Cerebrovascular accident (CVA) better known as a stroke, occurs when blood flow is interrupted to any part of the brain. There are two main types of cerebrovascular accident: ischemic stroke and hemorrhagic stroke. Cerebrovascular accidents are major causes of morbidity and mortality (Vora et al., 2019). Risk factors for CVA are divided into modifiable and non-modifiable risk factors. Non modifiable risk factors include age, sex, ethnicity and geography, family history of stroke. Modifiable risk factors include smoking, alcohol consumption, drug abuse, arterial hypertension, diabetes mellitus, dyslipidemia, heart disease and hyperhomocysteinemia. Sudden signs of stroke consist of FAST: face drooping, arm weakness, slurred speech, time to call 9-1-1. . Cultures are at higher risk for Cerebrovascular accidents are American Indian/Alaska natives. Native Americans have 2.3 greater odds of being diagnosed with diabetes than non-Hispanic Caucasians, a condition that is a risk factor for heart attack and stroke (Van Hooser et al., 2020). Native American continue to experience healthcare disparities therefore causing lack of awareness to heart diseases, diabetes, and stroke.  Deep tendon reflex reveals involuntary muscle contraction, the intactness of the reflex arc at specific spinal levels, and the normal override on the reflex of the higher cortical levels. The DTR is sometimes called stretch reflex or myotatic reflex because of the stretch action and the muscle response involved (Rodriguez-Beato & De Jesus, 2020). The deep tendon reflex has 5 components: an intact sensory nerve (afferent), a functional synapse in the cord, an intact motor nerve fiber (efferent), the neuromuscular junction, and a competent muscle. The reflex response is graded on a 4-point scale: 0 No response, 1+ Diminished, low normal, or occurs only with reinforcement, 2+ Average, normal, 3+ Brisker than average, may indicate disease, probably normal, 4+ Very brisk, hyperactive with clonus, indicative of disease.Peripheral neuropathy is symmetric damage to peripheral nerves (feet or hands), resulting in pain without stimulation of the nerves. Diabetic peripheral neuropathy manifests as lack of sensation in the toes spreading to the foot, and the leg causing numbness and pain (Tahir et al., 2020). What I would expect to find in a person with diabetic peripheral neuropathy impaired light touch sensation to the feet, hands or legs, vibratory perception, absent or diminished ankle-deep tendon reflexes as well as muscle weakness. Due to neuropathy, patients have difficulty with mobility and daily activities.  We constantly have diabetic patients in the COVID unit. Most of my family members are diabetic as well, my mother has daily neuropathy pain. At work many of my diabetic patients go have dialysis. I recall a time when I cared for a diabetic patient with bilateral lower extremity amputation and an unstageable pressure ulcer to the sacrum. Wound healing is difficult in diabetic patients. Wound debridement was done.  Patient was frequently repositioned, pain medication administered, glucose levels maintained, and wound care provided. Because of diabetic peripheral neuropathy, skin cuts and blisters often go unnoticed and lead to complications if not treated on time.

ReferenceVora, C., Talsaniya, K., & Prajapati, B. (2019). Clinical profile of cerebrovascular accident patients with special reference to serum homocysteine level. International Archives of Integrated Medicine, 6(1), 76–82.Rodriguez-Beato, F. Y., & De Jesus, O. (2020). Physiology, Deep Tendon Reflexes. In StatPearls. StatPearls Publishing.Van Hooser, J. C., Rouse, K. L., Meyer, M. L., Siegler, A. M., Fruehauf, B. M., Ballance, E. H., Solberg, S. M., Dibble, M. J., & Lutfiyya, M. N. (2020). Knowledge of heart attack and stroke symptoms among US Native American Adults: a cross-sectional population-based study analyzing a multi-year BRFSS database. BMC Public Health, 20(1), 40. https://doi.org/10.1186/s12889-020-8150-xTahir, M., Adil, M., Khalid, S. R., Khan, S., & Tariq, S. B. (2020). Prevalence and Risk Factors for Diabetic Peripheral Neuropathy among Type 2 Diabetes Mellitus Patients. Professional Medical Journal, 27(9), 1885–1890. https://doi.org/10.29309/TPMJ/2020.27.09.4239

Compare and contrast an online class and face-to-face class. Do you believe there are different skills and considerations involved? How do the roles of the teachers and students differ?

You are free to choose the method of completion for this assignment: a report, a graphic organizer, Venn Diagram, PowerPoint presentation, or you can create a rubric assessment

Assignment:

Provide a reflection of at least 600 words of how the knowledge, skills, or theories of the course Legal Regulation, Compliance and Investigation have been applied, or could be applied, in a practical manner to your current work environment. If you are not currently working, share times when you have or could observe these theories and knowledge could be applied to an employment opportunity in your field of study.

Requirements:

Provide a 600 word minimum reflection.

Use of proper APA formatting and citations. If supporting evidence from outside resources is used those must be properly cited.

Share a personal connection that identifies specific knowledge and theories from this course.

Demonstrate a connection to your current work environment. If you are not employed, demonstrate a connection to your desired work environment.