1. Discuss the pathophysiology related to CVA due to thrombus vs. embolus. Describe the stages in the development of an atheroma.
There are a few different pathophysiologies that can lead to a stroke. The most common cause of a stroke is from atheroma, or plaque buildup on the artery wall leading to narrowing and then finally an infarction of the brain, or a stroke (VanMeter & Hubert, 2014, p. 347). The progression of an atherosclerosis, starts with damage to the endothelium of the artery (VanMeter & Hubert, 2014, p. 235). This leads to inflammation and an accumulation of lipids, and white blood cells in the (middle) muscle layer of the vessel (VanMeter & Hubert, 2014, p. 235). This leads to further inflammation and plaque buildup (VanMeter …show more content…
He has a history of smoking and arteriosclerosis, as well as a family history of CVA and diabetes. Mr. Q has family history of CVA and diabetes, both are predisposing factors of a CVA (VanMeter & Hubert, 2014, p. 348). Mr. Q’s family history of CVA and diabetes, coupled with his history of smoking and arteriosclerosis, lead to Mr. Q being at a high risk for an ischemic CVA (VanMeter & Hubert, 2014, p. 348). Both smoking and arteriosclerosis lead to high blood pressure, and Mr. Q’s initial BP is 220/110, which is extremely high. Smoking leads to arteriosclerosis (VanMeter & Hubert, 2014, p. 236). Arteriosclerosis is the buildup of plaque and lipids (atheroma) on the walls of an artery, leading to a narrowing of room for the blood to flow and then a total occlusion of the artery (VanMeter & Hubert, 2014, p. 347). When there is narrowing of the artery or an occlusion the heart has to work hard to get blood to all the parts of the body. This is what leads to the increased in BP. The fact that Mr. Q presents with such a high BP indicates that there is a total occlusion and his heart is working hard to try to supply the body (and brain) with blood, but is meeting resistance in multiple places, due to the arteriosclerosis. He has a headache and right sided numbness (arm and face), as wells as slurred speech, indicates that there are maybe multiple occlusions, and they are on one side of the brain (VanMeter & Hubert, 2014, p. …show more content…
Q might be proscribed on discharge. Many stroke patients are prescribed more than one medication on discharge, with almost patients taking 2 or three medications (Bushnell et al., 2010, p. 1457). Mr. Q had an ischemic stroke, and has many risk facts for another one. The medication that he would be prescribed would be help ensure that he does not have another stroke. One medication that many patients that have ischemic stroke are proscribed is an antithrombotic ((“Stroke Fact Sheet”, 2015). According to a study done in by American Medical Association, about the vast majority of patients that have ischemic stroke are provided an antithrombotic medication on discharge (Bushnell et al., 2010, p. 1458). There are two classes of antithrombotic medication, anti-platelet and anticoagulant, both help to prevent the formation of thrombi, or clots, which if get caught in a brain blood vessel are what cause an ischemic stroke (“Antithrombotic Therapy”, 2016). More than 83% of ischemic stroke patients are proscribed an antiplatelet, with ASA(aspirin) being proscribed almost 57% of the time (Bushnell et al., 2010, p. 1458). Twenty three percent of patients are prescribed warfarin, which is anticoagulant (Bushnell et al., 2010, p. 1458). Mr. Q has arteriosclerosis which means that a clot could become an embolus and travel to his brain reality easily and cause another stroke, which is why proscribing an antithrombotic is important for him. The
There are a few different pathophysiologies that can lead to a stroke. The most common cause of a stroke is from atheroma, or plaque buildup on the artery wall leading to narrowing and then finally an infarction of the brain, or a stroke (VanMeter & Hubert, 2014, p. 347). The progression of an atherosclerosis, starts with damage to the endothelium of the artery (VanMeter & Hubert, 2014, p. 235). This leads to inflammation and an accumulation of lipids, and white blood cells in the (middle) muscle layer of the vessel (VanMeter & Hubert, 2014, p. 235). This leads to further inflammation and plaque buildup (VanMeter …show more content…
He has a history of smoking and arteriosclerosis, as well as a family history of CVA and diabetes. Mr. Q has family history of CVA and diabetes, both are predisposing factors of a CVA (VanMeter & Hubert, 2014, p. 348). Mr. Q’s family history of CVA and diabetes, coupled with his history of smoking and arteriosclerosis, lead to Mr. Q being at a high risk for an ischemic CVA (VanMeter & Hubert, 2014, p. 348). Both smoking and arteriosclerosis lead to high blood pressure, and Mr. Q’s initial BP is 220/110, which is extremely high. Smoking leads to arteriosclerosis (VanMeter & Hubert, 2014, p. 236). Arteriosclerosis is the buildup of plaque and lipids (atheroma) on the walls of an artery, leading to a narrowing of room for the blood to flow and then a total occlusion of the artery (VanMeter & Hubert, 2014, p. 347). When there is narrowing of the artery or an occlusion the heart has to work hard to get blood to all the parts of the body. This is what leads to the increased in BP. The fact that Mr. Q presents with such a high BP indicates that there is a total occlusion and his heart is working hard to try to supply the body (and brain) with blood, but is meeting resistance in multiple places, due to the arteriosclerosis. He has a headache and right sided numbness (arm and face), as wells as slurred speech, indicates that there are maybe multiple occlusions, and they are on one side of the brain (VanMeter & Hubert, 2014, p. …show more content…
Q might be proscribed on discharge. Many stroke patients are prescribed more than one medication on discharge, with almost patients taking 2 or three medications (Bushnell et al., 2010, p. 1457). Mr. Q had an ischemic stroke, and has many risk facts for another one. The medication that he would be prescribed would be help ensure that he does not have another stroke. One medication that many patients that have ischemic stroke are proscribed is an antithrombotic ((“Stroke Fact Sheet”, 2015). According to a study done in by American Medical Association, about the vast majority of patients that have ischemic stroke are provided an antithrombotic medication on discharge (Bushnell et al., 2010, p. 1458). There are two classes of antithrombotic medication, anti-platelet and anticoagulant, both help to prevent the formation of thrombi, or clots, which if get caught in a brain blood vessel are what cause an ischemic stroke (“Antithrombotic Therapy”, 2016). More than 83% of ischemic stroke patients are proscribed an antiplatelet, with ASA(aspirin) being proscribed almost 57% of the time (Bushnell et al., 2010, p. 1458). Twenty three percent of patients are prescribed warfarin, which is anticoagulant (Bushnell et al., 2010, p. 1458). Mr. Q has arteriosclerosis which means that a clot could become an embolus and travel to his brain reality easily and cause another stroke, which is why proscribing an antithrombotic is important for him. The