One of Greta’s close friends from the Latvian club has a daughter who is a second year student nurse. Greta has asked if you can explain the pathophysiology of a Cerebro Vascular Accident (stroke) and how it affects the central nervous system to her friend’s daughter, as she doesn’t understand and has an exam approaching.

Greta has given her permission for you to use her as an example. Please explain the pathophysiology of a Cerebro Vascular Accident (stroke) and how it affects the central nervous system using the correct medical and nursing terminology.

INTRODUCTION
Mrs Greta Balodis is a 75 year-old widow who until recently lived alone in her single-storey house. She has recently returned home from rehabilitation post a R) CVA. Her daughter Anne has relocated to the city with her family to become Greta’s full-time live-in carer. However, Anne’s family have psychosocial and psychological complexities that impact on the wider family dynamics. Greta is regularly subjected to her grandson and son-in-law’s problematic alcohol and drug use. Also, because of Anne and John’s relationship issues and Dylan’s erratic behaviour, Greta no longer feels safe in her own home. For some time, Anne manages to care for her mother in the home; however after Greta trips over the cat, she deteriorates post-fall and eventually needs to be placed in high level care.

Meet Greta
Patient
information MRN:
78012499 Surname:
BALODIS Given names:
Greta Ainija DOB:
22/4/1938 Gender:
F
•
Personal details
Patient: Greta Ainija Balodis
DOB: 22/4/1938
Age: 75
Address: 36 Main Street, Elizabeth North SA 5113
Weight: 84 kg
Height: 155 cm
MRN: 78012499
Migrated: Latvia to UK (age 20) and UK to Australia (age 35) under the ‘Skilled Workforce’ program
Family/Significant others
Daughter: Anne, 42yrs old
Son-in-law: John, 45yrs old
Grandchildren: Dylan 11yrs old, Jessica 5yrs old
No other family living in Australia
Background
Greta has been living independently for 38 years in a single-storey house with a garden in the northern suburbs of Adelaide. Over the past two years, Greta’s health has declined making it harder for her to carry out her activities of daily living as independently as she would like. She has been paying for Domiciliary Care to visit once per week and assist her with cleaning and shopping. Greta’s daughter Anne and her family have decided to move back to Adelaide and share Greta’s home in order to assist caring for her. Socially, Greta enjoys attending her local Latvian club for their monthly activities.
Past medical history
? Trans-ischemic attack (TIA) – 2/12 ago (refer year 1 lecturer notes, 1)
Hypertension (refer year 1 lecturer notes, 2)
3 falls in last 6/12
Past surgical history
Appendectomy 40 years ago
Current medication
Atenolol PO 50mg daily
Panadol PO 500mg prn
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Physiotherapy notes (Jill Garner PT): Day 2 Admission post CVA
Patient is in ICU, check with nursing staff and medical staff re status and read medical notes. Subjective assessment: diagnosis, noting area of stroke and interventions until this date, PMH, SH: living arrangements, steps inside and access to her home, services provided, falls history, note 3 falls in last 6 months, previous level of mobility including use of aids. Some of this information may be in the notes and some may not be able to be gained from the patient due to her state of alertness/orientation, so the assessment may continue over the next few days until a fuller picture of the patients SH is uncovered.

Objective assessment:
• state of alertness