The Role of RN-BSN Nurses in Understanding Disease Pathophysiology and Treatment Across the Lifespan

Critical Thinking Table

Clinical Manifestations Describe the clinical manifestations present in Mrs. T., focusing on what is normal and abnormal and how this relates to her current condition.
Subjective	Mrs. T. is a 42-year-old female schoolteacher who has been leading an active lifestyle with her family. Based on her health history, she has several risk factors that have likely contributed to her current presentation – she is a chronic smoker, consumes alcohol regularly, eats a diet high in fast and processed foods, and has a history of high cholesterol and atrial fibrillation. Witnesses reported that Mrs. T’s symptoms suddenly appeared at the time of the incident. She was noted to be mumbling incoherently to the children around her and appeared confused. Her right arm was limp, and the right side of her face was slackened. She exhibited difficulty walking and an inability to follow commands. She shook her head no when asked about pain. All of these symptoms indicate acute neurological changes and impairment.
Objective	Mrs. T’s vital signs revealed hypertension, tachycardia, tachypnea, and normal oxygen saturation – these may be normal or abnormal acute reactions to her sudden neurological changes. Her blood glucose was within normal limits. She had a positive FAST and VAN score, indicating a high probability of acute stroke, with an NIHSS score of 12, indicating moderately severe stroke symptoms. Her height, weight, and BMI indicate she is obese. Her presenting labs show normal white blood cell count, INR, and CT head. She tested negative for pregnancy, and her presenting cholesterol and triglycerides are elevated. The acute neurological symptoms combined with hypertension, obesity, history of AFib, high cholesterol, smoking, and alcohol use make acute ischemic stroke the most likely diagnosis. The sudden onset of her symptoms over a 5-minute timespan confirms the likelihood of a cerebrovascular accident.
Primary and Secondary Diagnoses Discuss the primary and secondary medical diagnoses that should be considered for Mrs. T., and why you chose this diagnosis.
Primary medical diagnosis and why you chose this diagnosis.	The primary medical diagnosis for Mrs. T is acute ischemic stroke. She has exhibited multiple acute neurological symptoms, including unilateral weakness, unilateral facial drooping, difficulty speaking and walking, and confusion – all indicative signs of a stroke (Kumar et al., 2020). The sudden onset over 5 minutes confirms that this is more likely a thrombotic stroke (acute ischemic CVA) and not a hemorrhagic stroke. Ischemic stroke matches her risk factor profile of hypertension, obesity, hypercholesterolemia, smoking, and previous AFib. Her presenting NIHSS score of 12 confirms moderately severe neurological impairment from a cerebrovascular accident.
Secondary medical diagnosis and why you chose this diagnosis.	The secondary diagnoses to consider in the differential include transient ischemic attack (TIA), complex migraine, seizure activity, electrolyte imbalance, and hypoglycemia (Kumar et al., 2020). However, her clusters of stroke symptoms and rapid onset make ischemic stroke far more likely than these other considerations.
Formulate a nursing diagnosis from the medical diagnoses	Nursing Diagnoses: Impaired physical mobility related to acute right-sided hemiplegia Acute confusion related to cerebral ischemia Risk for injury related to unilateral weakness, difficulty walking Anxiety related to acute medical illness Ineffective health maintenance related to chronic smoking, improper diet, and noncompliance with medications and medical advice (Makic & Martinez-Kratz, 2022)
Pathophysiological Changes Explain the pathophysiological changes in Mrs. T.
What pathophysiological changes would you expect to be happening to Mrs. T.?	Mrs. T is experiencing an acute ischemic stroke from sudden impaired blood flow to a focal region of her brain. This triggers a complicated ischemia/reperfusion biochemical cascade at the cellular level (Kumar et al., 2020). The ischemic insult triggers depletion of oxygen and glucose in brain tissue, lactic acid buildup, glutamate excitotoxicity, calcium influx, and subsequent failure of cellular metabolism. There is a release of inflammatory mediators and generation of free radicals, compromising the blood-brain barrier. This leads to cerebral edema, hemorrhagic transformation of the infarct, and expansion of the ischemic penumbra zone. Apoptotic cell signaling pathways then trigger programmed neuronal cell death. The infarct core experiences coagulation necrosis. The brain attempts to compensate for decreased perfusion through collateral circulation and autoregulatory vasodilation, but her chronic hypertension impairs autoregulation. MRI would likely show a localized zone of infarction with surrounding edema and diminished neural connectivity on functional sequences. There is also a risk of embolization with AFib and the release of more thrombi.
How will pathophysiological changes transition in the subacute phase after diagnosis and initial treatment?	In the subacute phase, after initial diagnosis and treatment, the primary pathophysiological process shifts from active, progressing ischemia and infarction to post-infarct edema, inflammation, and peri-lesional diaschisis (Kumar et al., 2020). With the restoration of blood flow, reperfusion injury can also occur from reactive oxygen species and overloaded calcium. In response to the ischemic insult, astrocytes become activated, which can modulate neuroinflammation – this plays an important role in neural repair and neuroplastic processes in the subacute and chronic phases post-infarct. If Mrs T. is treated acutely with tissue plasminogen activators to dissolve the blood clot rapidly, this increases her risk of hemorrhagic transformation in the subacute recovery phase. Edema peaks around five days post-infarct before beginning to subside. The integrity of the blood-brain barrier slowly recovers with the healing of cerebral endothelial cells. Gliosis and macrophage activity for clearing dead cells and debris generates a pro-inflammatory state. Neurogenesis pathways activated post-infarct can lead to limited neural plasticity. All of these subacute changes largely depend on location, extent of initial ischemia, collateral circulation, and efficacy of acute interventions.
Health Status Effect Describe the effects Mrs. T.’s current health status may have on her.
Describe the physical, psychological, and emotional effects Mrs. T.’s current health status may have on her.	If Mrs. T has suffered an acute moderate ischemic stroke, this can have major physical, psychological, emotional, and functional effects, especially in the acute phase. Physically, she has already exhibited unilateral weakness, facial drooping, difficulty speaking, confusion, and difficulty walking. This may or may not fully resolve, depending on the efficacy of treatments and severity of initial ischemia/reperfusion injury. There will likely be a prolonged recovery period with required rehabilitation interventions like physical, occupational, and speech therapy. Activities of daily living and quality of life will be impacted by the impairment. Additionally, the acute trauma of the cerebrovascular event can be profoundly frightening (Kumar et al., 2020). Many patients develop anxiety, depression, adjustment disorders, or post-traumatic stress afterward. There may be grief and hopelessness at the sudden major health event and life disruption. Mrs T. will require psychosocial support through recovery along with medications as needed to stabilize her mood and outlook. Her cognition, memory, and executive functions may also be temporarily or permanently affected depending on the area of infarction – this also requires deep psychological adjustment.
Discuss the impact it can have on her role in the family.	As the matriarch and female head of household in her family, Mrs T’s stroke can significantly impact the entire family dynamic. With school-aged children still at home, this places strain on the family network of support. Mrs. T and her husband, both working, helps provide for the high costs of raising teenagers. Her husband will likely need to take time away from work to assist with Mrs T’s care early in recovery. Additional childcare assistance may be needed temporarily, which will incur more costs. Her school-aged kids may react strongly and have difficulty coping psychologically and academically. Mrs T., who is playing an active role in care and duties for household management, will require adjustment to delegate responsibilities until she can resume activities independently after rehabilitation. This necessitates candid discussions amongst the family regarding processes, expectations, feelings, and how to persevere through challenges together. Open communication channels with empathy, patience, and cohesion are vital to family adaptation. The socio-emotional effects of this situation underscore why a collaborative, interdisciplinary approach must assess not just Mrs. T’s physical recovery but also facilitate psychosocial and spiritual support for the entire family system. Their resilience depends greatly on that network of care.
Treatments and Support Discuss treatments and support that can be completed for Mrs. T.
Discuss the immediate treatments that can be completed for Mrs. T.	As Mrs. T remains in the acute, emergent phase of treatment, the focus centers on rapid assessment, monitoring for deterioration, establishing a diagnosis, and stabilizing her condition. ABCs come first – airway patency, breathing, hemodynamic circulation. Neurological checks like GCS establish mental status for trends. Vital signs give indicators of physiological stability and location of infarction via neuro exam (Hall & Hall, 2020; Katzung et al., 2021). Labwork like CBC BMP assesses for secondary issues precipitating or resulting from CVA. Imaging like CT and MRI cerebral confirm diagnosis and distinguish hemorrhagic vs thrombotic stroke. Early interventions aim to salvage threatened penumbral tissue and limit the expansion of infarction. This includes maximizing oxygenation, maintaining Cerebral Perfusion Pressure (CPP) above 60, and limiting Intracranial Pressure (ICP). Fluid resuscitation and blood pressure augmentation with vasopressors may assist while avoiding extremes. If Mrs T meets the criteria, she may receive thrombolytics like tPA to dissolve the clot until 4.5 hours post-onset. Anticoagulants and antiplatelets are also initiated (common choices are aspirin, Plavix, and heparins) (Katzung et al., 2021). Standard stroke pathway orders facilitate optimal evidence-based treatment. Consultants like neurology assist in acute care and disposition planning.
Describe the long-term support she may need to return to the baseline activity level.	For Mrs T to make the best possible recovery long-term after her stroke, she needs a customized, patient-centered rehabilitation plan based on her residual deficits after acute care. The goals guiding this plan focus on regaining function independence with ADLs tailored to her home environment and roles like work duties. Physical and occupational therapy helps overcome residual hemiparesis, ataxia, and apraxia through focused strengthening, mobility training, and exercises targeting affected limbs while protecting the weaker side. Speech therapy facilitates relearning language skills and preventing aspiration. As Mrs T’s energy permits, she increases community ambulation and functionality. Assistive devices like canes, braces, or even wheelchairs early on assist progress. Her care team monitors for common post-stroke issues like spasticity, contractures, pain syndromes, fatigue, and mood changes — intervening promptly to optimize progress. Support groups connect survivors struggling through recovery. Long-term adherence to a stroke-healthy lifestyle with diet, exercise, and smoking cessation helps secondary prevention after significant cerebrovascular disease. Even once she returns to teaching work duties, she may require ongoing PT/OT support and accommodations for lasting hemiparesis, like mobility assistance. The goal is to maximize the restoration of her previous roles and activities as much as possible.
Explain how the interdisciplinary team is utilized to help her family support and cope with her diagnosis.	Mrs T’s situation exemplifies the need for collaborative interprofessional care with her multifactorial history and recovery needs after an acute stroke. Specialists across realms synergize respective expertise into a unified support plan: Neurology manages cerebrovascular aspects from the ICU through outpatient follow-up Neuroradiology interprets imaging distilling location/severity of infarction PT/OT/Speech shape patient-centered rehabilitation efforts Nursing provides 24/7 holistic care addressing biopsychosocial needs (Bendowska & Baum, 2023) Social work connects psychosocial and community support for family Case management coordinates complex care across phases of recovery Palliative care or ethics consults guide difficult decisions on the goals of care Chaplaincy tends to spiritual distress surrounding profound illness This interdisciplinary team works in steps to traction the patient’s priorities and values, empowering her recovery. Personalized education and counseling equip Mrs T and her loved ones to grapple with this life disruption, ask questions, express needs, and actively participate in shared decision-making at every step. This conveys respect and dignity. It facilitates adaptation, promoting her autonomy and appropriate self-care relative to long-term disease management after disability. Continuity of follow-up and outpatient services prevent gaps between phases of care. The support network remains invested in her maximal restoration per patient preferences even after hospital discharge through community referrals. Her resilient outcome emerges from this surrounding care, scaffolding her inner capacity to heal and thrive beyond limitation.

References

Bendowska, A., & Baum, E. (2023). The significance of cooperation in interdisciplinary health care teams as perceived by Polish medical students. International Journal of Environmental Research and Public Health, 20(2), 954. https://doi.org/10.3390/ijerph20020954

Hall, J. E., & Hall, M. E. (2020). Guyton and Hall Textbook of Medical Physiology E-Book: Guyton and Hall Textbook of Medical Physiology E-Book. Elsevier Health Sciences.

Katzung, B. G., Kruidering-Hall, M., Tuan, R. L., Vanderah, T. W., & Trevor, A. J. (2021). Katzung & Trevor’s Pharmacology Examination and Board Review, Thirteenth Edition. McGraw Hill Professional.

Kumar, V., Abbas, A. K., Aster, J. C., & Deyrup, A. T. (2020). Robbins Essential Pathology E-Book: Robbins Essential Pathology E-Book. Elsevier Health Sciences.

Makic, M. B. F., & Martinez-Kratz, M. R. (2022). Ackley and Ladwig’s Nursing Diagnosis Handbook: An Evidence-based Guide to Planning Care. Elsevier.

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Question

Directions: Read the case study below. Evaluate the information and formulate a conclusion based on your evaluation. Complete the critical thinking table and submit this completed template to the assignment dropbox.

Case Study: Mrs. T.

It is necessary for an RN-BSN-prepared nurse to demonstrate an enhanced understanding of the pathophysiological processes of disease, the clinical manifestations and treatment protocols, and how they affect clients across the lifespan.

The Role of RN-BSN Nurses in Understanding Disease Pathophysiology and Treatment Across the Lifespan

Evaluate the Health History and Medical Information for Mrs. T., presented below.

Health History and Medical Information

Mrs. T., a 42-year-old female, has been living at home with her two high school-age children, husband, and dog. She is a schoolteacher who works full-time teaching at the local grade school. She tries to be active by walking with her husband and dog for 20 minutes on the weekend but is starting to add weight as she gets older. She has no known allergies. She is a pack-a-day smoker and drinks three glasses of wine/per night after work. She tries to eat healthy but likes to eat out at fast food restaurants to avoid having to cook.

Medical history includes atrial fibrillation controlled with beta blocker, hypercholesterolemia, mild anemia related to heavy menses, and migraines. Current medications include:

Metoprolol 50mg daily
Pravastatin 40 mg at bedtime daily for cholesterol
Birth control pill Microgestin Fe in the AM
Amitriptyline 20 mg/daily for migraines

Case Scenario

You are the school nurse where Mrs. T. works. While at recess duty, another teacher runs up to you and reports that Mrs. T. is not acting like herself. When you approach, you see her sitting on a bench mumbling something to the kids gathered around her. She has dropped her cell phone on the ground, and her right arm appears limp. You try asking her questions and you notice the right side of her face is slackened, and she does not seem to be making sense when talking. You call an ambulance and try to walk her back to your office, but she does not move well. You reassure her and try to determine if anything occurred prior to her loss of speech and movement. The other teachers say it came on suddenly, within the last 5 minutes. Mrs. T. shakes her head no to pain.

Objective Data – Completed by Ambulance Personal:

Temperature: 36.5 degrees C
BP 184/92, HR 101, RR 24, Pox 99%
Blood Glucose = 107
Positive FAST & VAN score, NIHSS = 12
Height: 62 inches; Weight 89 kg

Laboratory/Test Results – On Arrival to the Emergency Department (Initial Results)

WBC: 9.4 (1,000/uL)
INR – 0.7
CT Head is normal.
Negative pregnancy test
Cholesterol – 247, Triglycerides – 302

Critical Thinking Table

Clinical Manifestations Describe the clinical manifestations present in Mrs. T., focusing on what is normal and abnormal and how this relates to her current condition.
Subjective
Objective
Primary and Secondary Diagnoses Discuss the primary and secondary medical diagnoses that should be considered for Mrs. T., and why you chose this diagnosis.
Primary medical diagnosis and why you chose this diagnosis.
Secondary medical diagnosis and why you chose this diagnosis.
Formulate a nursing diagnosis from the medical diagnoses
Pathophysiological Changes Explain the pathophysiological changes in Mrs. T.
What pathophysiological changes would you expect to be happening to Mrs. T.?
How will pathophysiological changes transition in the subacute phase after diagnosis and initial treatment?
Health Status Effect Describe the effects Mrs. T.’s current health status may have on her.
Describe the physical, psychological, and emotional effects Mrs. T.’s current health status may have on her.
Discuss the impact it can have on her role in the family.
Treatments and Support Discuss treatments and support that can be completed for Mrs. T.
Discuss the immediate treatments that can be completed for Mrs. T.
Describe the long-term support she may need to return to the baseline activity level.
Explain how the interdisciplinary team is utilized to help her family support and cope with her diagnosis.

The Role of RN-BSN Nurses in Understanding Disease Pathophysiology and Treatment Across the Lifespan