Briefly discuss what the likely discharge planning, education and allied health input (if required) would be needed for Mrs Cook.
Essay Criteria F:(150 words/5marks)
Nursing management of patients
address the essay criteria related to this case study in essay format. You may use appropriate headings to direct the reader. Use the suggested word count and weightings when addressing your criteria.
Essay Criteria: Case Study
Mrs Georgia Cook is a 39 year old lady who is day 3 post L) sided CVA. Three days ago, she was suddenly unable to verbalise words whilst talking on the phone. Mrs Cook was found by her husband 30 minutes later and taken to the Emergency Department; he stated that she didn’t seem to recognise him and was unable to move very much. On arrival she had dense R) sided hemiplegia, was aphasic, incontinent and displaying signs of agnosia. A head/brain CT scan revealed an ischaemic area, no bleed was seen.
Medical History – Mrs Cook is a maths teacher at a middle school, she is mildly overweight, on the oral contraceptive pill (OCP), has mild hypercholesterolemia, Type II Diabetes Mellitus and had a cholecystectomy two years ago. Her medications include: OCP, atorvastatin, metformin and multi-vitamins.
Social History – Mrs Cook is married to Tom and they have 2 young teenagers (Sommer 13, Damon 15); she is active in her children’s school committees and plays social netball twice a week.
Nursing Notes – Overnight Mrs Cook received regular pressure area care. At times, she appeared uncomfortable; paracetamol was offered and eventually given with good effect. She remains hemiplegic though RN Bronwyn (the morning shift nurse) thought she elicited a response from her R) hand. Mrs Cook is now showing signs of expressive aphasia but is frustrated++. An NGT is insitu and she is for dietician review ASAP as her weight continues to decrease. The speech pathologist will also have some input to assess her dysphagia. Her BSL and vital observations remain stable though patient hypertensive -150/88
Medications charted: Clexane S/C, Aspirin 100mg, Atorvastatin, Ramipril, multivitamins, Omeprazole IV, Metoclopramide, N/Saline 8/24.
Currently Mrs Cook has an IDC insitu, draining well. Her bowels have been loose and she has developed some redness to her perianal area. There is also some concern about mild pressure area at her r) heel. RN Bronwyn also voiced some concerns about unilateral neglect; the doctor will investigate this further today.
Mrs Cook’s husband is handling the situation well as can be expected but is struggling with her condition and is worried about the future. When her children come in to see her they are unsure what to do or say. Often Mrs Cook is teary when they leave.
Brief introduction- (150 words)-
Main context including:
Essay CriteriaA: (100words/5 marks)
• What sort of stroke has Mrs Cook had – provide rationale for your answer
Essay Criteria B:(200 words/10marks)
• Discuss Mrs Cook’s medication in relation to her condition.
Is there any other medication you would add or withhold?
Essay Criteria C:(200words/10 marks)
• Is Mrs Cook at risk of developing Increased Intracranial Pressure (IICP)?
Provide rationale for why/why not
• What are the signs and symptoms of IICP and what nursing assessments
would you conduct to identify this?
Essay Criteria D:(1000 words/30 marks)
• Highlight areas of concern (physical, mental, social, emotional…)
throughout Mrs Cook’s case study and discuss nursing management
care and rationale for these.
Essay Criteria E (200 words/10 marks)
• Briefly discuss what the likely discharge planning, education and
allied health input (if required) would be needed for Mrs Cook.
Essay Criteria F:(150 words/5marks)
• What lifestyle choices or health promotion would you recommend
to reduce the risk of someone developing a CVA? Provide rationale
for your answers
Conclusion (100 -150 words)
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