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Case Study

Mid Year presentation
by

megan douglas

on 4 July 2013

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Transcript of Case Study

Finally
Mr X Now
Clinical History
CASE STUDY
Mr X
Medication
Nursing assessment & Documentation
Falls risk; moderate* according to JHC
Physical Assessment
Nursing considerations
Location;
Pt moved closer to nurses station
77 year old
Male
TA
Symptoms & Diagnostic test
Post MI CT revealed at SCGH
Mobility
;
1x standby/supervision
JHC Policy; Interventions from FALLS RISK
Pt reminded to call for assistance
Neuro OBS
Pin point pupils => raised ICP
Alteration in limb movement or LOC => further bleed
R) Heminopia
(Chadwick Optical, 2009)
Loss of vision
in either the right or left sides of both eyes; a common
side effect of
stroke or
brain injury
.
WHY?
; Hemianopia (vision loss)
> Causes serious problems with mobility, bumping into objects,
increased incidence of falls and accidents
and reading problems.
Chadwick Optical, 2009
He is doing well at home, things are
"getting better, slowly, each day"
He has started
filling out

forms
by himself
Walks with his wife
when mobilising due to
tendency to divert right
Malnutrition Screening Tool
Recent
10kg weight loss
=> Symptom of
arteritis
Weight loss interventions
Referred to dietician
Initially
soft N/Fluids =>soft/normal diet
SCGH transfer
(for rehab)
Chungs Team
Parietal Craniotomy &
Evacuation ICH
L) sided
Parieto-Occiptal
Bleed
= scored 3
No decreased appetite
References
http://www.hemianopia.org/
Firestein, G.S., Budd, R.C., Harris, E.D., et al, eds. (2008). Kelley's Textbook of Rheumatology (8th ed.). Philadelphia, Pa: Saunders Elsevier.
(Firestein, Budd, & Harris, et al, 2008)
1.
2.
TA => Sudden vision loss or eye muscle weakness
Speech
therapist/pathologist
&
Parietal lobe

impairment
Speech;
Expressive dysphasia
Decrease in speech generation & comprehension
Receptive dysphasia
Difficulty in comprehension of language, reading & writing
Difficulty;
naming objects
writing words
focusing visual attention
reading
performing maths
drawing
Poor visual perception
Lack of awareness of certain body parts &/ surrounding spaces
Heminopia=>
Occipital Lobe
impairment
Neurological Assessment
LOC / GCS
'normal'
Limb movement
- 'normal power'
Balance & coordination
- impaired
including pupils
Inspection;
Head wound;
Healed
Cardiovascular Assessment
http://e-ageing.wacha.org.au/index.php?id=2065
2013
Inspection;

Auscultation;




Neurovascular;
No jugular vein distension
Normal S1 &S2 heart sounds at APETM
No audible heat murmurs
Low BP (varies)
Pulses palpable; weak & regular
NOTE; No tenderness of temporal arteries
no current AF
Extremities;
bilaterally warm,
'normal' colour,
dry
cap. refill <3sec
no oedema
AMI x2
Acute Myocardial Infarction
12 days post op
Hypertension
CT at JHC 1 day post admission
showed
another bleed
Hypercholesterolemia
High cholesterol
http://www.heartfoundation.org.au
CVA
Stroke/ cerebrovascular accident
Unstable Angina
http://www.who.int/topics/cerebrovascular_accident/en/
New
AF
Atrial Fibrillation
Temporal artritis
LAD
Left

Anterior Descending
Coronary artery stenosis
(narrowing)
Movicol
Coloxyl & Senna
Pantoprazole
Ramipril
Rosuvastatin Calcium
Aspirin
Metoprolol
Poly tears- eye drops
Paracetamol
Headaches
Vision problems
Tissue biopsy
Duplex ultrasound
(AAHCC, 2013)
American Accreditation HealthCare Commission (2013). Temporal Arteritis. New york.
Prednisone
(Later ceased)
Physio
OT
Shower chair on D/C
Regular mild exercises; inc. balance & coordination
Bowel Chart
EWS
Hypotensive
-Medical Devices were not warranted
Visitors
-On top of daily allied health, visitors would stay for hours.
-This was taking a toll on the pt's health - very tired
-Nursing spoke to pt & wife, who later limited time for friends to visit
Emotionally
Pt has been incredibly positive throughout the experience and feels
his situation has to be handled one day at a time.
Reading, Writing & Word Pronunciation/ recognition
Speech
therapist/pathologist also;
Family
Wife visited daily. Very supportive family.
Full transcript