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.
REQUIRED READING:
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).
Conclusion
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.
References
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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