Pathophysiology template essay paper

Pathophysiology template essay paper


Pathophysiology template


Disease: Ischaemic stroke affecting the dominant left cerebral hemisphere

Definition: An ischaemic stroke is death of brain tissue resulting from an occluded artery caused either by an atherosclerotic obstruction or embolus that interrupts blood supply to the area of the brain supplied by the occluded artery. The sudden loss of blood circulation results in a corresponding loss of neurologic function (Jauch, 2014).Pathophysiology template essay paper



A depletion of blood flow in a cerebral artery resulting from a:

  • Thrombus –atherosclerotic plaque that has ruptured in a cerebral artery
  • Embolus
  • from heart e.g. left atrial thrombus, left ventricular thrombus, atrial fibrillation
  • from carotid artery (Craft &Gordon,2011)



  • Interruption of blood flow to cerebral tissue initiates a biochemical ischaemic cascade.
  • Mitochondrial production of ATP ceases èdepolarisation è influx of sodium and calcium and efflux of potassium. Passive inflow of water into cells causes cytotoxic oedema and destruction of cells in infarct core.
  • Membrane depolarization also stimulates the release of neurotransmitters. Glutamate release èexcessive calcium influx into nearby neurons (exocitotoxicity) èdestruction of cells by lipolysis, proteolysis and free radicals.
  • Mitochondria break down releasing toxins and apoptotic factors.
  • Injured brain tissue triggers inflammatory response èrelease of inflammatory mediators ècell death and oedema

èdestruction of cells in infarct core  ènecrosis

èischaemic penumbra around core has diminished blood flow but preserved cellular metabolism.


Areas of necrotic tissue are not able to conduct nerve impulses so functions such as initiating and conveying motor impulses, receiving and interpreting sensory information and speech control will be interrupted.

(Bautista, 2014; Craft & Gordon, 2011; Maas & Safdieh,2009).




Just superior to the medullary junction, 90% of axons in the left pyramid cross to      the right ® right motor dysfunction.

The middle cerebral artery supplies the frontal, temporal and parietal lobes as well as the basal ganglia and internal capsule.                                              (Tocco,2011).


Therefore specific clinical manifestations include:

  • Hemiplegia and weakness on right side of body
  • Sensory loss on right side
  • Inability to see the right visual field of each eye
  • Aphasia
  • Apraxia
  • Dysarthria
  • Impaired reasoning
  • Behavioural changes
  • Problems with memory

(Bautista, 2014; Craft & Gordon, 2011).



  • Complete history
  • Physical and neurological examination
  • Brain MRI or CT scan – Essential in differentiating cerebral haemorrhage from ischaemic stroke. MRI is superior as cerebral ischaemia can be identified within minutes and can identify small areas of stroke.
  • Other tests for vascular imaging can be used e.g. CT angiography, magnetic resonance angiography

(Silverman & Rymer, 2009).



The emphasis of ischaemic stroke treatment is placed on salvaging potentially reversible ischemic penumbra brain tissue, preventing secondary stroke and minimising longterm disability.                             (Jaunch, 2014).


  • Reperfusion
  • thrombolytic agent (e.g.tPA)
  • intra-arterial technique


  • Neuroprotection

-antithrombotic therapy (e.g. aspirin)


  • Nursing management

Acute phase

  • frequent evaluation of neurological status
  • frequent evaluation of vital signs
  • Monitor oxygen saturation – administer oxygen if required
  • Screen for swallowing deficits and manage appropriate hydration and nutrition strategies
  • Manage activities of daily living
  • Screen for communication deficits and address appropriate communication strategies
  • Prevent complications e,g pressure areas, contractures, DVT
  • Assess urinary and faecal continence and address appropriately



  • begin as early as possible by preventing complications, passive and active movement and mobilizing as early as possible.
  • Support and encourage activities provided by physiotherapists, occupational therapists and speech therapists
  • Education – e.g. lifestyle modification, adherence to medications

(National Stroke Foundation, 2010).





  • With reperfusion – blood is restored to the area and signs and symptoms gradually resolve


  • Without treatment – Course is determined by severity of stroke. Ischaemia will extend to penumbra as stroke evolves, signs and symptoms worsen. As  cerebral oedema resolves, and with  structural and functional reorganisation recovery may continue for 6 months to a year. (peak recovery in about 3 months). Requires rehabilitation to optimise function.Pathophysiology template essay paper


(Teasell & Hussein, 2014).

  • Complications




Mood disturbances


Dysarthria and aphasia



  • Stroke prognosis is influenced by factors such as age and stroke severity.
  • One in five likely to die within one month of suffering ischaemic stroke.
  • Of those who recover about 90% will experience some impairment




Eliminating modifiable risk factors will prevent an ischaemic stroke.

  • Don’t smoke
  • Diet high in fruit and vegetables, low in fats and salt
  • 30 minutes of moderate-intensity physical activity on most days of the week
  • Maintain healthy BMI
  • Limit alcohol to no more than two standard drinks per day

(National Stroke Foundation, 2010)


If a history of atrial fibrillation – ensure adherence to anticoagulation therapy.









Bautista, C. (2014). Disorders of Brain Function. In S. Grossman & C. Porth (Eds),

      Porth’s pathophysiology: Concepts of altered health states (9th ed.). (pp489-

524). Philadelphia: Lippincott Williams & Wilkins.

Craft, J. & Gordon, C. (2011), Alterations of Neurological Function across the

Lifespan. In J.Craft, C.Gordon & A. Tiziani (Eds). Understanding

      Pathophysiology (pp 188-226). Sydney, Australia:Elsevier Australia.

Dashe, J. F. (2014). Stroke prognosis in adults. UpToDate. Retrieved from:

Jaunch, E.C. (2014). Ischemic stroke treatment and management, Retrieved from:

Maas, E.B. & Rymer, M.M. (2009). Ischaemic stroke: Pathophysiology and Principles

of Localization. Neurology 13 .Retrieved from:

National Stroke Foundation (2010).  Clinical guidelines for stroke management

  1. Melbourne Australia.

Silverman, I.E. & Rymer, M.M. (2009). An atlas of investigation and treatment.

      Ischaemic stroke. Clinical publishing:Oxford,U.K.

Teasell, R.& Hussein, N. (2014)Brain reorganization, recovery and organizecare.

In Stroke rehabilitation clinician handbook 2014. Retrieved from:,%20Recovery%20and%20Organized%20Care_June%2018%202014.pdf

Tocco, S. (2011). Identify the vessel recognize the stroke. American Nurse Today

      9 (6).    Pathophysiology template essay paper












Numerical analysis homework help

Explain the central limit theorem.

Numerical analysis homework help

Perform an analysis of the problem facing Allied Insurance and prepare a report that summarizes your findings and recommendations. Be sure to address the following issues:


The payoff table of Russo Manufacturing, ignoring all the probabilities.

(5 marks)

Recommendations regarding which decision the management should take if they ignore

the probabilities and decide to apply the following decision criteria:


Optimistic Approach

Conservative Approach

Minimax Regret Approach

(5 marks)


(5 marks)


(5 marks)


Computation of the posterior probabilities of weak demand, medium demand and strong demand given the market research is conducted. Briefly explain the meaning of

these probabilities.

(5 marks)

A decision tree illustrating the decisions and events that Russo is facing. All the payoffs,

probabilities and decision at each step need to be labelled carefully on the tree.

(25 marks)

A recommendation whether the market research should be undertaken. Explain clearly the reasons for your recommendation.

(10 marks)

A decision strategy that Russo should follow if they take the recommended action in 5. (10 marks)

A sensitivity analysis to illustrate how different decisions change if the prior probability

of [xiii.] change by 0.1 at a time.


(20 marks)


Presentation (10 marks)


The report must be written in a clear manner and including the required items. There is no need to restate the questions in your report. Your report must have the following structure:


Executive summary

Give an overview of the problem, the solutions and the recommendation


Introduce the case study and the objectives of the report

Main body

This section addresses all the questions associated with the case study.


Conclude the case study and present your recommendations to the board of directors based on the analysis.

Numerical analysis homework help

MATH 312 Final Exam Past Due Date Final Exam Will Not Be accepted

Due on Sunday, December 06, 2020 Print your name: _________________________________.

Page 1 of 3

(Show all work.) [1] Find the small positive integer solution of each problem: (38 pts)

(Hint: you may find any integer solution first, then add/subtract a multiple of n)

[1a] 7x ≡ 6 (mod 41), 0 ≤ ≤ 40


[1b] 35x ≡ 15 (mod 64), 0 ≤ ≤ 64

[1c] 0 ≤ ≤ 17 • 19 = 323

� x ≡ 5 (mod 17) x ≡ 11 (mod 19)













MATH 312 Final Exam Past Due Date Final Exam Will Not Be accepted

Due on Sunday, December 06, 2020 Print your name: _________________________________.

Page 2 of 3

[2] Given = 41 = 9. Solve each equation: (20 pts) [2a] Find satisfying 1 ≤ < 41 and ≡ 1 ( 41)


[2b] Find satisfying 1 ≤ < 41 and ≡ 28 ( 41) (Use [2a] is easier.)

[3] Find the set of quadratic residues and the set of nonresidues of p = 17. 12 pts



MATH 312 Final Exam Past Due Date Final Exam Will Not Be accepted

Due on Sunday, December 06, 2020 Print your name: _________________________________.

Page 3 of 3

[4] Use [4*] to find the smallest positive integer solutions (if any) of each quadratic congruence equation: (30 pts)

[4*] 12 ≡ 1 ( 11), 22 ≡ 4 ( 11), 32 ≡ 9 ( 11), 42 ≡ 5 ( 11),

52 ≡ 3 ( 11), 62 ≡ 3 ( 11), 72 ≡ 5 ( 11), 82 ≡ 9 ( 11),

92 ≡ 4 ( 11), 102 ≡ 1 ( 11)

[4a] Solve the congruence equation: 9 2 + 6 + 1 ≡ 0( 11), 0 ≤ ≤ 10







[4b] Solve the congruence equation: 5 2 + 3 + 2 ≡ 0 ( 11), 0 ≤ ≤ 10






[4c] Solve the congruence equation: 3 2 − 4 + 1 ≡ 0 ( 11), 0 ≤ ≤ 10