35814/04 Case Study of Mrs. Betty Jones - Medical Science Assignment Help

Assignment Task
 

Case study background information - Mrs Betty Jones:

Betty is a 72-year-old English lady who lives with her partner Malcolm in their own 2-bedroom house.  Betty has two daughters who visit regularly, and she cares for one of her grandsons on Tuesdays and Thursdays while his parents are working.
Betty presented to her GP following a 12hr history of ‘droopy eye’ which is diagnosed as ptosis.  

On neurological examination, the GP noted that her L) pupil was sluggish to respond to light and she was hypertensive 172/98mmHg on assessment.  Neither of these symptoms were present in Betty’s past medical history so suspecting a neurological event. 

The GP sent Betty to the local hospital for an MRI and further investigation by the neurological team. Now in the hospital, Betty complains of a sudden intense headache with visual disturbance, neck stiffness and nausea. 

Past medical history:

• Hypertension, diagnose 20 years ago
• Hypercholesterolaemia diagnosed 20 years ago 
• L) TKR, 10 years ago 
• Osteoarthritis 
• Psoriasis diagnosed 55 years ago 
• L) Leg DVT, post TKR 

Vital signs: 

• Pulse: 115 beats per minute 
• BP:172/98 mmHg
• Respirations: 26 breaths per minute
• Temperature: 38.4oC 

Current medications include:

• PO Ibuprofen 400mg QID 
• PO Panadol Osteo 650mg TDS 
• PO Simvastatin 40mg nocte 
• PO Trandolapril 4mg Daily 
• Celestone Ointment applied to Psoriatic patches TDS PRN  

Q1. Regular Neurological observations will be necessary for this patient, discuss the rationale for undertaking these observations.

Q2. Discuss the likely changes you would expect to see in Betty’s neurological and vital signs when her condition deteriorates?  Explain the pathophysiology. 

Q3. List three (3) priorities of your immediate care for a rise in intracranial pressure. 

Q4. How would you explain to Malcolm the pathophysiology of an aneurysm? Include in your response concepts of mediation, negotiation or conflict resolution.  

Q5. When answering Malcolm's questions, explain how you would demonstrate the concepts of mediation, negotiation or conflict resolution. 

Q6. Outline the procedure for the application of anti-embolic stockings and the rationale for their use for this patient. 

In this case betty has L) weakness and she immobile after post-surgery most of times so anti-embolism socks will place pressure on the legs to increase circulation. It will reduce the risk of blood clots in deep vein in the legs, also called deep vein thrombosis (DVT). Doctor will prescribe correct size socks for her as it is essential, she wear correct size sock to avoid complications, such as pressure sore. For applying anti-embolic stocking needs to follow this procedure. 

•    Measure to ensure to proper fit.
•    Powder skin lightly unless contraindicated .
•    Turn stocking inside out, tucking heel inside.
•    Stretch stocking over knee.
•    Pull stocking over leg.
•    Check skin for color, temperature, sensation and swelling.

Q7. Discuss your scope of practice in relation to the care of the deteriorating patient within the interdisciplinary health care team.  

Q8. Using the care plan below, outline the nursing care and rationale for the management of an unconscious patient and include preoperative care. Provide three (3) actual or potential problems with at least one (1) nursing intervention, rationale and evaluation of the goal for each problem you identify.

Scenario update Day 2 Post-op:

2 days postoperative, Betty is recovering well and has some residual L) leg weakness.  She has been mobilising short distances with x1 assistance and a 4-wheel walking frame.  She is tolerating a ward diet with free fluids and the doctor has requested her Indwelling Urinary Catheter to be removed.   

Q9 . Discuss how you can encourage Betty to maintain her own independence, taking in to account her physical, emotional and psychosocial needs. 

Q10. Discharge planning commences on admission.  Research three (3) support services Betty might need on discharge and discuss how three (3) members of the interdisciplinary health care team may assist in her recovery at home. 

Q11. While preparing Betty for discharge home her partner Malcolm states to you that he is scared about Betty coming home and does not believe he will be able to cope with her increased dependence.  How could you address these concerns with the Registered Nurse?  

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