, and anterior cingulate cortex (Huang, Chao, & Hu, 2020).

            The nurse should educate the family about the chronic and progressive nature of Alzheimer’s disease. The disease presents with progressive decline in memory at the initial onset of the disease, which is gradually followed by other cognitive dysfunctions, such as navigation difficulties, visuospatial abnormalities, language disturbances, and executive problems. Poor judgment is an indication of deterioration of the cognitive functions (Huang, Chao, & Hu, 2020).

Case III: Mr. Tom Costa

Mr. Costa’s weak right upper and lower extremities can be described as unilateral flaccid paralysis associated with stroke. It qualifies as a flaccid paralysis presentation since the right upper and lower extremities presents with muscle weakness as opposed to spastic paralysis which presents with muscle stiffness (Grefkes & Fink, 2020).

The lesion that caused Mr. Costa’s weak clinical manifestations including weak right upper and lower extremities is located in the left cerebral motor cortex due to decussation of the nerve fibers. Therefore, the left cerebral hemisphere controls the functions on the right side of the body and vice versa (Maldonado & Alsayouri, 2020).

            Mr. Costa’s history, suggests that he may have had an ischemic stroke rather than a hemorrhagic stroke. First of all, about 80% of cases of stroke are ischemic in nature. Although hypertension is considered as an important risk factor for hemorrhagic stroke it is also contributes to development of atherosclerotic disease, which can result in ischemic stroke. Atrial fibrillation is a key risk factor for cardioembolic stroke. Other relevant risk factors for ischemic risk factors include smoking, obesity, and diabetes. There is also genetic predisposition to ischemic stroke (Boehme et al., 2018).

            There is a positive correlation between atrial fibrillation and stroke. Atrial fibrillation contributes to stasis of blood in the affected left atrium. This results in thrombus formation as well as embolization in the brain, which subsequently result in ischemic stroke (Boehme et al., 2018).

            Hypertension has a direct, strong, continuous, and linear relationship with stoke risk. Better control of hypertension through adoption of healthy dietary practices and physical may help reduce the risk of stroke in the future. Diabetes is also positively associated with the risk of stroke. Similarly, dietary practices and physical activity may improve prognosis of diabetes and hence, reduce the risk of stroke. Weight loss may also reduce the risk of stroke in the future since obesity is positively associated with increased risk of stroke. Smoking is a major risk of stroke since it leads to hardening of blood vessels. Smoking cessation is recommended in this case (Boehme et al., 2018).

            Tom’s grandfather and Mr. Tom himself are likely to have experienced stroke in different areas of the brain. Different areas of the brain have different functions including speech, language, motor activity, and learning. Therefore, the rationale in presentation of symptoms is because stoke has been experienced in different blood vessels supplying different areas of the brain (Maldonado & Alsayouri, 2020).

            Yes, a transient ischemic attack (TIA) is characterized by a temporary period of symptoms which are similar to that of stroke. TIA can last for a few minutes and may not cause any permanent damage. However, it is important to call a doctor since TIA acts as a warning sign for potential occurrence of a stroke, which may be life threatening (MayoClinic, 2021).