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 fou
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 near her washing line unable to move or speak.
Mrs Thuy was admitted to your ward via Emergency. She has been diagnosed as having a ischaemic cerebro-vascular accident. She was immediately commenced on anti-coagulant therapy.
Mrs Thuy (URN: 30081965) was born to Vietnamese parents in Australia . The family are Buddist and speak both Vietnameses and English. She lives with her husband and 2 children Grace 4 years and Ty 13 years of age.Her parents came to live with her six years ago. Unfortunately her mother passed away from cancer three years ago and since then Anh has struggled to look after the household. He father is frail due to heart failure and arthritis. Mrs Thuys sadness and depression has meant that Mr Thuy has had a large workload. Some days Mrs Thuy is unable to get out of bed so Mr Thuy is caring for his family as well as working at night time to make ends meet.
Admission Information
Anh has a medical history of hypertension, type 2 diabetes mellitus and asthma. She is Lactose intolerant and has a mild degree of of hearing loss.She wears a hearing aid in her left ear. She usually wears bi-focal glasses but they were broken in the fall. Mr Thuy has taken them for repair. She has a small upper partial plate.
Other than the birth of her children, this is Anhs first admission to hospital. Mrs Thuy was taking the following medications prior to admission: Norvasc, Diabex, Ventolin inhaler. She does not have her tablets or inhaler with her today. She is compliant and has had a good understanding of her medications.
Mrs Thuys observations were taken on admission:
BP 170/100
PR 90 regular
RR 24
To 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 but able to move left limbs on command
PEARL (Pupils equal and reacting to light)
Mrs Thuy appears to have pain on movement.You notice that she grimaced and moaned when she was transferred to her bed particularly when her right hip and shoulder were repositioned.
Mrs Thuy has a large haematoma on her right R) hip.
She also has a 5cm skin tear just below her right R) elbow.
There is marked swelling in both her right arm and right leg following the fall.
Mrs Thuy reports that she only has pain when she moves and only on the R) side.
Mrs Thuy has an IDC (indwelling catheter) insitu.
She has intravenous therapy in progress with the cannula positioned in her left L) forearm.
Due to the right sided hemiparesis, the doctor has requested Mrs Thuy remains resting in bed (RIB). Mrs Thuy will initially require full assistance with her hygiene needs. She is to be assessed by the physiotherapist. The goal would be to improve level of function and mobility to enable her to return to her home safely.
Mrs Thuy is experiencing problems with her speech (dysphasia). She is able to be understood, but her speech is slurred. She reports difficulty swallowing (dysphagia) and has an obvious right sided facial droop. The medical officer has requested a review by a speech pathologist and has asked that Mrs Thuy remains nil by mouth (NBM) until review. Following the assessment the texture of food and fluid may be modified to ensure Mrs Thuy is able to swallow safely. She will be reassessed during rehabilitation and further modifications made according to her progress.
Mr Thuy is Mrs Thuys Power of Attorney for all health matters. Mrs Thuy does not have an Advanced Health Directive in place.
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.
14. 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.You recognise she has deteriorated .
a) Using the knowledge gained in the assessment process and your knowledge of anatomy and physiology, what would you suspect was the problem?
b) Outline the steps you would take to manage this situation as a Student Enrolled Nurse. Remember to reference your answer
.
20. Mr Thuys son has been exhibiting challenging behaviours since his mothers admission. To assist Mr Thuys understanding of his sons behaviour outline the major developmental stages and common health issues of adolescence.
21. Complete the following table in relation to growth and development to help Mr Thuy understand the stages of childhood.
Stage
Physical growth
Psychosocial development
Cognitive
development
Motor development
0-12 months Toddler
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