Assignment: Case of Man with the Weak Arm

Assignment: Case of Man with the Weak Arm

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This week’s topic is : The Case of the Man with the Weak Arm

Albert, a seventy-two year old African-American man, is brought into the emergency room by his daughter. Approximately 45 minutes before arriving, Albert dropped his book when his right arm and hand “fell asleep”. When he tried to rise, he noticed his right leg was weak and he needed to hold onto the couch to stand up. He had a difficult time talking because the right side of his face and mouth were “numb” and his tongue felt “thick”.

In obtaining a medical and family history it was noted that Albert has smoked at least 1 pack of cigarettes per day for the last 40 years and both of his parents died of strokes when they were in their mid sixties. He has previously been diagnosed with both essential hypertension and hypercholesterolemia. He admits to “skipping” his anti-hypertensive medication because of the unpleasant side effects it causes. Albert notes that he has been experiencing short (5 – 10 minutes) incidences of weakness on his right side, but he attributed this to the position he was in, causing his arm or leg to “fall asleep”. He has also noticed that he is having mild headaches, but recently, these have been less frequent.

Physical examination indicated that Albert was alert and anxious, but his speech was slurred. He was afebrile, had a respiratory rate of 16 breaths per minute, a regular heart rate of 86 beats per minute and a blood pressure of 190/120 mm Hg. Albert had no irregular heart sounds and presented with slight bilateral edema of the ankles. Examination of the nervous system indicated intact tactile sensory function, decreased strength of the right extremities, a diminished gag reflex, diminished right deep tendon reflexes, and right facial droop. Based on these symptoms the emergency room physician suspected a thrombolytic stroke and immediately ordered a head CT scan and various blood tests. The physician also discussed the relative benefits and risks of various treatments and courses of action with Albert and his daughter. Albert was given aspirin for possible thrombosis and a b-blocking anti-hypertensive and his condition was monitored closely while awaiting the test results.

Results of the laboratory tests indicated hyperglycemia, hypercholesterolemia, normal blood clotting times and platelet numbers. In addition, the head CT was normal. Despite the treatments initiated, Albert’s condition continued to deteriorate. While his blood pressure decreased to 170/84 mm Hg, his heart rate was elevated to 100 beats per minute and became irregular. He continued to demonstrate decreased sensation on his right side, slight dysarthria, and further decreases in strength in both right extremities. Based on these results, treatment with plasminogen activator was initiated and an electrocardiogram (ECG) was conducted. The results of the ECG indicated atrial flutter.

After 5 hours, Albert’s condition improved to the point that the hemiparesis and dysarthria were at baseline levels and his blood pressure was stabilized at 156/70 mm Hg. Further treatments were then initiated to stabilize Albert’s atrial flutter and hypertension. He was given digoxin, which stabilized the atrial flutter and heart rate at 80 beats per minute and an angiotensin converting enzyme (ACE) inhibitor was prescribed for the hypertension. An echo-cardiogram indicated bilateral stenosis of the carotid arteries. Anti-thrombolytic therapy (325 mg aspirin/day) was also prescribed. Albert was encouraged to stop smoking and to modify his diet and was discharged.

What symptoms suggested that Albert was having a stroke? What risk factors did Albert present which would support the symptoms observed? Why does Albert’s treatment include aspirin?

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Ehrlich_Ch10.pptx

Assignment: Case of Man with the Weak Arm

Assignment: Case of Man with the Weak Arm

You must proofread your paper. But do not strictly rely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort on your part and you can expect your grade to suffer accordingly. Papers with numerous misspelled words and grammatical mistakes will be penalized. Read over your paper – in silence and then aloud – before handing it in and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes.

Use a standard 10 to 12 point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. It is better to let your essay run over the recommended number of pages than to try to compress it into fewer pages.

Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor.

The paper must be neatly formatted, double-spaced with a one-inch margin on the top, bottom, and sides of each page. When submitting hard copy, be sure to use white paper and print out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument.

ADDITIONAL INSTRUCTIONS FOR THE CLASS

Discussion Questions (DQ)

Initial responses to the DQ should address all components of the questions asked, include a minimum of one scholarly source, and be at least 250 words.
Successful responses are substantive (i.e., add something new to the discussion, engage others in the discussion, well-developed idea) and include at least one scholarly source.
One or two sentence responses, simple statements of agreement or “good post,” and responses that are off-topic will not count as substantive. Substantive responses should be at least 150 words.
I encourage you to incorporate the readings from the week (as applicable) into your responses.
Weekly Participation

Your initial responses to the mandatory DQ do not count toward participation and are graded separately.
In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days, for a total of three replies.
Participation posts do not require a scholarly source/citation (unless you cite someone else’s work).
Part of your weekly participation includes viewing the weekly announcement and attesting to watching it in the comments. These announcements are made to ensure you understand everything that is due during the week.
APA Format and Writing Quality

Familiarize yourself with APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for APA paper templates, citation examples, tips, etc. Points will be deducted for poor use of APA format or absence of APA format (if required).
Cite all sources of information! When in doubt, cite the source. Paraphrasing also requires a citation.
I highly recommend using the APA Publication Manual, 6th edition.
Use of Direct Quotes

I discourage overutilization of direct quotes in DQs and assignments at the Masters’ level and deduct points accordingly.
As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content.
It is best to paraphrase content and cite your source.
LopesWrite Policy

For assignments that need to be submitted to LopesWrite, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me.
Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes.
Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own?
Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for tips on improving your paper and SI score.
Late Policy

The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies.
Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances.
If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect.
I do not accept assignments that are two or more weeks late unless we have worked out an extension.
As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.
Communication

Communication is so very important. There are multiple ways to communicate with me:
Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class.
Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.