CAN155: Clinical Reasoning Report- Case Study Assignment

Internal Code: MAS1061

Case Study Assignment:

A Case Study of Mr. Brown: Mr. Brown presented in the hospital after a syncopal episode observed by his wife with complaint of dizziness and lightheadedness. Syncope, the result of the sudden drop of blood pressure (BP) in the arteries that perfuse the cerebrum, usually causes interruption of the oxygen supply to the cerebral cortex (Puppala, Dickinson & Benditt 2014). However, he is conscious and able to turn to interact with staff, suggesting he is alert and orientated. Normal ranges of vital signs (VS) for adults are: temperature 35.8°C-37.5°C, pulse 60 -100 beats per minute (bpm), BP less than 120/80 mm Hg, and respiration rate 10 -20 breaths per minute (bmp) (Jarvis et al. 2012). Assessment was conducted 30 minutely, and Mr. Brown’s temperature has been within the normal range yet slightly elevated; he is tachycardic at 110 bpm and has an elevated respiration rate at 22 bpm. A BP below 90/60 mm Hg, is generally considered hypotensive. Medical history shows that Mr. Brown has had hypertension, yet according to the case notes, it is usually well controlled. Currently, his BP has seen significant declination, dropping from 98/60 mm Hg to 90/40 mm Hg. Two major causes— decreased blood volume and post administration of antihypertensive medication can affect the BP (Martini, Welch & Martini 2005).A peripheral vascular assessment finds his radial pulse is weak, and his jugular venous pressure (JVP) is decreased. JVP is the indicator of the venous blood volume (Jugular Venous Pressure 2012), and low JVP usually reflects hypovolaemia (Walker, Hall & Hurst 1990). Moreover, his capillary refill is less than 4 seconds, indicating poor peripheral perfusion (Jarvis et al. 2012). According to the case notes, Mr. Brown has high cholesterol, a risk factor of atherosclerosis (McCance & Huether 2010). Cardiac assessment, however, shows that his heart’s location, size and sounds are all normal. He denies chest pain. No carotid bruit is heard, indicating there is no stenosis of the artery. Question: Write a clinical reasoning report. Demonstrate your understanding of the clinical reasoning cycle by applying the first three components of the cycle to the case above. a) Consider the patient situation (tells us what is significant about her age, culture, health specific issues, medical history and social history, making links to the presenting situation). b) Collect cues and information by reviewing current information, gathering new information (telling us what assessments are needed while linking this to a clear understanding of what is going on with the patient from a functional and structural perspective within the brain). Making these links requires you to recall knowledge of the bio scientific principles underlying the case. c) Process the information by careful analyses identifying normal from abnormal. Discriminate by narrowing down to tell us what are the most important and relevant cues to Mrs Amari at this time (the current situation). Relate the cues collected to tell us which cues can be clustered together and ‘connect the dots’ to inform us that Mrs Amari is having a deterioration. Next infer -think about the cues collected and consider what Mrs Amari is experiencing. These questions are not allocated any marks towards the clinical reasoning report. They are guiding questions to assist with knowledge recall in preparation to write the clinical reasoning report. 1. What causes a TIA and what is the natural progression of a TIA? 2. Explain how a TIA differs from a cerebrovascular accident (stroke, brain attack, CVA)? 3. Discuss the defining characteristics of a transient ischemic attack (TIA). 4. How does Mrs. Amari’s case fit the profile of the “typical” client with a TIA? 5. Mrs. Amari has hypertension and hypercholesterolemia. Think about why this is a concern. 6. Identify Mrs. Amari’s predisposing risk factors for a TIA and possible stroke. Which factors can she change and which factors are beyond her control? What can she do to change her risk factors? 7. A nurse reports she hears a carotid bruit on physical assessment. What is a bruit and why is this of concern to the nurse? 8. What assessments are normally carried out on a patient with a changed neurological health status?