Cerebral vascular accident

Mrs. Amelia Middleton is a 68 year old retired receptionist who is bought in by ambulance to theemergency department (ED) of her local hospital. Her son Paul is with her. Paul had called theambulance service earlier stating that his mother woke this morning complaining of a headache and is now unable to lift her right arm and has been having difficulty speaking.

On examination Mrs. Middleton has a BP of 200/110, pulse 78 and irregular, respiratory rate 16,SpO2 98%, Glasgow Coma Scale 12, and Temp 36.8. Her blood sugar level is 4.8mmol/L. She also has paralysis of the right arm and face and loss of sensation to touch on the right side of her face and right arm. She appears to understand what is being said to her but cannot respond verbally. Mrs. Middleton’s history includes depression and lower gastrointestinal bleeding associated with haemorrhoids. She has no known allergies. Mrs. Middleton is an only child. Her father died of an anterior myocardial infarction at age 57 and her mother died of breast cancer at age 72.

Mrs. Middleton currently lives with her son after the recent death of her husband, Geoff. She is in the process of trying to sell the family home. She has three other children, all of whom live interstate.

Amelia Middleton’s current medications are:

Sertraline 100mg mane
Rectinol HC topically as required

At the time of arrival Mrs. Middleton had a provisional diagnosis of CVA/stroke.Mrs. Middleton was ordered a CT scan which was conducted 6 hours after her arrival to ED, theresults excluded the presence of a haemorrhagic stroke but indicated ischaemic stroke.A 12 lead ECG was also conducted on arrival and Mrs. Middleton was found to be in atrial fibrillation.

Directions:

This assessment task requires you to apply the Clinical Reasoning Cycle (CRC) to the above case study, using the following questions/instructions to guide and organise your response. Your answers should be presented in an integrated essay-format with good introduction and conclusion (rather than short-answer responses) and be informed and supported by your reading of current research and literature.

1) What additional data/cues would you gather in regard to this case, and how and why would this be performed?

2) Draw upon existing knowledge and relevant scholarly literature to process the above information.

3) Given that the diagnosis of ischaemic stroke has already been confirmed, identify and explain two other issues/problems for Mrs Middleton that emerge from your analysis of the data (remember, these do not necessarily have to be other specific diagnoses/conditions, but could be particular problems that arise due to the stroke).

4) Select one of these issues/problems and establish a clear goal for your care.

5) Discuss your key actions/interventions for achieving this goal, drawing upon appropriate practice literature.