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Final Project: Case Study 7-1
Tara Panciotti, RN
Southern New Hampshire University
NUR-540 Advanced Pathophysiology 20EW4
Mariea Snell DNP, APRN, FNP-C
April 19,2020
Final Project: Case Study 7-1
Millie Larson, an 84-year-old African American widow, had been found at home by her
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daughter after a fall. Mrs. Larson was noted with left sided weakness and slurred speech. Her
past medical history includes: Hypertension, hypercholesterolemia, osteoporosis, diabetes
mellitus and she is a smoker. At the hospital, her CT scan did not note an apparent bleed. The
. following will introduce the case study and the assessments needed to develop a plan of care
Introduction
Ethnicity, Culture, and Socioeconomic Status
Ethnicity, culture and socioeconomic status play a large role in the development of
chronic and acute diseases. As an African American, Mrs. Larson is 150% more likely to suffer
from a stroke than a white person (McCance & Huether, 2019, p. 565). Hypertension and
diabetes, both risk factors for stroke, have a higher incidence of occurrence in African Americans
(Sajatovic, et al., 2017). African Americans also have higher rates of obesity, smoking, social
stress, unemployment, coping skills and issues accessing healthcare (Sajatovic, et al., 2017)
Barriers to healthcare include cultural and religious stigmas. Many African Americans rely on
their faith in God to heal them which delays them in seeking care and may discourage them from
don't react as quickly as whites to situations, and many prefer home remedies in place of seeking
medical help (Magwood, et al., 2019). Magwood, et al. (2019) noted, that often, accessing
medication due to financial constraints, and lack of insurance or concerns about taking too many
medications, caused noncompliance to plans of care. Addressing ethnic, cultural and
socioeconomic barriers to stroke prevention and treatment are important in developing the plan
.of care
Cellular Changes
A stroke occurs when blood supply to the brain is occluded by either a cerebral thrombi
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or emboli (McCance & Huether, 2019, p. 566). Severe decrease in blood flow, rapidly decreases
levels of ATP and stores of energy causing ionic gradients to decrease (Arai et al., 2011). The
process of Glutamate re-uptake is impaired increasing calcium release which contribute to
neuronal death (Arai et al., 2011). The calcium irregularity produces nitric oxide and
peroxynitrate which affects nearby cells (Arai et al., 2011). Mitochondrial functions fail releasing
oxygen radicals that attack proteins, lipids and nucleic acid (Arai et al., 2011). Irreversible
necrosis surrounded by the ischemic penumbra occurs (McCance & Huether, 2019, p. 698). In
ischemic strokes, the area of infarct becomes pale and soft within 6 to 12 hours and, necrosis and
disintegration is visible by 48 to 72 hours (McCance & Huether, 2019, p. 698). Infiltration of
macrophages and phagocytosis of necrotic tissue occurs leaving a cavity and glial scarring by the
second week (McCance & Huether, 2019, p. 698). Angiogenesis can sprout new arterioles from
penumbra vessels to establish blood circulation (McCance & Huether, 2019, p. 698). Cellular
changes to the cardiovascular system occurs in patients tha