3 children who all live interstate and they see them once or twice a year.

3 children who all live interstate and they see them once or twice a year. Both Fred and Joan are very social and like getting together with their friends. Fred plays bowls three times a week and then joins his friends at the local club for lunch.

Fred was shaving a week ago when he noted that the left side of his face was drooping.  His left arm felt very weak, and he tried to call out to Joan, but he could not speak properly. Fred fell to the floor, and Joan found him shortly after and immediately called an ambulance.

Fred was taken to the Emergency Department where on arrival he had a BP of 190/91, HR 115, RR 24, SaO2 95% on room air and a temperature of 37.2. He was immediately sent for a CT head and diagnosed with a CVA.

Fred’s past medical history includes hypertension, hypercholesterolemia, Diabetes Mellitus, GORD, Atrial Fibrillation and a cholecystectomy 5 years ago.

Fred was transferred to the neurological ward.  On assessment he had a GCS of 13, left sided hemiplaegia, expressive dysphasia, dysphagia & blurred vision in his left eye.  He was scheduled to see the speech pathologist and the physiotherapist.

After a week of therapy Fred is ready to be discharged to a rehabilitation environment.  He still has some residual dysphasia, but the dysphagia and blurred vision have largely resolved.  He still has significant weakness on his left side and discharge medications included:

Apixaban 5 mg PO daily Ezetimibe 10 mg PO daily
Digoxin 125 mcg PO daily Perindopril 2 mg PO daily
Simvastatin 40 mg PO daily Amlodipine 10 mg PO daily

1. Identify the most likely aetiology of Fred’s CVA• Explain how and why this can lead to a CVA from a pathophysiological perspective.• Include the pathophysiology of Fred’s CVA.• In other words, discuss the pathogenesis of the most likely cause and how it can lead to CVA in relation to Fred’s case.

2. Identify two (2) other risk factors that Fred has that may contribute to a CVA• For each of these risk factors explain how & why they increase the risk of a CVA.3. Select two (2) signs and/or symptoms that Fred has as a result of his CVA  • For each sign/symptom explain how and why it occurs, from a pathophysiological perspective.

4. Select three (3) of Fred’s medications and explain why each of these are ordered.• Include the pharmacodynamics and pharmacokinetics of each medication, relevant adverse effects, contraindications, and nursing considerations.5. All Fred’s medications are administered orally. Explain what the first pass is and the implications this has for a drug’s bioavailability.

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