James is a 78 year old man who lives with his wife Taara in NewSouth wales. Both James and Taara are fullyindependent. They have 5 children who all live overseas,so they only see them once or twice a year. James & Taara arevery social and like getting together with their friends. Jamesplays bowls three times a week and then joins his friends at thelocal club for lunch.
James was shaving this morning when he noted that the left sideof his face was drooping. His left arm also felt veryweak. James tried to call out to Taara, but he could notspeak properly. He then fell to the floor. Taara heard the fall,ran to James & then immediately called an ambulance.
James was taken to ED where on arrival he had a BP of 190/91, HR115, RR 24, SaO2 95% on room air and a temperature of 37.2. He wasimmediately sent for a CT head and James was diagnosed with aCVA.
PMHx:
Hypertension
Hypercholesterolaemia
T2DM
AF
GORD
Cholecystectomy 5 years ago
James is transferred to the neurological ward. Onassessment he has a GCS of 13, left sided hemiplaegia, expressivedysphasia, dysphagia & blurred vision in his lefteye. He is scheduled to see the speech pathologist andthe physiotherapist later today.
After a week of therapy James is ready to be discharged torehab. He still has some residual dysphasia, but thedysphagia and blurred vision have largely resolved. Hestill has significant weakness on his left side.
The doctors have ordered the following medications fordischarge:
Apixaban 5 mg PO daily
Digoxin 125 mcg PO daily
Simvastatin 40 mg PO daily
Ezetimibe 10 mg PO daily
Perindopril 2 mg PO daily
Amlodipine 10 mg PO daily
Assignment Instructions
2000 words (+/- 10%)
35%
- Identify the most likely type and cause (what you think is themain risk factor) of James’s CVA
- Your answer must include a rationale for this selection andexplain how and why this cause can lead to a CVA from apathophysiological perspective.
- Include in your answer the pathophysiology of James’s CVA.
- In other words, discuss the pathogenesis of the most likelycause and how it can lead to CVA. Consider his past medicalhistory.
20%
- Identify two (2) other risk factors that James has for CVA
- For each of these risk factors explain how & why they canincrease the risk of & lead to CVA.
- Select two (2) signs and/or symptoms that James had as a resultof his CVA
- For each sign/symptom explain how & why it can occur aftera CVA, again from a pathophysiological perspective.
35%
- Select three (3) of Brian’s medications and explain why each ofthe three (3) medications was ordered for James
- Your discussion should include the pharmacodynamics andpharmacokinetics of each medication, including relevant adverseeffects and contraindications.
- Each of James’s discharge medications is to be administeredorally. This means they will all undergo the first pass effect.Explain what first pass is and the implications this has for adrug’s bioavailability.
This is a case study, not a general discussion ofCVA. It is important that only information relevant tothe specific case be discussed in thisassignment. Information that is not directly relevant tothe case study should not be included.
The assignment is not an essay, i.e. it does not require anintroduction or conclusion. However, it must be writtenin accordance with academic conventions, i.e. full sentences, notdot points. Headings can be used to organise your assignment andplease ensure appropriate use of paragraphs.
All claims or assertions must be supported with evidence formthe literature, using APA6 referencing guidelines.
