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.

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

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

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.

ADDITIONAL INFORMATION;

Neurological disorders middle-aged adults

Introduction

Neurological disorders are more common in middle-aged adults than in younger or older adults. This is due to the fact that a person’s risk of developing a neurological disorder increases with age, and their ability to recover from one also decreases. However, people who are diagnosed with a neurological disorder at any stage of life can improve their condition through treatment and lifestyle changes.

Migraine headaches

Migraines are a common condition in middle-aged adults and can be debilitating. This is because migraines aren’t just headaches, but also include other symptoms like nausea, vomiting and sensitivity to light or sound.

Migraine headaches are often treated with medication like anti-seizure drugs (e.g., gabapentin), antidepressants and beta blockers for blood pressure control. To prevent migraines from occurring again after you’ve had one attack:

• Exercise regularly

• Avoid stress as much as possible

• Eat healthy foods that contain omega-3 fatty acids

Stroke

A stroke is a medical condition in which the blood flow to part of your brain is interrupted by a blocked blood vessel. The result is that vital tissue dies and cannot be revived.

Symptoms of a stroke include:

• Difficulty speaking or understanding speech; loss of vision, feeling or control on one side of your face or arm; numbness on one side of the body; difficulty walking, dizziness and unsteady gait (walking with an unsteady gait means that it’s hard to keep your balance).

• These symptoms can happen suddenly or gradually over time depending on how much damage has been done to your brain tissue as well as its location within your skull (cranial nerve damage). If you have had a stroke then you should seek immediate medical attention at hospital immediately after experiencing any symptoms listed above because this could mean another serious complication developing such as bleeding into one side near where there was previously an untreated clotting issue present before treatment started but now gone due to successful surgery performed successfully by doctors who know how important it is for everyone involved working together towards common goals instead just focusing only on personal gain alone without considering anyone else’s needs first!

Brain tumor

Brain tumors are a common neurological disorder that can affect people of all ages. Most brain tumors are benign and do not require treatment, but some are malignant.

Brain tumors may be located in the brain, spinal cord, or nerves (neurological disorders). Tumors may be caused by genetic factors, viral infections or environmental toxins.

Multiple sclerosis (MS)

Multiple sclerosis is a chronic, unpredictable disease that affects the central nervous system. It can cause fatigue, numbness and weakness in limbs, difficulty walking and vision problems. Cognitive impairment may also occur.

There is no cure for MS; however treatment may help manage symptoms such as balance problems or pain while walking. Doctors recommend that people with MS receive regular checkups to monitor their condition over time so they can catch any problems early on before they become severe enough to require hospitalization or other specialized care.*

Sleep apnea and insomnia

Sleep apnea is a serious medical condition in which a person stops breathing repeatedly during sleep. It’s estimated that 40 million Americans have sleep apnea, with one in five adults having symptoms of the disorder at some point in their lives.

Insomnia is trouble falling asleep or staying asleep for at least three nights per week for at least three months, according to the National Institute of Neurological Disorders and Stroke (NINDS).

Sleep apnea and insomnia often occur together because they share some similar symptoms, including daytime fatigue or impaired concentration levels due to poor sleep quality; frequent headaches; excessive snoring; morning headaches that don’t go away after using an over-the-counter pain reliever like Tylenol PM or Excedrin Cold & Flu Nighttime Formula; ringing in ears (tinnitus); sensitivity to light & noise during waking hours that makes it difficult to concentrate on tasks requiring concentration such as reading books or studying for exams.”

Peripheral neuropathynGout

Peripheral neuropathy is a disease that affects the nerves in the hands and feet. It can cause pain, numbness or tingling in these areas.

Symptoms may be similar to those of other neurological disorders, but if you experience chronic pain without any underlying structural problems (such as diabetes), you should see your doctor immediately.

Chronic pain syndrome (CPS)

• Chronic pain syndrome (CPS) is a common and debilitating condition that can affect people of all ages.

• Though it comes in many forms, CPS typically causes long-term pain, disability and reduced quality of life. Symptoms include:

• Back pain

• Arthritis

• Cancer

Parkinson’s disease

Parkinson’s disease is a degenerative disorder of the central nervous system, characterized by slowness of movement, stiffness and tremor. The symptoms may arise gradually over several years or can appear suddenly. Parkinson’s disease is associated with loss of dopamine in the brain; however, there are many other causes as well.

The cause of Parkinson’s disease remains unknown but it has been linked to inheritance (genetic factors) through mutations in genes that control how nerve cells communicate with each other. Research suggests that there is also an environmental component – thinking about your favorite activities may help reduce your risk for developing this condition!

High blood pressure (hypertension)

Hypertension is a common condition that can lead to heart disease and stroke. It’s more common in middle-aged adults than in younger or older adults. If you have high blood pressure, it’s important to get treatment so your risk of developing other health problems like heart attack or kidney disease is reduced.

Hypertension can be controlled with medication such as ACE inhibitors (such as lisinopril), beta-blockers (such as atenolol), calcium channel blockers (such as amlodipine), angiotensin II receptor antagonists (ARBs) and diuretics like hydrochlorothiazide or furosemide.*

Neurological disorders are more common in middle-aged adults than in younger or older adults.

Neurological disorders are more common in middle-aged adults than in younger or older adults. In fact, the rate of neurological disorders is three times higher for men than for women.

Neurological disorders can be caused by diseases such as stroke and Alzheimer’s disease, but they can also be caused by other factors like high blood pressure or diabetes. People who have a family history of neurological disorders are at greater risk than those who don’t; so too are people who drink alcohol heavily or smoke cigarettes excessively (especially if you’re overweight).

Conclusion

Together, these conditions can cause a variety of symptoms including dizziness, blurred vision and difficulty walking. If you’re experiencing any of these symptoms, it’s important to visit your doctor as soon as possible.