Case Study - Mrs Anh Thuy

Mrs Anh Thuy is a 43 year old lady admitted following an incidence of blurred vision, numbness down the right side and a sharp pain in her head. A neighbour found her on the ground unable to move or speak.

She has been diagnosed as having an ischaemic cerebro-vascular accident. She was immediately commenced on anti-coagulant therapy.

Family history -

·             Born to Vietnamese parents in Australia

·             Buddist & speaks Vietnamese & English

·             Lives with husband & 2 children, Grace 4 years old & Ty 13 years old. Also father who is a frail 82 year old.

Medical history -

·             Hypertension, Type 2 Diabetes, Asthma

·             Depression

·             Lactose intolerant

·             Hearing aid left ear

·             Bi-focal glasses (broken in fall)

·             Upper dental partial plate

·             Medication - Amlodipine, Metformin, Salbutomole.

Admission observations -

BP 170/100

PR 90 regular

RR 24

T^o 36.4

SpO₂ 98% on room air

BGL 7.4 mmol

Weight 71 kg

Height 152 cm

GCS (Glasgow coma scale) = 14

Eyes open to speech

Oriented to time, place and person (speech slurred, but able to be understood)

Right hemiparesis

PERL (Pupils equal reactive to light)

Issues/impacts of the CVA -

·             Pain on movement, mainly right hip & shoulder

·             Large haematoma right hip

·             5cm skin tear right elbow

·             Dysphasia

·             Dysphagia

·             Right sided facial droop

Doctor's orders and interventions-

·             Rest in bed (RIB)

·             2nd hourly Neurological observations

·             Nil by mouth (NBM) until Speech Therapist review

·             Physiotherapist review

·             Full assistance with hygiene

·             IDC insitu

·             Intravenous Therapy via cannula in left forearm

Discharge Information -

Mrs Thuy will remain in acute care for two (2) weeks and then be transferred to the Rehabilitation Unit for intensive physiotherapy and occupational therapy.  Community Services and the Discharge Planning team have been contacted.

1.        Using the headings below explain how you would prepare for Mrs Thuy's arrival to the ward.

1. Preparation of room in ward?

2. Care Plan

Nursing diagnosis (NANDA)

Risk for impaired social function related to depressed mood and impact of major health event (CVA)

Assessment (client has/has not, data)

Plan (goal, expected outcome, what do you hope to achieve)

Implementation (nursing interventions)

Rationale (reason why)

Evaluation (did the plan of care work, how will you know)

3.     Mrs Thuy presses her call bell and tells you she feels "dizzy and has the shakes", you observe that she is cold and clammy and notice that she has not eaten any of her breakfast as she was unable to reach her breakfast tray. Using the information in Mrs Thuy's medical history, knowledge gained in the assessment process and your knowledge of anatomy and physiology, what would you suspect was the problem? 

Outline the steps you would take to manage this situation as a Student Enrolled Nurse.

a)What is the problem? 

b)List three (3) nursing interventions to manage the presenting problem?

4.       Mr Thuy is providing ADL support to his 82 year old father-in-law, Mrs Thuy and his two children. Complete the following table to look at health needs across the lifespan. Provide two (2) extra examples of the cares that can be carried out for each activity of daily living 

Personal hygiene/grooming:

4 year old

1.

2.

Mrs Thuy ( on discharge)

1.

2.

82 year old

1.

2.

Eating and drinking

4 year old

1.

2.

Mrs Thuy (on discharge)

1.

2.

82 year old

1.

2.

Mobility

4 year old

1.

2.

Mrs Thuy (on discharge)

1.

2.

82 year old

1.

2.

Safety

4 year old

1.

2.

Mrs Thuy (on discharge)

1.

2.

82 year old

1.

2.

Toileting

4 year old

1.

2

Mrs Thuy (on discharge)

1.

2.

82 year old

1.

2.

stuck on these 4 questions please help.