NURS 6531: Week 9: Evaluation and Management of Neurologic Disorders

NURS 6531: Primary Care of Adults Across the Lifespan | Week 10

In the United States, stroke is the fourth leading cause of death and a leading cause of adult disability (National Stroke Association, 2012). Of all stroke cases, 20% are recurrent strokes in patients (American Heart Association, 2012). NURS 6531: Week 9: Evaluation and Management of Neurologic Disorders. This outlines the importance of patient education for stroke prevention and disorder management. Depending on the patient’s medical history, stroke prevention might be as simple as recommendations for changes in behavior and lifestyle. This was the case for Connie Bentley, an avid weightlifter. She exercised often and was healthy, but her blood pressure always rose when she lifted weights, which eventually caused her to suffer a stroke. After receiving treatment for her stroke, Bentley’s provider recommended that she stop lifting weights, as it would increase her risk of recurrent stroke. Instead, her provider suggested alternative activities such as tai chi, swimming, and hiking (Bentley, 2012). Although this change was difficult for Bentley, she understood the risks because of provider-patient collaboration and education. When developing treatment and management plans that include behavior and lifestyle changes, provider-patient collaboration is essential, as this will increase the likelihood of patient adherence to established plans.

This week, as you explore neurologic disorders, you examine stroke prevention methods for select patient populations.

Learning Objectives – NURS 6531: Week 9: Evaluation and Management of Neurologic Disorders

By the end of this week, students will:

• Assess differential diagnoses for patients with neurological disorders
• Analyze the role of patient information in differential diagnosis for neurological disorders
• Evaluate the patient treatment options for neurological disorders
• Understand and apply key terms, concepts, and principles related to neurological disorders
• Analyze pattern recognition in patient diagnoses

Learning Resources

Required Readings

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Buttaro, T. M., Trybulski, J., Polgar Bailey, P., & Sandberg-Cook, J. (2017). Primary care: A collaborative practice (5th ed.). St. Louis, MO: Elsevier.

• • Part 19, “Evaluation and Management of Multisystem Disorders”

• • • Chapter 227, “Sleep Disorders” (pp. 1209-1217)

This chapter differentiates between normal sleep from abnormal sleep and identifies the epidemiology, clinical presentation, and management of sleep disorders.

• • Part 16, “Evaluation and Management of Neurologic Disorders” (pp. 999-1070)

This part explores the evaluation process of neurologic disorders. It then covers the pathophysiology, clinical presentation, diagnostic criteria, and complications of neurologic disorders.

Lawrence, M., Fraser, H., Woods, C., & McCall, J. (2011). Secondary prevention of stroke and transient ischemic attack. Nursing Standard, 26(9), 41–46.

This article examines risk factors for stroke and explores prevention methods for patients at high risk of suffering from strokes.

Lawrence, M., Kerr, S., Watson, H. E., Jackson, J., & Brownlee, M. G. (2009). A summary of the guidance relating to four lifestyle risk factors for recurrent stroke. British Journal of Neuroscience Nursing, 5(10), 471–476.

This article explores lifestyle and behavioral risk factors for stroke. It also describes the role of nurses in educating patients about stroke prevention.

Perry, M. (2012). Stroke prevention. Practice Nurse, 42(8), 14–18.

This article identifies patient risk factors for strokes. It also explores patient prevention and education methods to lower the prevalence of the disorder.

National Institute of Health. (n.d.). National institute of neurological disorders and stroke. Retrieved November 1, 2012, from http://www.ninds.nih.gov/index.htm

This website provides information about neurological disorders and strokes, as well as potential causes, prevention strategies, diagnosis, and treatment of these disorders.

Discussion: Diagnosing Neurological Disorders

As an advanced practice nurse, you will likely observe patients who experience neurological disorders. Challenging to the diagnosis of neurological disorders is the realization that many manifestations of disease may not be overt physically.

For this Discussion, consider the following three case studies of patients presenting with neurological disorders.

Case Study 1

80-year-old male Caucasian male brought to the clinic by his wife concerned about his “memory problems”. Per the wife, she has noticed his memory declining but has never interfered with his daily activities until now. He is unable to remember his appointments and heavily relies on written notes for reminder. Just last week, he got lost driving and was not found by his family until 8 hours later. He is unable to use his cell phone or recall his home address or phone number. He has become a “hermit” per his wife. He has withdrawn from participating with church activities and has become less attentive.

PMH: HTN, controlled
Prostate cancer 20 years ago
Dyslipidemia
SH: no alcohol or tobacco use; needs assistance with medications
PE: VS stable, physical exam unremarkable

Case Study 2

A 30-year-old Asian female presents to the clinic with headaches. History of headaches since her teen years. Headaches have become more debilitating recently. Describes the pain as sharp, worsens with light and accompanied by nausea and at times vomiting. Rates the pain as 7/10. Typically takes 2 tabs of OTC Motrin with ‘some help’. “Sleeping it off in a darkened room’ helps alleviate the headache. VS WNL, physical exam unremarkable.

Case Study 3

A 50-year-old African American male presents with complaints of dizziness left arm weakness and fatigue. PMH: poorly controlled diabetes, hypertension, hyperlipidemia
PE: Upon exam, you noted a very mild dysarthria, he understands and follows commands very well. Mild weakness on the left side of the face is noted, and left sided homonymous hemianopsia but no ptosis or nystagmus or uvula deviation.

To Prepare:

• You will either select or be assigned one of the three case studies provided.
• Reflect on the provided patient information including history and physical exams.
• Think about a differential diagnosis. Consider the role the patient history and physical exam played in your diagnosis.
• Reflect on potential treatment options based on your diagnosis.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!

By Day 3

Post an explanation of the primary diagnosis, as well as 3 differential diagnoses, for the patient in the case study that you selected or were assigned. Describe the role of the patient history and physical exam played in the diagnosis. Then, suggest potential treatment options based on your patient diagnosis.

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on two different days who selected or were assigned a different case study than you did. Respond to questions posed to you during the week.NURS 6531: Week 9: Evaluation and Management of Neurologic Disorders