Case study

 

 

Case Scenario 2 Mrs. Barlow is a 77-year-old woman living in Melbourne. She was admitted to a medical ward via her GP’s surgery where she presented with a severe headache.  In the Emergency Department, Mrs. Barlow, had a full blood screen, an ECG, commenced on cardiac monitoring and was sent for a CT scan. Her past history includes: Hypertension, obesity and diabetes.  Mrs. Barlow lives alone in a flat, is active in her church and attends a seniors group once a week. She has two grown up children who live in Adelaide. Her medications include: nifedipine (CR) 60 mgs daily, furosemide 20 mgs daily and potassium chloride 8 mEq twice a day. Mrs. Barlow is on a low calorie and reduced sodium diet. She has been instructed by her GP to take a short walk twice a day, however, her knees get painful and she does not always comply with his advice. When you initially meet Mrs. Barlow you observe that while she appears to understand you, she is having difficulty following your conversation. You also observe that her responses to your questions are at times inappropriate. Her initial obs: T, 36.8, P 106, BP 174/98 mmHg, R 26, Oxygen sats. 96% on room air and BSL 16. She had been prescribed aspirin and was administered TPA (Tissue Plasma Accelerator) in the ED.
Part a: no need to write part “A” JUST PART “B”• Explain the pathophysiology that occurs in an ischaemic vs a haemorrhagic stroke. 350 words Mrs. Barlow has been diagnosed with an ischaemic stroke. Taking into consideration her past history and current condition, identify potential complications, providing rationales from current literature.  For three (3) of these complications, utilising current literature, discuss:• a) the nursing interventions required to prevent or minimise the risks of each complication identified. AND • b) how you would monitor Mrs. Barlow in the initial 24 hours of her admission. 1,100-1200 words Part b: Mrs. Barlow is recovering with no further episodes since admission and is to be discharged with support from her GP, the allied health team and district nurse. Her daughter has flown from Adelaide to support her mother when she initially returns home. This is a temporary measure as she has school aged children, and cannot stay with her mother long term. Her daughter tells you that her mother is not always taking her medication, particularly her furosemide, as she does not like getting up at night to go to the toilet. She also has a preference for eating cakes and biscuits. You have been assigned to manage Mrs. Barlow’s discharge plan.  • Which topic/s should be addressed in the teaching session for Mrs. Barlow and her daughter? AND who should be involved? 600 words• In your discharge plan, what would you do to ensure continuity of care following discharge to community services? Provide evidence based rationales for your proposed strategies. 600 words

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