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MDT Case: Vera Campbell

on 5 December 2013

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Transcript of Brain

Case overview
Vera (58) was taken to A&E 4 weeks ago after an emergency call from her son, Elijah.

She is currently in the stroke rehabilitation unit receiving care from a multidisciplinary healthcare team.

She suffered from Breast Cancer 8 months previous of this, which she was successfully treated for.
Multidisciplinary Case:
Who has been involved?
Addressing Vera's concerns
Outlining a care plan
Case summary

Vera admitted to A&E
Concerns addressed
Rehabilitation and return to normality

Multidisciplinary team:
Nisha Denoo
Jenny Harbour
Tafadzwa Kabambe
Isaac Kamau
Maegan Navaratnam
Marie Reinertsen
Karshana Selvarajah
Poppy Tidswell
Max Whittaker
Euan Williams
Background image courtesy of Alpha Coders: http://wall.alphacoders.com/big.php?i=263254

Section 1:
[1] (NICE, 2009) (http://www.nice.org.uk/nicemedia/live/12132/43315/43315.pdf)
[2] (Cancer Research UK, 2012) (http://www.cancerresearchuk.org/cancer-help/type/breast-cancer/about/types/dcis-ductal-carcinoma-in-situ)

[3] (Map of Medicine, 2013) (http://healthguides.mapofmedicine.com/choices/map/breast_cancer1.html)

http://www.csp.org.uk/your-health/conditions/cancer#how-can-physiotherapy-help-cancer – 06/11/2013
http://healthguides.mapofmedicine.com/choices/map/breast_cancer1.html )
Breast cancer treatment
Stroke treatment
Concerns about treatment
Concerns about abilities
Additional Support
Thank you for listening
Vera's case to date involves two areas of focus:
• Breast Cancer treatment
• Stroke treatment
Introduction to Breast cancer [1] [2]
Breast assessment clinic (radiographer,
breast physician, nurse, surgeon, pathologist)
Clinical nurse specialist in breast care
Counselling and psychological support team
Oncologist surgeon and specialist nursing team (lumpectomy)
Physiotherapist (post-operative care)
GP, pharmacist and oncology team (long-term treatment) [3]
First contact - Son (Elijah)
Admission to ITU by staff in A&E [4]
Diagnostic Radiographers [4]
Admission to acute stroke ward (3 days later) [4]
Consultant stroke physician, stroke medicine services expert, neurologist, clinical nurse specialist, stroke SpR [4]
Admission to rehab unit (3 days ago) [4]
Specialist medical and nursing team [4]
MDT assessment [5] [6] [7]
Counselling, psychological and physiotherapy support team [5]
Home visit support as required
Vera has several concerns relating to the treatment she has received, her physical abilities and what the future holds for her.
• Vera can't understand why this has happened to her
- to be addressed by: doctor, oncologist or any health professional with whom she has a good rapport

-Genetic disposition to Cancer and possible link to Stroke [8] [9]
- Environmental factors
- Age
- Ethnicity [10]

• She is angry that she has not had the best treatment
- to be addressed by: doctor, oncologist, specialist nurse

-Explain that the emergency clot busting drugs for Stroke have a four hour window to be administered in

Vera should be informed about the complaints procedure or given a chance to talk to Patient Advice and Liaison Service in the Hospital [15]

Why address Vera's Concerns

The importance of addressing these issues is:

• To reassure Vera

• To ensure she does not lose trust with healthcare professionals

• To ensure she complies with future medical treatment

supporting and assisting her regain the ability to perform day-to-day tasks

Vera is worried about returning to work and how she will pay the bills.

-Social service - financial benefits
-Occupational therapists

Suffering from:
Abnormal speech (dysphasia)
Speech therapist [7]
Right sided weakness (hemiparesis)
Physiotherapist [16]

The need for further medication
Doctor and pharmacist
Once discharged from the rehabilitation unit, Vera will have a care plan including:
Psychological assessment in first month
Teaching of cognitive functions and communication skills
Physiotherapy [14]
Physiotherapy will play a crucial role in Vera's recovery.
Initially, the physio will:

• improve posture and balance [11] [14] [16]
• form an exercise plan [14] [16]
• daily tasks [14]
• attempt/ensure involvement of family and friends [16] - especially the Church group

If progress is good, and Vera feels strong enough, the physio will then:

long term goal
set a new home exercise plan
home visits [16]

Vera can benefit from support from other organisations, such as the Stroke Association, who offer services such as:
• Information, advice and support service
• Communication support
• Stroke prevention
• Getting back to life
• Carer support [14] [16]

References (continued)
Vera Campbell
Aiding her recovery, regaining independence, getting back to work
To help improve her quality of life by
[4] Torbey MT, Selim MH.
The Stroke Book
. 2nd edn. Cambridge: Cambridge University Press;2013
[5] Ansari Y.
. [Online]. Available from: http://www.prospects.ac.uk/physiotherapist_job_description.htm [Accessed 31st October 2013]
[6] AGCAS editors.
Occupational therapist
. [Online]. Available from: http://www.prospects.ac.uk/occupational_therapist_job_description.htm [Accessed 31st October 2013]
[7] AGCAS editors.
Speech and language therapist
. [Online]. Available from: http://www.prospects.ac.uk/speech_and_language_therapist_job_description.htm [Accessed 31st October 2013]
Part 2:
[8] http://www.birmingham.ac.uk/news/latest//09/Study-confirms-long-term-benefits-of-tamoxifen-are-relevant-to-all-women-who-take-it-for-five-years.aspx
[9] http://www.cancer.gov/cancertopics/pdq/genetics/overview/healthprofessional

References (continued)
[10] http://www.nhs.uk/Conditions/Stroke/Pages/Whosatriskpage.aspx
[11] The NHS Choice website [Acessed 06/11/2013] http://www.nhs.uk/Conditions/Stroke/Pages/recovery.aspx
[12]] http://www.stroke.ie/iopen24/stroke-rehabilitation-t-483_495_508.html
[13] http://www.ouhsc.edu/geriatricmedicine/Education/swallowing/Treatment_Approches_to_Dysphasia.htm

Part 3:
[14] NICE website [Acessed on 07/11/2013] http://pathways.nice.org.uk/pathways/stroke/acute-stroke
[15]] The NHS website [Accessed on ] http://www.nhs.uk/Service-Search/Patientadviceandliaisonservices
Physiotherapy after stroke,
Stroke Association booklet, Factsheet 16, version 01, published April 2012
Full transcript