NURS2003 - Brian Fuller Case Study, Hypercholesterolaemia - Nursing Assignment Help

Assignment Task

Brian Fuller Case Study 

Brian Fuller is a 78 year old man who lives with his wife Esme in suburban Adelaide.  Both Brian and Esme are fully independent.  They have 3 children who all live overseas, so they only see them once or twice a year. Brian & Esme are very social and like getting together with their friends. Brian plays bowls three times a week and then joins his friends at the local club for lunch.

Brian was shaving this morning when he noted that the left side of his face was drooping.  His left arm also felt very weak.  Brian tried to call out to Esme, but he could not speak properly. He then fell to the floor. Esme heard the fall, ran to Brian & then immediately called an ambulance.

Brian was taken to ED where on arrival he had a BP of 190/91, HR 115, RR 24, SaO2 95% on room air and a temperature of 37.2. He was immediately sent for a CT head and Brian was diagnosed with a CVA.

PMHx:

• Hypertension
• Hypercholesterolaemia
• T2DM
• AF
• GORD
• Cholecystectomy 5 years ago

Brian is transferred to the neurological ward. On assessment he has a GCS of 13, left sided hemiplaegia, expressive dysphasia, dysphagia & blurred vision in his left eye.  He is scheduled to see the speech pathologist and the physiotherapist later today.

After a week of therapy Brian is ready to be discharged to rehab.  He still has some residual dysphasia, but the dysphagia and blurred vision have largely resolved.  He still has significant weakness on his left side.

The doctors have ordered the following medications for discharge:

• Apixaban 5 mg PO daily
• Digoxin 125 mcg PO daily
• Simvastatin 40 mg PO daily
• Ezetimibe 10 mg PO daily
• Perindopril 2 mg PO daily
• Amlodipine 10 mg PO daily

Assignment Instructions
 

1. Identify the most likely type and cause (what you think is the main risk factor) of Brian’s CVA

• Your answer must include a rationale for this selection and explain how and why this cause can lead to a CVA from a pathophysiological perspective.

• Include in your answer the pathophysiology of Brian’s CVA. 

• In other words, discuss the pathogenesis of the most likely cause and how it can lead to CVA. Consider his past medical history. 

2. Identify two (2) other risk factors that Brian has for CVA

• For each of these risk factors explain how & why they can increase the risk of & lead to CVA. 

3. Select two (2) signs and/or symptoms that Brian had as a result of his CVA  

• For each sign/symptom explain how & why it can occur after a CVA, again from a pathophysiological perspective.

4. Select three (3) of Brian’s medications and explain why each of the three (3) medications was ordered for Brian

• Your discussion should include the pharmacodynamics and pharmacokinetics of each medication, including relevant adverse effects and contraindications.

5. Each of Brian’s discharge medications is to be administered orally. This means they will all undergo the first pass effect. Explain what first pass is and the implications this has for a drug’s bioavailability.

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