NURS530 Week 3 Discussion 2 Case Study

 NURS530 Week 3 Discussion 2 Case Study

 Case Scenario

Yes, I would advise my client to take part in the study. In research and clinical trials, the aforementioned scenario is an ethical consideration. Due to memory issues, the patient is unable to give informed, voluntary consent for the study. Consequently, he or she needs the consent of a legitimate legal representative. The 20-30% of schizophrenics who do not respond to dopaminergic medicines may benefit from those that target glutamate, according to a recent study. Several glutamatergic substances have been reported to have shown positive effects in phase II therapeutic studies (Wada et al., 2022). Since the patient has been taking previous traditional dopaminergic medications without improvement and the new medications may be able to provide them with a better prognosis, I, as the legal representative, would permit them to take part in the trial.

Pathophysiology of Cerebrovascular Accidents

In thrombotic stroke, atherosclerosis causes vessel constriction, which can lead to thrombosis and disrupt blood flow. Plaque accumulation leads to vascular chamber constriction and clot formation, which in turn leads to thrombotic stroke. An embolism causes a stroke by cutting off blood supply to part of the brain, leading to extreme cellular stress and eventual death (necrosis) (Schneider & Maier, 2020). After neuronal death, the plasma membrane ruptures, organelle enlargement and contents flow out into the extracellular space, and neuronal function is lost.

Most of the time, a blood clot (embolus) develops elsewhere in the body and then travels through the circulatory system to the brain, causing an embolic stroke. Strokes caused by emboli typically occur suddenly and without warning after heart disease or heart surgery. Atrial fibrillation is a form of irregular cardiac rhythm in which the upper chambers of the heart do not beat properly, and it is responsible for about 15% of embolic strokes (Schneider & Maier, 2020). When a blood vessel supplying the brain bursts and bleeds, it is called a hemorrhagic stroke. A lack of oxygen and nutrients is particularly detrimental to cerebral cells and tissues in the event of a cerebral arterial bleed (Hanna et al., 2020). Pressure on the brain also causes inflammation and swelling in the tissues around it, which can irritate and harm the brain.

In many cases, alteplase injections, used to treat ischemic strokes, can break up blood clots and get blood flowing again to the brain. Thrombectomy is an emergency treatment that can treat some cases of severe ischemic stroke (Hanna et al., 2020). Anticoagulants are prescribed to some patients to assist in preventing the formation of new blood clots. Anticoagulants work by altering the blood’s chemical makeup in a way that renders clot formation impossible.

Characteristics of Common Headaches

Tension headache is the most common kind of headache. The following are symptoms commonly associated with tension headaches: Constant without giving rise to a pulsing sense and distress of a mild to moderate degree. There are bilateral (situated on both sides of the head), Medication available at the drugstore can help, but it can make daily activities more difficult. Migraine headaches are very common and the second most common primary headache kind (Burch, 2019). Migraine symptoms include mild to severe pain, nausea and/or vomiting, and hammering pain. Other symptoms that may linger for up to three days include the inability to tolerate bright light, loud noise, or strong odors, abdominal pain, or nausea.

Cluster headaches are the most severe kind of primary headaches that can occur. Headaches, known as cluster headaches, typically manifest themselves all at once in the spring or fall. They can happen anywhere from once to eight times every day throughout a cluster phase, which can last anywhere from two weeks to three months. The headaches may disappear for a period of months or years, only to reappear at a later time. The presence of the following symptoms characterizes cluster headaches: a sensation similar to that of being burned or stabbed is present behind one of your eyes or in the ocular region, and it does not change sides (Burch, 2019). This sensation may be continuous, or it may throb.

Most of the time, over-the-counter pain relievers successfully treat sporadic tension headaches. However, frequent usage of these medications can lead to chronic daily headaches. If the persons get frequent or severe headaches, the doctor could advise taking prescription headache medications. Triptans and other prescription drugs can assist to stop a migraine attack. As soon as a headache begins to appear, the medication prescribed is taken (Okusanya et al., 2022). Utilizing drugs for high blood pressure, seizures, or depression can occasionally prevent migraines. The doctor could suggest trying one of these medications to minimize the frequency of headaches.

References

Burch R. (2019). Migraine and tension-type headache: Diagnosis and treatment. The Medical Clinics of North America, 103(2), 215–233. https://doi.org/10.1016/j.mcna.2018.10.003

Hanna, K., Douglas, M., Asmar, S., Khurrum, M., Bible, L., Castanon, L., & Joseph, B. (2020). Treatment of blunt cerebrovascular injuries: Anticoagulants or antiplatelet agents. Journal of Trauma and Acute Care Surgery, 89(1), 74-79. https://doi.org/ 10.1097/TA.0000000000002704

Katan, M., & Luft, A. (2019). Global burden of stroke. Seminars in Neurology, 38(2), 208–211. https://doi.org/10.1055/s-0038-1649503

Okusanya, B. O., Lott, B. E., Ehiri, J., McClelland, J., & Rosales, C. (2022). Medical cannabis for the treatment of migraine in adults: A review of the evidence. Frontiers in Neurology, 13, 871187. https://doi.org/10.3389/fneur.2022.871187

Schneider, G. T., & Maier, S. A. (2020). Cerebrovascular accident. In Neurologic and neurodegenerative diseases of the larynx (pp. 215-228). Springer, Cham.

Wada, M., Noda, Y., Iwata, Y., Tsugawa, S., Yoshida, K., & Tani, H., (2022). Dopaminergic dysfunction and excitatory/inhibitory imbalance in treatment-resistant schizophrenia and novel neuromodulatory treatment. Molecular Psychiatry, 27(7), 2950–2967. https://doi.org/10.1038/s41380-022-01572-0

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Week 3 Discussion Forum Prompt 2
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Select all of the following discussion prompts to address:

Consider the following scenario: Your patient has suffered from schizophrenia for two decades and has received classic dopaminergic treatments since the onset of illness. The latest research supporting use of the glutamatergic model has not been tried on your patient, and there is an opportunity for your patient to enter clinical trials utilizing glutamate-based treatments. Your patient suffers significant executive function impairment and memory impairment. Do you recommend participation in the clinical trial? Why or why not?
Discuss the pathophysiology of cerebrovascular accidents (CVAs)—thrombotic, embolic, hemorrhagic, and lacunar—their incidence and prevalence, clinical manifestations, evaluation, and treatment.
Discuss the characteristics of common headaches—migraine, cluster, and tension—and describe their evaluation and treatment options. What prevention strategies would you advise?
Use at least one scholarly source other than your textbook to connect your response to national guidelines and evidence-based research in support of your ideas.