Cultural Health and Safety for Cerebral Vascular- myassignmenthelp

Question: Discuss about theCultural Health and Safety for Cerebral Vascular. Answer: Introduction: This essay will discuss the Gretas case. She was diagnosed with Cerebral vascular accident (CVA) and atrial fibrillation. She was discharged from the rehabilitation centre. Pathophysiology of CVA and its signs and symptoms will be discussed with reference to the Gretas presenting condition. Theoretical aspects of the pathophysiology and signs and symptoms of the CVA will be corelated to the Gretas condition. It is important for the healthcare professionals to understand theoretical basis of pathophysiology and signs and symptoms of the disease and link it to the patient condition. Pathophysiology: CVA occurs due to reduced blood supply to the brain. Primary pathophysiology of CVA involves heart or blood vessels disease. Secondary pathophysiology involves brain due to heart or blood vessel disease. Heart diseases responsible for CVA include hypertension, atherosclerosis leading to coronary artery disease, dyslipidemia, heart disease, and hyperlipidemia. Reduced supply of blood can lead reduced oxygen supply to brain. Brain stops working if blood supply stops to brain for about 60 to 90 seconds. After three hours of reduced supply of blood to the brain, it can result in the tissue injury and tissue death which is termed as infraction. Reduction in the blood supply might occur due to the atherosclerosis which interrupt blood supply due to narrowing of the blood vessels. Narrowing of blood vessels occur mainly due to blood clot formation and release of small emboli due to breakdown of the atherosclerotic plaques (Ma et al., 2015). In atrial fibrillation, there is formation of embolic infraction due to emboli formation in the heart. Due to blockage of the blood vessels to the brain, it initiates anaerobic metabolism in the region of brain with ischemia. Due to anaerobic metabolism, there is formation of less amount of adenosine triphosphate (ATP); however, there is formation of lactic acid. Due to acidic nature of lactic acid, it disrupts cells of brain and disturb the acid-base balance of the brain. This ischemic area of brain is called as ischemic penumbra. Due to reduced production of the ATP, brain fails to perform energy dependent activities like ion pumping which is required for the cell survival. All these events lead to cell injury and death. Excitatory neurotransmitter glutamate release is mainly responsible for neuronal injury. Concentration of glutamate outside the cells of nervous system is usually kept low due to uptake carriers. These uptake carriers are controlled by Na+ concentration gradients a cross the cell membrane. Due to reduced supply of oxygen and glucose, there is disruption in this gradient. This lead to low gradient across the membrane which lead to reverse direction for glutamate transporters. Hence, there is increased concentration of glutamate in the extracellular space. Glutamate act on the N-methyl-D-aspartate (NMDA) receptors in the neuronal cells which lead to the influx of calcium. Calcium influx results in the dysfunction of mitochondria. It can also lead to energy depletion and programmed cell death (Dirnagl, 2012). Oxygen free radicals and reactive oxygen species can be produced due to ischemia. These species damage multiple cellular and extracellular components. It produces blood vessel lining or endothelium damage. Brain is more vulnerable to ischemia because brain is mainly dependent on the aerobic metabolism and there is less respiratory reserve in the brain. Ischemia and infarction also can result in the release of zinc- and calcium-dependent matrix metalloproteases and proteases. It produces breakdown of collagen, hyaluronic acid, and other elements of connective tissue which results in loss of structural integrity of brain tissue and blood vessels. It can lead to disruption of protective blood brain barrier which produces cerebral edema (Shah and Abbruscato, 2014). It can result in secondary progression of brain injury. Hemorrhagic stroke occur due to hypertensive hemorrhage, ruptured aneurysm, ruptured AV fistula, transformation of prior ischemic infarction, and drug induced bleeding. H emorrhagic stroke produces injury due to compression of tissue due to expanded haematoma. As a result of increased blood pressure, there can be reduced blood supply which results in the ischemia and infraction. Blood released form the haemorrhage can also produce toxic effect on brain tissue and vasculature. Haemorrhage can produce inflammation which can produce secondary brain injury. In arteriovenous malformations, arteries blood flow gets directed towards veins which result in CVA. Arteriovenous malformations can create pressure on brain tissue which result in the reduced blood flow to the brain tissues (Bivard et al., 2014). These pathological changes like reduced supply of blood can lead to symptoms like headache, nausea and drop in one side of the body. All these symptoms are evident in Greta and these symptoms are evident due to stroke or CVA in her. Signs and symptoms: Greta is exhibiting dizziness. It is the most common symptom of CVA. Due to dizziness patient lose spatial perception and stability. Dizziness can also be termed as vertigo, presyncope, disequilibrium and giddiness. Vertigo is associated with feeling of nausea and vomiting. Greta is also exhibiting feeling of nausea. One of the most common causes of dizziness include reduced supply of blood to the brain. It might occur due to the sudden drop in the blood pressure, heart problem and artery blockage. Distortion of brain and nervous system can also produce dizziness. It can occur due to the nerve injury. Nerve injury can occur due to reduced supply of blood to the nerves. Reduced supply of oxygen can lead to hardening of the arteries and vessel inflammation which lead to the numbness (Lee and Kim, 2015). Abnormal levels of calcium can produce dizziness. In CVA patients like Greta, increased glutamate can lead to augmented levels calcium which can result in dizziness. Dizziness in CVA patients is associated with severe imbalance and weakness in one side of the body. In Greta, weakness occur in left side of the body because her mouth and face are falling on the left side of the body. Imbalance is considered as the type of dizziness and it is mostly due to neurological disease. In Greta, neurological disease occurs due to the disruption of nervous system due to reduced supply of blood to the brain. Dizziness can occur in multiple disease; hence differential diagnosis need to be carried out to establish relationship of dizziness with CVA in that particular patient. Moreover, other symptoms of CVA also need to be considered for the diagnosis of CVA. In few of the studies, specifically vertigo has been considered instead of non-specific dizziness for the diagnosis of CVA. It has been found that vertigo found to be more predictive as compared to the dizziness in the presentation of CVA (Kerber et al., 2015). Headache is found to be one of the primary symptoms evident in cases of CVAs. In case of Greta also sudden headache was evident. Headache can occur in CVA patients mainly due to less supply of oxygen and blood to the brain. Swelling in the brain is also responsible for headache in CVA patients. Swelling can occur due to oedema which mainly occur due to infraction in the brain. Headache can be present in multiple conditions; however, headache associated with neurological symptoms like confusion, blurry vision, personality changes, weakness on one side of the body, numbness, or sharp facial pain; can be considered as specific to CVA (Goddeau and Alhazzani, 2014). In Greta also along with headache; dysfunction of one side of body was evident. In CVA headache can occur suddenly without any warning. Such headache is called as thunderclap headache and it is mainly occur due to bleeding in the brain. FAST test can be used to confirm headache due to CVA. FAST stands for face, arm, speech and time. Face get dropped in patients with headache which is associated with CVA. In Greta also left side of the face get dropped. Prevalence of headache was found to be less in ischemic patients as compared to the intraparenchymal haemorrhage. Ischemic events in the posterior circulation as compared to the anterior circulation are mainly responsible for the onset of headache in stroke patients. Approximately 40 % patients with headache in stroke exhibit nausea and vomiting. Greta also exhibiting headache associated with nausea symptoms. It has been proved that infract in the insular cortex is mainly responsible for the headache in CVA patients (Jamieson et al., 2014; Balami, et al., 2013). Conclusion: This essay discussed pathophysiology of CVA and established its link to the Gretas presenting condition. Most relevant signs and symptoms of CVA for Greta identified and reasons for the occurrence of these signs and symptoms are discussed. These signs and symptoms are corelated to the Gretas presenting condition. Understanding of pathophysiology and signs and symptoms of CVA can be helpful in implementing nursing intervention to Greta. References: Balami, J.S., Chen, R.L., and Buchan, A.M. (2013). Stroke syndromes and clinical management. QJM, 106(7), 607-15. Bivard, A., Levi, C., Krishnamurthy, V., Hislop-Jambrich, J., Salazar, P., Jackson, B., Davis, S., and Parsons, M. (2014). Defining acute ischemic stroke tissue pathophysiology with whole brain CT perfusion. Journal of Neuroradiology, 41(5), 307-15. Dirnagl, U. 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