NURS 6531: Primary Care of Adults Across the Lifespan | Week 10

In the United States, stroke is the fourth leading cause of death and a leading cause of adult disability (National Stroke Association, 2012). Of all stroke cases, 20% are recurrent strokes in patients (American Heart Association, 2012). This outlines the importance of patient education for stroke prevention and disorder management. Depending on the patient’s medical history, stroke prevention might be as simple as recommendations for changes in behavior and lifestyle. This was the case for Connie Bentley, an avid weightlifter. She exercised often and was healthy, but her blood pressure always rose when she lifted weights, which eventually caused her to suffer a stroke. After receiving treatment for her stroke, Bentley’s provider recommended that she stop lifting weights, as it would increase her risk of recurrent stroke. Instead, her provider suggested alternative activities such as tai chi, swimming, and hiking (Bentley, 2012). Although this change was difficult for Bentley, she understood the risks because of provider-patient collaboration and education. When developing treatment and management plans that include behavior and lifestyle changes, provider-patient collaboration is essential, as this will increase the likelihood of patient adherence to established plans. Discussion: Diagnosing Neurological Disorders Paper

This week, as you explore neurologic disorders, you examine stroke prevention methods for select patient populations.

Learning Objectives

By the end of this week, students will:

• Assess differential diagnoses for patients with neurological disorders
• Analyze the role of patient information in differential diagnosis for neurological disorders
• Evaluate the patient treatment options for neurological disorders
• Understand and apply key terms, concepts, and principles related to neurological disorders
• Analyze pattern recognition in patient diagnoses

Learning Resources – NURS 6531:Week 9: Evaluation and Management of Neurologic Disorders

Required Readings

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Buttaro, T. M., Trybulski, J., Polgar Bailey, P., & Sandberg-Cook, J. (2017). Primary care: A collaborative practice (5th ed.). St. Louis, MO: Elsevier.

• • Part 19, “Evaluation and Management of Multisystem Disorders”

• • • Chapter 227, “Sleep Disorders” (pp. 1209-1217)

This chapter differentiates between normal sleep from abnormal sleep and identifies the epidemiology, clinical presentation, and management of sleep disorders.

• •  
  • Part 16, “Evaluation and Management of Neurologic Disorders” (pp. 999-1070)

This part explores the evaluation process of neurologic disorders. It then covers the pathophysiology, clinical presentation, diagnostic criteria, and complications of neurologic disorders.

Lawrence, M., Fraser, H., Woods, C., & McCall, J. (2011). Secondary prevention of stroke and transient ischemic attack. Nursing Standard, 26(9), 41–46.

This article examines risk factors for stroke and explores prevention methods for patients at high risk of suffering from strokes.

Lawrence, M., Kerr, S., Watson, H. E., Jackson, J., & Brownlee, M. G. (2009). A summary of the guidance relating to four lifestyle risk factors for recurrent stroke. British Journal of Neuroscience Nursing, 5(10), 471–476.

This article explores lifestyle and behavioral risk factors for stroke. It also describes the role of nurses in educating patients about stroke prevention.

Perry, M. (2012). Stroke prevention. Practice Nurse, 42(8), 14–18.

This article identifies patient risk factors for strokes. It also explores patient prevention and education methods to lower the prevalence of the disorder.

National Institute of Health. (n.d.). National institute of neurological disorders and stroke. Retrieved November 1, 2012, from http://www.ninds.nih.gov/index.htm

This website provides information about neurological disorders and strokes, as well as potential causes, prevention strategies, diagnosis, and treatment of these disorders.

Discussion: Diagnosing Neurological Disorders Paper

As an advanced practice nurse, you will likely observe patients who experience neurological disorders. Challenging to the diagnosis of neurological disorders is the realization that many manifestations of disease may not be overt physically.

For this Discussion, consider the following three case studies of patients presenting with neurological disorders.

Case Study 1

80-year-old male Caucasian male brought to the clinic by his wife concerned about his “memory problems”. Per the wife, she has noticed his memory declining but has never interfered with his daily activities until now. He is unable to remember his appointments and heavily relies on written notes for reminder. Just last week, he got lost driving and was not found by his family until 8 hours later. He is unable to use his cell phone or recall his home address or phone number. He has become a “hermit” per his wife. He has withdrawn from participating with church activities and has become less attentive.

PMH: HTN, controlled
Prostate cancer 20 years ago
Dyslipidemia
SH: no alcohol or tobacco use; needs assistance with medications
PE: VS stable, physical exam unremarkable

Case Study 2

A 30-year-old Asian female presents to the clinic with headaches. History of headaches since her teen years. Headaches have become more debilitating recently. Describes the pain as sharp, worsens with light and accompanied by nausea and at times vomiting. Rates the pain as 7/10. Typically takes 2 tabs of OTC Motrin with ‘some help’. “Sleeping it off in a darkened room’ helps alleviate the headache. VS WNL, physical exam unremarkable.

Case Study 3

A 50-year-old African American male presents with complaints of dizziness left arm weakness and fatigue. PMH: poorly controlled diabetes, hypertension, hyperlipidemia
PE: Upon exam, you noted a very mild dysarthria, he understands and follows commands very well. Mild weakness on the left side of the face is noted, and left sided homonymous hemianopsia but no ptosis or nystagmus or uvula deviation.

To Prepare: 

• You will either select or be assigned one of the three case studies provided.
• Reflect on the provided patient information including history and physical exams.
• Think about a differential diagnosis. Consider the role the patient history and physical exam played in your diagnosis.
• Reflect on potential treatment options based on your diagnosis.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!

By Day 3

Post an explanation of the primary diagnosis, as well as 3 differential diagnoses, for the patient in the case study that you selected or were assigned. Describe the role of the patient history and physical exam played in the diagnosis. Then, suggest potential treatment options based on your patient diagnosis.

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on two different days who selected or were assigned a different case study than you did. Respond to questions posed to you during the week. NURS 6531:Week 9: Evaluation and Management of Neurologic Disorders, Discussion: Diagnosing Neurological Disorders Paper.

ADDITIONAL INFORMATION;

Discuss diagnosing neurological disorders

Introduction

If you have a neurological disorder, it’s important that you understand what a neurologist is looking for in your medical history. The diagnosis of any disease can be complex, and the best way to determine whether or not you have a neurological disorder is through an accurate diagnosis.

Define the disorder and what causes it.

You will need to discuss the cause of the disorder, as well as what symptoms it causes.

You’ll also have to explain how your test results would be interpreted by a doctor and why this is important.

The most common neurological disorders are:

• Multiple sclerosis (MS) – An autoimmune disease that destroys myelin sheaths around nerves, causing them to become inflamed or swollen; symptoms include numbness, tingling and pain in the limbs and back. There is no cure for MS but treatments can reduce its severity if caught early enough; it’s estimated that one person in 100 develops MS at some point in their lives.

• Parkinson’s disease (PD) – A condition characterized by tremors caused by loss of dopamine neurons in an area called substantia nigra pars compacta the part of our brains responsible for movement control; PD affects about 1 million Americans over age 60[1]. Some cases may improve on their own over time while others require medication like Levadopa which boosts levels of dopamine.[2]

Discuss symptoms of the disorder.

• Describe the symptoms of the disorder.

The symptoms of a neurological disorder can vary widely, depending on which part of the brain is affected. If a patient has difficulty speaking or moves slowly, for example, these are two ways in which their daily life may be affected. In addition to describing what symptoms you see from your patients and how they affect them on a daily basis, explain how these issues affect other aspects of their lives (e.g., ability to go to work).

Explain neurological tests that may be used to diagnose the disorder.

The following tests may be used to diagnose the disorder:

• Brain function tests. These include tests that measure brain waves, such as an electroencephalogram (EEG), or electromyogram (EMG) and electrophysiological recordings from the brain surface and spinal cord. Electroencephalograms may show signs of reduced brain activity in some people with autism spectrum disorder, which suggests a problem with communication between different parts of the nervous system.

• Brain structure tests. These include magnetic resonance imaging (MRI), computerized axial tomography (CAT scan), positron emission tomography (PET) scan and single photon emission computed tomography (SPECT). MRI scans allow doctors to see whether any part of your brain is affected by its function – for example if it’s structurally abnormal or damaged by disease or trauma – while CAT scans provide detailed pictures of internal organs; PET scans provide information about how much energy there is in various parts within certain organs; SPECT shows where blood flows through certain areas during particular activities such as thinking clearly at work or playing sport without being distracted by other things around them.”

Describe what a negative result would look like for these tests.

When a test is negative, it means that the condition is not present. For example, if you have high blood pressure and take an electrocardiogram (ECG), the results will be positive because your heart rate increases during exercise. This can cause some confusion for people who are unfamiliar with interpreting ECGs; however, there are many reasons why someone might have an elevated heartbeat without having any symptoms of disease or injury.

A false positive result occurs when a person has symptoms but does not actually have a disease; this occurs when someone gets tested for something other than what he or she really has (i.e., premenstrual syndrome). False negatives occur when people don’t have enough information about their health history to determine whether they’re having symptoms from some underlying condition for example: If someone has been taking antibiotics regularly but doesn’t know how long ago they started taking them or which one(s) they were prescribed by their doctor (and therefore cannot rule out whether these drugs could be causing side effects), then those drugs may cause false negatives in future tests such as urine drug screens done at pharmacies after returning home from visiting family members overseas where alcohol consumption may pose risk factors associated with liver damage caused by chronic alcoholism.”

Describe what a positive result would look like for these tests.

A positive result would look like this:

• The patient has a seizure.

• The doctor determines that they have epilepsy or another neurological disorder, and orders an EEG to confirm the diagnosis.

The EEG technician takes the EEG from the patient and sends it in for analysis. The doctor reviews the results and confirms that the patient does indeed have epilepsy.

It is important that we understand the different approaches neurologists take in diagnosing neurological disorders, so that we can advocate for ourselves or our loved ones effectively.

It is important that we understand the different approaches neurologists take in diagnosing neurological disorders, so that we can advocate for ourselves or our loved ones effectively. A diagnosis is a complex process that relies on many factors, including the patient’s history and physical exam findings.

There are several different types of tests used by neurologists to diagnose neurological disorders:

• Physical exam: This involves a thorough assessment of your body to determine if there are any symptoms associated with certain diseases. For example, if you have numbness in one hand and difficulty walking across floors (one leg may be dragging behind), this could indicate carpal tunnel syndrome (CTS). CTS is an inflammation of the median nerve at the wrist where it passes through tendons into its root structures within your forearm bones; this can cause tingling sensations along with pain when pressure is applied to it immediately after activity such as typing at work or carrying groceries out onto a busy street where cars pass by frequently every day after dark when most people go home from work/school early because they have no reason not too!

Conclusion

It is important that we understand the different approaches neurologists take in diagnosing neurological disorders, so that we can advocate for ourselves or our loved ones effectively.