[ANSWERED 2023] A 74-year-old male with a history of hypertension and smoking is having dinner with his wife when he develops sudden onset of difficulty speaking

A 74-year-old male with a history of hypertension and smoking is having dinner with his wife when he develops sudden onset of difficulty speaking

A 74-year-old male with a history of hypertension and smoking is having dinner with his wife when he develops sudden onset of difficulty speaking

Case Study Analysis

A 74-year-old male with a history of hypertension and smoking is having dinner with his wife when he develops sudden onset of difficulty speaking, with drooling from the left side of his mouth, and weakness in his left hand. His wife asks him if he is all right and the patient denies any difficulty. His symptoms progress over the next 10 minutes until he cannot lift his arm and has trouble standing.

The patient continues to deny any problems. The wife sits the man in a chair and calls 911.

The EMS squad arrives within 5 minutes. Upon arrival in the ED, the patient‘s blood pressure was 178/94, pulse 78, and regular, PaO2 97% on room air. Neuro exam – Cranial nerves- Mild left facial droop. Motor- Right arm and leg extremity with 5/5 strength. Left-arm cannot resist gravity, left leg with mild drift.

The sensation is intact. Neglect- Mild neglect to the left side of the body. Language- Expressive and receptive language intact. Mild to moderate dysarthria. Able to protect the airway.

An understanding of the symptoms of alterations in neurological and musculoskeletal systems is a critical step in diagnosis and treatment. For APRNs this understanding can also help educate patients and guide them through their treatment plans.

In this Assignment, you examine a case study and analyze the symptoms presented. You identify the elements that may be factors in the diagnosis, and you explain the implications to patient health.

To prepare:

By Day 1 of this week, you will be assigned to a specific case study scenario for this Case Study Assignment. Please see the “Course Announcements” section of the classroom for your assignment from your Instructor.

Assignment (1- to 2-page case study analysis)

In your Case Study Analysis related to the scenario provided, explain the following:

  • Both the neurological and musculoskeletal pathophysiologic processes that would account for the patient presenting these symptoms.
  • Any racial/ethnic variables that may impact physiological functioning.
  • How these processes interact to affect the patient.


McCance, K. L. & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). St. Louis, MO: Mosby/Elsevier.

  • Chapter 15: Structure and Function of the Cardiovascular and Lymphatic Systems (stop at Aging and the nervous system)
  • Chapter 16: Pain, Temperature Regulation, Sleep, and Sensory Function (stop at Sleep); Summary Review
  • o   Chapter 17: Alterations in Cognitive Systems, Cerebral Hemodynamics, and Motor Function; pp. 504–511, pp. 516–530 (start at Acute confusional states and delirium) (stop at Alterations in neuromotor functions); (Parkinson’s Disease); Summary Review
  • Chapter 18: Disorders of the Central and Peripheral Nervous Systems and the Neuromuscular Junction (stop at Degenerative disorders of the spine); (start at Cerebrovascular disorders) (stop at Tumors of the central nervous system); Summary Review
  • Chapter 44: Structure and Function of the Musculoskeletal System (stop at Components of muscle function); Summary Review
  • Chapter 45: Alterations of Musculoskeletal Function (stop at Bone tumors); (start at Disorders of joints); Summary Review

Chin, L. S. (2018). Spinal cord injuries. Retrieved from https://emedicine.medscape.com/article/793582-overview#a4

Expert Answer and Explanation

Alteration of Neurological and Musculoskeletal Systems

Nurses must understand the processes causing patient symptoms. The knowledge can help them identify the actual diseases ailing the clients and then proper treatment plans. The knowledge can also help APRNs educate patients about their health. The purpose of this assignment is to understand the alterations in musculoskeletal and neurological systems of a 74-year-old male with a history of hypertension and smoking.

Neurological and Musculoskeletal Pathophysiologic Processes

Speech problem relates to speech organs, such as mouth, tongue, vocal cords, nerves, and muscles. When one speaks, air from their lungs is pushed between the vocal cords, and as a result, they vibrate and produce speech (Carding et al., 2017). However, the patient experienced difficulty speaking because the vocal folds made sudden involuntary movements, interfering with the cord vibrations.

The patient also experienced speech problems because the arcuate fasciculus connecting lobe, a part of the brain that controls speech and speech organs, is damaged (McCance & Huether, 2017). The patient also experienced drooling because his swallowing muscles had relaxed. The patient felt a hand weakness because the nervus medianus, a nerve connecting his ligaments and wrist, was damaged.

The patient could not lift his arm because the radial, median, and ulnar nerves were damaged and could not communicate with hand muscles (Hyvönen, Lohi, & Tuuminen, 2020). The nerves controlling facial muscles pass through a corridor of bone into the face region. The patient also experienced mild left facial droop because the nerves connecting muscles in his face’s left side are swollen or inflamed.

Racial Variables Impacting Physiological Functioning

Physiological functioning can be defined as various body system functions that depend on certain factors, such as molecules, ions, or protons. Various factors can impact physiological functioning. One such factor is ethnicity or race. El Khoudary et al. (2019) conducted a study and found a difference in lean mass and muscle strength among Hispanic, white, and African Americans.

The study found that Hispanic and black people had a higher lean mass compared to Caucasians. The researchers also noted that white men had higher physical function compared to black and Hispanic males. Therefore, people are less likely to suffer neurological and musculoskeletal disorders than blacks and Hispanic males. Another study done by Fujishiro et al. (2017) wanted to compare serum testosterone levels among white and black females. The study found that black females have higher levels of serum testosterone.

How the Processes Interact to Affect the Patient

If the patient is a black male, he had higher testosterone hormone levels, a hormone responsible for muscle growth, and the bone’s strength. As a result, the patient is less likely to suffer bone problems. However, according to El Khoudary et al. (2019), the patient has low levels of physical functioning and is at greater risk of suffering musculoskeletal and neurological disorders.

The patient also risks suffering diseases such as hypertension, diabetes, and arthritis. The patient also has strong skeletal mass, bone mass, and muscle strength and can help him withstand the tendons’ heavy loading. Therefore, the patient has the chance to recover faster (Fujishiro et al., 2017).


The patient has been diagnosed with mild dysarthria. The disease occurred because the nerves connecting the speech organs to the lobe were damaged, making the vocal cord involuntary movements. However, he has a chance of recovering because he has a strong skeletal muscle and muscle mass.


Carding, P., Bos‐Clark, M., Fu, S., Gillivan‐Murphy, P., Jones, S. M., & Walton, C. (2017). Evaluating the efficacy of voice therapy for functional, organic and neurological voice disorders. Clinical Otolaryngology, 42(2), 201-217.

El Khoudary, S. R., Greendale, G., Crawford, S. L., Avis, N. E., Brooks, M. M., Thurston, R. C., … & Matthews, K. (2019). The menopause transition and women’s health at midlife: a progress report from the Study of Women’s Health Across the Nation (SWAN). Menopause (New York, NY), 26(10), 1213. doi: 10.1097/GME.0000000000001424

Fujishiro, K., Hajat, A., Landsbergis, P. A., Meyer, J. D., Schreiner, P. J., & Kaufman, J. D. (2017). Explaining racial/ethnic differences in all-cause mortality in the Multi-Ethnic Study of Atherosclerosis (MESA): Substantive complexity and hazardous working conditions as mediating factors. SSM-population health, 3, 497-505. https://doi.org/10.1016/j.ssmph.2017.05.010

Hyvönen, S., Lohi, J., & Tuuminen, T. (2020). Moist and Mold Exposure is Associated With High Prevalence of Neurological Symptoms and MCS in a Finnish Hospital Workers Cohort. Safety and Health at Work. https://doi.org/10.1016/j.shaw.2020.01.003

McCance, K. L. & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). St. Louis, MO: Mosby/Elsevier.

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Central Nervous System: Exploring the Master Control Unit of the Body


The central nervous system (CNS) is an intricate and fascinating network of nerves and cells that act as the control center for the entire body. It is responsible for processing information, sending and receiving signals, and coordinating the body’s functions. This article delves into the workings of the central nervous system, exploring its structure, functions, and significance in human behavior and daily life.

Understanding the Central Nervous System

The Brain: Command Center of the CNS

The brain is undoubtedly the most critical organ in the central nervous system. It not only controls basic bodily functions like breathing and heartbeat but also enables complex cognitive processes such as decision-making, problem-solving, and creativity. We’ll explore the different regions of the brain and their respective functions.

The Spinal Cord: The Information Highway

Working in tandem with the brain, the spinal cord acts as a communication bridge, transmitting signals between the brain and the rest of the body. We’ll discuss the spinal cord’s segments and how they are responsible for different motor and sensory functions.

The Structure of the Central Nervous System

The Brain’s Divisions: Forebrain, Midbrain, and Hindbrain

The brain can be divided into three main parts: the forebrain, midbrain, and hindbrain. Each division plays a vital role in processing information and coordinating various functions throughout the body. We’ll explore the unique functions of each brain division.

The Spinal Cord’s Segments

The spinal cord consists of a series of segments, each associated with specific areas of the body. Understanding these segments helps us comprehend how the brain communicates with different parts of the body.

How the Central Nervous System Works

Neurons: The Building Blocks of Communication

At the core of the central nervous system are neurons – specialized cells responsible for transmitting information throughout the body. We’ll delve into the structure of neurons and their role in neural communication.

Neurotransmitters: The Messengers of the Brain

Neurotransmitters are chemical substances that facilitate communication between neurons. We’ll explore the different types of neurotransmitters and how they influence our emotions, thoughts, and behaviors.

Synaptic Transmission: How Neurons Communicate

Synaptic transmission is a crucial process by which neurons relay information. Understanding this process helps us appreciate the complexity of neural networks and how they shape our perceptions and actions. Additionally, we’ll touch upon common CNS disorders that affect synaptic transmission.

The Role of the Central Nervous System in Human Behavior

Emotions and the Limbic System

The limbic system plays a pivotal role in processing emotions and memories. We’ll examine how this region influences emotional responses and contributes to our overall well-being.

Memory Formation and Storage

Memories are an integral part of human experience. We’ll explore how the central nervous system forms, stores, and retrieves memories, shedding light on why some memories are vivid while others fade over time.

Central Nervous System Development and Aging

Prenatal Development

The central nervous system begins to form even before birth. We’ll explore the stages of prenatal development that shape the foundation of our neurological functions.

Age-Related Changes

Aging inevitably affects the central nervous system. We’ll discuss the changes that occur as we grow older, affecting cognitive abilities and motor skills.

Factors Affecting the Central Nervous System

Nutrition and Brain Health

Proper nutrition is essential for maintaining optimal brain health. We’ll discuss the impact of various nutrients on cognitive function and how a balanced diet can boost brainpower.

Exercise and Cognitive Function

Physical exercise not only benefits the body but also has a profound effect on cognitive function. We’ll explore the connection between exercise and improved brain health.

Stress and Its Impact

Stress can have both short-term and long-term effects on the central nervous system. We’ll examine how stress impacts brain function and ways to manage it effectively.

Advancements in Studying the Central Nervous System

Brain Imaging Techniques

Advancements in technology have revolutionized our understanding of the central nervous system. We’ll explore cutting-edge brain imaging techniques used by neuroscientists to study brain structure and function.

Neuroplasticity: The Brain’s Adaptive Ability

The brain’s ability to adapt and reorganize itself is known as neuroplasticity. We’ll discuss the significance of neuroplasticity in learning, recovery from injuries, and rehabilitation.

The Central Nervous System and Everyday Life

Sleep and Its Importance

Adequate sleep is crucial for the proper functioning of the central nervous system. We’ll emphasize the importance of quality sleep and its impact on cognitive performance.

Learning and Studying Techniques

Understanding how the brain learns can enhance our study techniques and boost learning efficiency. We’ll provide practical tips to improve memory retention and understanding.

Coping with Stress and Mental Health

In our fast-paced world, mental health is becoming increasingly important. We’ll discuss strategies to cope with stress and maintain good mental well-being.


The central nervous system is undeniably the master control unit of the human body, orchestrating all bodily functions and enabling us to experience the world around us. Understanding its complexity and significance empowers us to take better care of our brain health and overall well-being.


  1. What are the common disorders of the central nervous system?Some common CNS disorders include Alzheimer’s disease, Parkinson’s disease, multiple sclerosis, and epilepsy.
  2. Is it possible to improve cognitive function as we age?Yes, adopting a healthy lifestyle, including regular exercise, a balanced diet, and mental stimulation, can positively impact cognitive function in aging individuals.
  3. Can stress lead to physical health problems?Yes, chronic stress can have adverse effects on the body, leading to conditions such as cardiovascular diseases and weakened immune systems.
  4. How can I enhance my memory retention?Engaging in activities that challenge your brain, maintaining a healthy sleep schedule, and managing stress are effective ways to improve memory retention.
  5. What are the benefits of neuroplasticity?Neuroplasticity allows the brain to adapt and recover from injuries, learn new skills, and form new neural connections.

What are the 7 main parts of the CNS?

The seven main parts of the Central Nervous System (CNS) are:

  1. Brain: The brain is the command center of the CNS and controls various cognitive and bodily functions.
  2. Spinal Cord: The spinal cord acts as an information highway, transmitting signals between the brain and the rest of the body.
  3. Cerebrum: The largest part of the brain responsible for conscious thoughts, voluntary actions, and sensory perception.
  4. Cerebellum: Located at the back of the brain, it plays a crucial role in coordination, balance, and motor control.
  5. Brainstem: The brainstem connects the brain to the spinal cord and regulates essential functions like breathing, heart rate, and blood pressure.
  6. Diencephalon: This part of the brain includes the thalamus and hypothalamus, which are involved in relaying sensory information and maintaining homeostasis.
  7. Midbrain: The midbrain is responsible for controlling eye movement, auditory and visual processing, and other vital functions.

What are the 3 functions of the central nervous system?

The three main functions of the Central Nervous System (CNS) are:

  1. Processing Information: The CNS processes sensory information received from the body’s internal and external environments. It interprets this information and generates appropriate responses to stimuli, enabling the body to adapt and interact with its surroundings effectively.
  2. Coordinating Body Functions: The CNS coordinates and regulates various bodily functions to maintain homeostasis. It controls involuntary actions, such as heart rate, breathing, and digestion, as well as voluntary movements, allowing individuals to perform complex tasks and activities.
  3. Facilitating Communication: The CNS facilitates communication between different parts of the body. It uses specialized nerve cells called neurons to transmit electrical signals, ensuring seamless communication between the brain, spinal cord, and peripheral nervous system, which extends throughout the body. This communication network allows for the integration of sensory input and the generation of appropriate motor responses.

What are the main organs parts involved in the CNS?

The main organs and parts involved in the Central Nervous System (CNS) are:

  1. Brain: The brain is the central and most vital organ of the CNS. It is responsible for processing information, controlling thoughts, emotions, voluntary movements, and regulating various bodily functions.
  2. Spinal Cord: The spinal cord is a long, cylindrical bundle of nerve fibers that extends from the brainstem to the lower back. It acts as a communication pathway, transmitting signals between the brain and the rest of the body. The spinal cord also coordinates reflex actions.
  3. Cerebrum: The cerebrum is the largest part of the brain, comprising two cerebral hemispheres. It plays a crucial role in conscious thought, memory, language, perception, and voluntary movements.
  4. Cerebellum: Located at the back of the brain, the cerebellum is responsible for coordinating voluntary movements, balance, and posture. It helps refine motor skills and ensures smooth and accurate movement.
  5. Brainstem: The brainstem connects the brain to the spinal cord and comprises three parts: the medulla oblongata, pons, and midbrain. It regulates essential functions like breathing, heart rate, blood pressure, and digestion.
  6. Diencephalon: The diencephalon includes the thalamus and hypothalamus. The thalamus acts as a relay station for sensory information, while the hypothalamus regulates various physiological processes, including body temperature, hunger, thirst, and sleep.

These organs and parts work together to form the central nervous system, which is the master control unit of the body, responsible for processing information, coordinating bodily functions, and facilitating communication between different parts of the body.

Central nervous system disorders

Central nervous system disorders are conditions that affect the brain, spinal cord, or both, leading to disruptions in the normal functioning of the central nervous system. These disorders can have a wide range of causes and symptoms, and they can significantly impact a person’s cognitive, motor, sensory, and emotional abilities.

  1. Alzheimer’s Disease: A progressive neurodegenerative disorder that primarily affects memory, thinking, and behavior. It is the most common cause of dementia in older adults.
  2. Parkinson’s Disease: A chronic and progressive movement disorder caused by the degeneration of dopamine-producing neurons in the brain. It leads to tremors, stiffness, and difficulties with balance and coordination.
  3. Multiple Sclerosis (MS): An autoimmune disease in which the immune system attacks the protective covering of nerve fibers, leading to communication problems between the brain and the rest of the body. MS can cause a wide range of symptoms, including fatigue, muscle weakness, and problems with vision and coordination.
  4. Epilepsy: A neurological disorder characterized by recurrent seizures, which are caused by abnormal electrical activity in the brain.
  5. Stroke: Occurs when blood flow to a part of the brain is interrupted, leading to brain cell damage. Strokes can result in a variety of neurological deficits, such as paralysis, speech difficulties, and cognitive impairments.
  6. Migraine: A severe headache disorder that can be accompanied by visual disturbances, nausea, and sensitivity to light and sound.
  7. Amyotrophic Lateral Sclerosis (ALS): Also known as Lou Gehrig’s disease, ALS is a progressive neurodegenerative disease that affects motor neurons, leading to muscle weakness, paralysis, and eventually respiratory failure.
  8. Huntington’s Disease: A hereditary condition that causes the degeneration of brain cells, leading to uncontrolled movements, cognitive decline, and behavioral changes.
  9. Cerebral Palsy: A group of neurological disorders that appear in infancy or early childhood and affect movement, muscle tone, and motor skills.
  10. Traumatic Brain Injury (TBI): Occurs due to a severe blow or jolt to the head, leading to brain damage and a range of neurological impairments depending on the location and extent of the injury.

develops sudden onset

Central nervous system depressants

Central nervous system depressants are a class of drugs that slow down the activity of the central nervous system (CNS). These substances act as sedatives or tranquilizers, leading to a calming and relaxing effect on the brain and body. They are primarily prescribed for medical purposes, such as treating anxiety, insomnia, and certain seizure disorders.

However, they can also be misused for their calming and euphoric effects, leading to potential health risks and addiction.

  1. Benzodiazepines: Benzodiazepines are a class of drugs commonly prescribed to treat anxiety, panic disorders, and insomnia. Examples include alprazolam (Xanax), diazepam (Valium), and lorazepam (Ativan).
  2. Barbiturates: Barbiturates were once widely used as sedatives and anesthetics but are now less commonly prescribed due to their potential for abuse and overdose. They have been largely replaced by safer alternatives. Examples include phenobarbital and secobarbital.
  3. Alcohol: Alcohol is one of the most common and widely used central nervous system depressants. It is legal for adults in many countries but can be highly addictive and harmful when misused.
  4. Non-Benzodiazepine Sleep Medications: These medications, also known as “Z-drugs,” are used to treat insomnia. Examples include zolpidem (Ambien) and eszopiclone (Lunesta).
  5. Gamma-Aminobutyric Acid (GABA) Agonists: GABA is an inhibitory neurotransmitter that helps reduce brain activity. Some drugs target GABA receptors to produce a calming effect. Examples include gabapentin (Neurontin) and pregabalin (Lyrica), primarily used to treat certain seizure disorders and nerve pain.

Difference between central nervous system and peripheral nervous system

The central nervous system (CNS) and peripheral nervous system (PNS) are two main components of the human nervous system, each serving distinct roles in transmitting and processing information. Here are the key differences between the central nervous system and peripheral nervous system:

  1. Location and Components:
    • Central Nervous System (CNS): The CNS consists of the brain and the spinal cord, which are located within the protective bony structures of the skull and the vertebral column, respectively. It serves as the main control center of the nervous system.
    • Peripheral Nervous System (PNS): The PNS is composed of all the nerves and ganglia (collections of nerve cell bodies) that lie outside the CNS. It includes the nerves that extend from the brain and spinal cord to reach various parts of the body, including muscles, organs, and sensory receptors.
  2. Function:
    • Central Nervous System (CNS): The CNS is responsible for processing and integrating sensory information, coordinating motor commands, and controlling most bodily functions. It plays a crucial role in conscious thought, memory, emotions, and voluntary movements.
    • Peripheral Nervous System (PNS): The PNS serves as a communication network between the CNS and the rest of the body. It relays sensory information from various body parts to the CNS and transmits motor commands from the CNS to muscles and organs, enabling voluntary and involuntary movements and responses.
  3. Nerve Pathways:
    • Central Nervous System (CNS): Nerve pathways in the CNS are primarily composed of interneurons, which facilitate communication between different regions of the brain and spinal cord.
    • Peripheral Nervous System (PNS): The PNS includes two main types of nerves: sensory (afferent) nerves, which carry sensory information from the body to the CNS, and motor (efferent) nerves, which transmit motor commands from the CNS to muscles and organs.
  4. Protection:
    • Central Nervous System (CNS): The CNS is surrounded by protective structures, such as the skull and the vertebral column, as well as cerebrospinal fluid, which cushions and protects the brain and spinal cord from physical damage.
    • Peripheral Nervous System (PNS): Unlike the CNS, the PNS is not directly protected by bone and cerebrospinal fluid. Instead, nerves in the PNS are vulnerable to injury and damage from trauma and other external factors.

develops sudden onset

Peripheral nervous system parts

The peripheral nervous system (PNS) is a complex network of nerves and ganglia (collections of nerve cell bodies) that extend from the central nervous system (CNS) to reach various parts of the body, including muscles, organs, and sensory receptors. It can be further divided into two main parts: the somatic nervous system and the autonomic nervous system.

  1. Somatic Nervous System (SNS):
    • Sensory (Afferent) Nerves: These nerves carry sensory information from the body’s sensory receptors (such as skin, muscles, and joints) to the CNS. They enable us to perceive and respond to different stimuli in the external environment.
    • Motor (Efferent) Nerves: Motor nerves transmit motor commands from the CNS to the skeletal muscles, allowing us to perform voluntary movements and actions.
  2. Autonomic Nervous System (ANS):
    • Sympathetic Nervous System: The sympathetic division is responsible for the body’s “fight or flight” response during stressful situations. It increases heart rate, dilates pupils, and redirects blood flow to essential organs to prepare the body for action.
    • Parasympathetic Nervous System: The parasympathetic division works in opposition to the sympathetic division, promoting the “rest and digest” response. It slows down heart rate, constricts pupils, and aids in digestion and other bodily processes during periods of relaxation.
  3. Nerves:
    • Cranial Nerves: These are the nerves that emerge directly from the brain, specifically from the brainstem. There are twelve pairs of cranial nerves, each with distinct functions related to sensory, motor, and autonomic functions in the head and neck region.
    • Spinal Nerves: Spinal nerves are the nerves that arise from the spinal cord and extend through openings in the vertebral column called intervertebral foramina. There are 31 pairs of spinal nerves, which are further divided into cervical, thoracic, lumbar, sacral, and coccygeal regions, serving various areas of the body.
  4. Ganglia:
    • Sensory Ganglia: These are clusters of nerve cell bodies located outside the CNS that relay sensory information from peripheral receptors to the CNS.
    • Autonomic Ganglia: Autonomic ganglia are collections of nerve cell bodies that are part of the autonomic nervous system. They are involved in relaying autonomic commands from the CNS to various organs and tissues.

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