Mr John Smith is a 72 year old gentleman admitted to your ward after an episode of collapse & altered level of consciousness at home early this morning.
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On examination in the emergency department, he was found to be slightly confused with mildly slurred speech.
His confusion resolved prior to coming to the ward but his speech remans slurred.
He is fully mobile but has a slightly unsteady gait as he ‘ feels numb in the right leg & arm’.
His only other complaints are a headache & cough.
His observations & diagnostic studies are as follows:
T. 36.2
HR. 76
RR.18
BP 182/94
ECG – Normal sinus rhythm
SPa02 96% room air
GCS E=4, V=4, M=6 14/15
weight 75kg
Chest xray – normal
CT head (non – contrast) – normal
Haematology & Biochemistry results – normal
Mr Smith is commenced on 5mg oral Perindopril (ace inhibitor) (mane).
PART ONE: (1000 words)
Compare & describe the two classifications of Stroke & their clinical manifestations, how does this explain why Mr Smith’s intial CT head showed no abnormality. Discuss your intial nursing management of Mr Smth in relation to his pathophysiology.
PART TWO: (1000 words):
Describe potential adverse events Mr Smith is at risk of developing. Discuss your intereventions and plan of care to reduce them, including the use of multidisciplinary health professionals. Give a rationale.
Two days after admission to your unit. Mr Smith is noted to be febrile & his cough has worsened.
He is feeling generally unwell & has a decreased appetite.
Repeat investigations& observations are:
T. 38.2
HR. 88
RR. 28
BP 112/61
SPa02 90% room air
GCS E=4, V=5, M=6 15/15
pupils equal & reactive
Chest xray shows consolidation in the right lower lobe
Repeat CT with (contrast) shows moderate area of infaction in the left frontal lobe.
Haematology shows elevated white cell count.
Mr Smith is commenced on IV Ceftriaxone 2gms daily & 75mg clexane subcut daily.
PART THREE: (1000 words):
Mr Smith is commenced on oral Perindopril, IV Ceftriaxone & s/c clexane.
Discuss the use of these pharmacologic therapies in rletaion to Mr Smith’s current medical problems.
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