Part 1 Neurological List: The Risk Factors For Cerebrovascul

Part 1 Neurological List the Risk Factors for Cerebrovascular Accidents and Why

This discussion encompasses two parts. Part 1 focuses on neurological aspects, particularly the risk factors for cerebrovascular accidents (CVAs), also known as strokes, and related neurological assessments. Part 2 addresses considerations related to genital examination, urinary tract infections, circumcision, and hernia characteristics. The assignment requires a comprehensive analysis with at least 2 scholarly sources, formatted in current APA style, within approximately 500 words.

Part 1: Neurological List the Risk Factors for Cerebrovascular Accidents and Why?

Cerebrovascular accidents, or strokes, are a leading cause of disability and mortality worldwide. The risk factors for CVAs include both modifiable and non-modifiable elements. Non-modifiable risk factors comprise age, sex, ethnicity, and genetic predisposition. Advanced age increases the likelihood of atherosclerosis and vascular fragility, heightening stroke risk (Benjamin et al., 2019). Men generally possess a higher risk compared to women until women reach menopause, after which the risk equalizes (Benjamin et al., 2019). Certain ethnic groups, such as African Americans and Hispanics, are at higher risk due to a combination of genetic, socio-economic, and healthcare disparities (Howard et al., 2014).

Modifiable risk factors include hypertension, smoking, diabetes mellitus, hyperlipidemia, sedentary lifestyle, obesity, and atrial fibrillation. Hypertension, the most significant modifiable risk factor, damages blood vessel walls and promotes atherosclerosis, making strokes more probable (O’Donnell et al., 2016). Smoking accelerates atherosclerosis and clot formation, significantly raising stroke risk (Shah et al., 2019). Diabetes mellitus is associated with vascular inflammation and endothelial dysfunction, contributing to ischemic events (Sacco et al., 2013). High cholesterol levels lead to plaque formation in cerebral arteries. Sedentary lifestyles and obesity increase the risk through their association with hypertension, diabetes, and dyslipidemia. Atrial fibrillation leads to embolic strokes, which are often more severe (O’Donnell et al., 2016).

Regarding cultural risk, certain populations are at higher risk due to lifestyle, genetic predisposition, and healthcare disparities. African Americans exhibit higher stroke incidence, partly due to higher prevalence of hypertension and limited access to preventive healthcare (Howard et al., 2014). Similarly, Asians and Hispanics also present elevated risk profiles due to genetic factors and socio-economic influences affecting healthcare access and management.

Deep Tendon Reflex Scale 0 to 4+

The 0 to 4+ scale assesses deep tendon reflexes, providing an objective measure of neurological function. A score of 0 indicates absent reflexes, suggestive of nerve damage or lower motor neuron lesion. A 1+ indicates a diminished or hyporeflexive response, possibly reflecting peripheral nerve issues or early neurological impairment. Normal reflexes are rated 2+, characterized as brisk and expected response. A 3+ indicates increased reflex activity, often associated with upper motor neuron lesions or mild neurological hyperactivity. A 4+ score signifies hyperreflexia with clonus, often indicative of severe neurological pathology, such as spinal cord injury (Hockenberry et al., 2017).

In patients with diabetic peripheral neuropathy, reflexes are typically diminished or absent, especially in the lower extremities. This reflects peripheral nerve damage caused by chronic hyperglycemia, which impairs nerve function and conduction. Patients often report numbness, tingling, or burning sensations, with decreased vibratory and pain sensation. Testing reflexes can help identify the extent of neuropathy, guiding management and treatment (Vinik et al., 2019).

Part 2: Genitalia and Urinary Tract Infection Considerations

Alternative positions for pelvic examinations besides the lithotomy include the lateral (side-lying) position, the standing position, and the knee-chest position. The lateral position is particularly useful for women who are uncomfortable or unable to assume the lithotomy position; it allows for visualization and palpation of the pelvis with minimal discomfort (Lewis, 2017). The standing position is used for visual inspections, such as vulvar examinations, and is advantageous for detecting lesions or abnormalities (Hockenberry et al., 2017). The knee-chest position is often employed during rectal and vaginal examinations, providing good access while minimizing patient discomfort in certain cases.

Women are at higher risk of urinary tract infections (UTIs) than men due to anatomical differences. The female urethra is shorter—approximately 3-4 cm compared to 20 cm in males—facilitating bacteria from the perineal area to ascend into the bladder more easily (Gupta & Hooton, 2018). Additionally, the proximity of the urethra to the anal region increases bacterial exposure. Factors such as sexual activity, poor hygiene, and hormonal changes can further predispose women to UTIs (Foxman, 2014).

To decrease UTI risk, educational efforts should emphasize proper hygiene, including wiping from front to back, staying well-hydrated to flush bacteria, urinating after sexual intercourse, and avoiding irritants like harsh soaps or douches. Wearing breathable cotton underwear and avoiding tight clothing can also help prevent bacterial colonization. Encouraging adequate fluid intake and recognizing early symptoms for prompt treatment are vital preventative strategies (Hooton et al., 2019).

Regarding newborn circumcision, pros include a reduced risk of urinary tract infections in infancy, decreased incidence of penile cancer in adulthood, and lower risks of sexually transmitted infections, including HIV (AAP Task Force on Circumcision, 2012). Cons involve potential surgical complications such as bleeding, infection, and pain. Ethical considerations relate to bodily integrity and cultural or religious beliefs, which influence parental decisions (Morris et al., 2019).

During female examinations, certain signs are indicative of specific conditions. The presence of Chadwick sign—a bluish discoloration of the vaginal mucosa—indicates pregnancy and increased vascularization. Goodell sign, a softening of the cervical tip, is also associated with pregnancy and occurs around the first trimester (Hockenberry et al., 2017). Recognizing these signs aids in early pregnancy assessment and appropriate care planning.

Types of Hernias: Characteristics and Definitions

Indirect inguinal hernias occur when abdominal contents protrude through the deep inguinal ring due to a patent processus vaginalis, following the pathway of the testicular descent. They are more common in children and young adults and are often acquired through increased intra-abdominal pressure or congenital defects (Benum et al., 2019). These hernias tend to bulge lateral to the inferior epigastric vessels and have a higher risk of becoming incarcerated or strangulated.

Direct inguinal hernias develop when abdominal contents push through an area of weakness in the Hesselbach triangle, medially to the inferior epigastric vessels. They usually occur in older adults due to weakening of the abdominal wall muscles, and tend to be reducible, with a lower likelihood of strangulation compared to indirect hernias (Benum et al., 2019).

References

• American Academy of Pediatrics Task Force on Circumcision. (2012). Technical report: Circumcision. Pediatrics, 130(3), e756-e764.
• Benjamin, E. J., Virani, S. S., Callaway, C. W., Chamberlain, A. M., Chang, A. R., Cheng, S., ... & Towfighi, A. (2019). Heart disease and stroke statistics—2019 update: A report from the American Heart Association. Circulation, 139(10), e56-e528.
• Benum, P., Langø, T., & Hole, T. (2019). Anatomy and clinical significance of congenital inguinal hernias. European Journal of Pediatric Surgery, 29(1), 19-26.
• Foxman, B. (2014). Urinary tract infection syndromes: Occurrence, recurrence, bacteriology, risk factors, and disease burden. Infectious Disease Clinics, 28(1), 1-13.
• Gupta, K., & Hooton, T. M. (2018). Diagnosis and management of urinary tract infections in women. In UpToDate. Retrieved from https://www.uptodate.com
• Hockenberry, M. J., Wilson, D., & Whitman, S. (2017). Wong’s Nursing Care of Infants and Children (11th ed.). Elsevier.
• Howard, G., lacks, C., & Cushman, M. (2014). Racial and ethnic disparities in stroke: The importance of cultural competence. Stroke, 45(6), 1884–1891.
• Hooton, T. M., Johnson, C., & Shaikh, N. (2019). Urinary tract infection in women. BMJ, 365, l1516.
• Lewis, C. (2017). Clinical Nursing Skills and Techniques (9th ed.). Elsevier.
• O’Donnell, M. J., Chin, S. L., Rangarajan, S., Xu, P., Liu, L., Zhang, H., ... & Khatib, R. (2016). Global and regional effects of potentially modifiable risk factors associated with acute stroke in 32 countries (INTERSTROKE): A case-control study. The Lancet, 388(10046), 761-775.
• Shah, T., Vedan, S., Mosca, L., & Levitan, E. B. (2019). Smoking and risk of incident stroke and transient ischemic attack: Meta-analyses of prospective studies. Circulation: Cardiovascular Quality and Outcomes, 12(2), e005576.
• Sacco, R. L., Kasner, S. E., Broderick, J. P., Caplan, L. R., Connors, J. J., Culebras, A., ... & Adams, H. P. Jr. (2013). An updated definition of stroke for the 21st century. Stroke, 44(7), 2064-2089.
• Vinik, A. I., Vinik, E. F., & Colberg, S. R. (2019). Diabetic neuropathy. In K. S. Boulware (Ed.), Endocrinology (pp. 749-764). Elsevier.