Case Studies About Sylvester Charles

CASE SCENERIO ABOUT SYLVESTER CHARLES 1 CASE SCENERIO ABOUT SYLVESTER CHARLES 13 Case Scenario about Sylvester Charles Student Name: Institution of Affiliation: Date: Introduction Case studies are basically used in hypothesis testing, drawing plans for different real-world problems as well as generating concrete discussions of potential needs and solutions amongst other such things. Case study essays entail the analysis of cases that involve the finding out of the problems, examination of the problems and the identification of

Running head: CASE SCENERIO ABOUT SYLVESTER CHARLES 1
Case Scenario about Sylvester Charles
Student Name:
Institution of Affiliation:
Date:

CASE SCENERIO ABOUT SYLVESTER CHARLES 2
Introduction
Case studies are basically used in hypothesis testing, drawing plans for different real-world problems as well
as generating concrete discussions of potential needs and solutions amongst other such things. Case studies are quite
fundamental in many sectors ranging from the education sector to the business sector. Case study essays entail the
analysis of cases that involve the finding out of the problems, examination of the problems and the identification of
various viable solutions. Case study essays offer a clear indication of the reasons for effective solutions with
substantial supporting pieces of evidence for them. The essay will succinctly demonstrate a critical analysis of
Sylvester Charles’s nursing care that I have decided to implement. The paper ill succinctly discusses the critical
appraisal of the assessment framework that is the ADLs in accordance with the Roper-Logan-Tierney model and hot
e model impacted the informed decision making in the care planning. The essay will also involve a critical analysis
of the causes of the two nursing problems that have been identified together with the factors that affect the care
planned for the patient. The conclusion of the essay will entail an evaluation of the nursing care plan, which will
indicate an appreciation of the need for evaluating nursing care.
Identification of the Nursing Scenario
Sylvester Charles exhibits a history of hypercholesterolemia, hypertension and diabetes type 2. The three
kinds of diseases are correlated since they can lead to ischaemic stroke. My two priority nursing problems are
ischaemic stroke and type 2 diabetes. On assessment, Sylvester was diagnosed with left-sided ischaemic stroke
related to the inability to move the right side of the body as evidenced by Intermitted confusion, poor attention span,
poor interaction, lack of interest for garden activities, lack of interact for meeting with family and friends, lack of
proper sleep at night. The assessment indicated that the patient had type 2 diabetes related to hypertension as
evidenced by difficulty in walking, troubles in speaking as well as understanding what other people are saying,
occurring due to stroke. There exists a significant connection between stroke and diabetes. As a matter of fact,
diabetes increases an individual’s risk for multiple health conditions, not leaving stroke aside (Sacco, 2012, 32).
Generally, individuals suffering from diabetes have high chances to suffer from stroke as compared to those that

CASE SCENERIO ABOUT SYLVESTER CHARLES 3
have no diabetes (Keswani and Sharma, 2019, 43). Diabetes is associated with affecting the ability of the body to
produce insulin or even make proper use of it. Due to the fact that insulin plays a fundamental role whereby it pulls
glucose from the bloodstream into cells, individuals with diabetes are said to be left with high levels of sugar in
their blood (Chatterjee et al. 2017, 2243). After some time the excess sugar contributes to clot stockpile of fat
deposits in the individual’s blood vessels, which supply blood to the brain and neck through a process referred to as
atherosclerosis (Dichgans, 2017, 153). The growth of these fat deposits translates into the narrowing of the
individual’s blood vessel walls and sometimes a full blockage. Stroke, therefore, occurs when blood course to the
individual's brain discontinues (Campbell et al. 2019, 19). This justifies the selection of the two nursing problems
since type 2 diabetes is deemed to be the root cause of Sylvester’s condition. It is not always wise to treat the
symptoms of a disease but the root cause of the disease, which in this case is type 2 diabetes.
Causes of the Identified Nursing Problems
The two identified nursing problems, ischaemic stroke, and type 2 diabetes exhibit different causes. A stroke
occurs due to a lack of blood supply in an individual’s brain (Hassan and Markus, 2026, 1791). Ischaemic stroke is
deemed to be the most common type of stroke which takes place after the blockage of arteries around an
individual’s brain. Ischaemic stroke is caused by atherosclerosis that causes cholesterol and fatty deposits to build
up plaque in the blood vessels (Hankey, 2013, 17). After the collection of too much plaque in a single spot, it
translates into the blockage of the flow of blood to crucial body organs. Clots of blood may embed themselves in to
plague build up when passing through blood vessels hence creating blockages. The neck has carotid arteries that
provide the brains with blood. After a blockage of the carotid arteries by plaques that are commonly referred to as
carotid artery disease, stroke may occur (Dirnagl et al. 2019, 393). Moreover, atherosclerosis is majorly
symptomless. Consequently, it may not be easy for many people to realize that they indeed have atherosclerosis
until the time they experience a stroke or other impacts of blocked arteries close to various organs like a heart
attack. High blood pressure is said to be the primary cause of stroke (Bath, 2014, 55). Initially, Sylvester Charles
was a tobacco smoker. Smoking greatly exposed him to ischemic stroke since it is another risk factor. Smoking
tobacco contributes to an increased build-up of plaque in his blood vessels (Hankey, 2016, 209). Smoking also

CASE SCENERIO ABOUT SYLVESTER CHARLES 4
increased the likelihood of his blood clot together with heightening the levels of cholesterol. It also contributed to
narrowed blood vessels and damaged the lining of his blood vessels. Dynamics in Sylvester’s job led to depression.
As a matter of fact, depression leads to increased risks of stroke (Bos et al. 2018, 999). Type 2 diabetes occurs when
an individual’s body turns resistant to insulin. It also occurs when the pancreas fails to secrete adequate insulin. The
apparent result for this is not quite clear despite the fact that environmental factors like being inactive and
overweight may contribute to diabetes. Type 2 diabetes is also said to be caused by genes (Gerstein et al, 2019,
127). It can be educed that Sylvester was not much active when he was an employee. He took early retirement so
that he can enjoy better quality with his wife with the determination of being more physically active in his
retirement. He had planned to tend his garden that had been neglected for some time as well as playing golf more
regularly. This indicates that Sylvester was not quite active and this could have contributed to type 2 diabetes that in
return translated to his present condition, ischaemic stroke.
Medications
Sylvester’s medical prescription included Clopidigrel 75mg od, Atorvastatin 40mg nocte, Ramipril 5mgs od,
Metformin 500mg bd, Aspirin 75mg od, and Omeprazole 20mg od. Clopidigrel is a suitable medication for the
prevention of heart attack as well as stokes in individuals fighting heart disorders, blood circulation disease or
recent stroke (Guyatt, 2018, 17). It fights stroke through obstructing platelets from stabbing together hence
thwarting them from making detrimental clots. This is simply an antiplatelet drug that assists the blood to flow well
in the body (Kim, 2019, 264). Atorvastatin is benevolent in reducing the levels of lethal fats and cholesterol thus
raising good cholesterol levels in the blood (Gaspardone and Area, 2017, 59). With this medication, I would ensure
that the patient exercises well, takes in a balanced diet, loses unnecessary weight if overweight and refrains from
smoking to enable it to work better. Sylvester had a history of hypertension. Ramipril would help in the treatment of
congestive failure of the heart and high blood pressure (Warner and Perry, 2012, 1393). In relation to type 2
diabetes, the administration of metformin would play a crucial role in controlling the intensities of glucose in the
blood. This is deemed to be the first choice of medicine in the control of the blood glucose level. Sylvester will be
expected to maintain strict exercises together with diet regimen when using this drug in order to realize a positive

CASE SCENERIO ABOUT SYLVESTER CHARLES 5
outcome. Aspirin is used in the prevention of blood clots that occur in the blood vessels. It is also a suitable
inflammatory and pain reliever (Bath, 2011, 707). As a registered nurse and responsible for reviewing Mr. Charles
at his home, I will carry out close monitoring of the platelets count which is deemed quite fundamental. Omeprazole
is important for the reduction of the acid influx.
Goals
The fundamental goal in ischemic stroke therapy is to reinstate the stream of blood to the left side of the
patient’s body that has been affected by stroke in the shortest time possible. On the other hand, the central goal in
the cure of type 2 diabetes is to reduce the chances of acute decompensation, prevention or delays of the
manifestation of complications of the late disease, prevent the loss of life as well as maintaining a good quality life.
Stroke is said to the third most common grounds of loss of lives in the United Kingdom. It scoops 11% of all lives
lost whereby it denotes the largest adult disability cause. The Multidisciplinary Teams perform crucial roles in
helping patients to successfully fight stroke (Clarke, 2013, 06). In hospitals, the teams are composed of what is said
to be the periphery and the core members. These members are majorly found in the stroke units, based on either
inpatient units or community settings. They include for instance language therapists, nurses, and occupational
therapists among others. The multidisciplinary team care is said to be benevolent in helping patients to regain
independence in undertakings, which give support to daily living. This results in few patients calling for long term
institutional care. An effective multidisciplinary team plays a key role in ensuring that there is more patient-centred
decision making, reduced disintegration of care, amplified satisfaction of staff together with more effective and
efficient resource utilization. Nonetheless, research evidence, guidelines or policies do not contribute to health
professionalism behaviour by themselves. There must be an existence of a universal understanding of purpose,
perception or even actual gains at the organisational or individual level. According to David J Clarke, services
relating to stroke have yielded substantial improvements concerning the care quality in the previous five years
(Clarke, 2013, 06). The multidisciplinary team that has been properly coordinated has made a substantial
contribution to the improvements. The pace of changes together with the skyrocketing demand for quality
adjustments in progressively time-limited stroke recuperation will keep on challenging care providers.

CASE SCENERIO ABOUT SYLVESTER CHARLES 6
Interventions with Rationale
Various interventions or actions will be required in addressing the identified problems. The employment
ambulatory devices in case the patient shows limb weakness, initiation of DVT prophylaxis whether chemical or
mechanical thus reducing the chances for any subsequent stroke since the patient will not be as mobile as he was at
baseline will be amongst the interventions for ischemic stroke. Additionally, the prevention of aspiration, promotion
of adequate nutrition, prevention of contractions and enhancing cluster care hence rest, promotion and proper
monitoring of vital signs and knowledge of the BP limits to attain an appropriate CPP will be put into consideration.
Other interventions are the prevention of edema by limb elevation and the use of compression stockings when
necessary and promotion of self-care, as well as the facilitation of communication that includes the promotion of
family coping and communication because having an ischaemic stroke, is an event in life. The desired outcomes in
carrying out these interventions include the restoration of much flow of blood as possible in the shortest time
possible. Another desired outcome is the minimisation of cellular damage or death which is quite fundamental. For
ischemic strokes, clot-busting meds can be administered which significantly help in the restoration of the blood
flow. This kind of medication can be administered alongside other drugs. The overall aim of these interventions is
to help Mr. Charles to gain back many functions as possible even though the same interventions may bring about
profound deficits in other patients. Interventions for type 2 diabetes include the improvement of the patient’s
nutrition to assess present timing as well as the content of the meals. Additionally, teaching the patient about insulin
to help in reducing fear of injection. Other interventions may include lose monitoring of the levels of blood glucose
hence the prevention of secondary injuries to hypoglycemia and advising the patient on assessing the level of blood
glucose after strenuous exercise to improve activity tolerance.
Activities of Daily Living and Assessment tools
In nursing, the Roper-Logan-Tierney Model is embraced as an assessment and is applied all the way through
Sylvester’s care. It classifies the sightings into activities of living via comprehensive assessment that ends up in

CASE SCENERIO ABOUT SYLVESTER CHARLES 7
actions or interventions, which over unwavering support to independence in undertakings that may be challenging
for patients to solely sail through (Roper et al. 2016, 77). The assessment and interventions will grant Mr. Charles
maximum independence. I will employ this model in assessing Sylvester’s relative independence as well as the
potential for self-reliance in undertakings of his daily living. Sylvester’s independence will be evaluated on a
continuum, stretching from total dependency to total self-reliance. This will assist me in identifying the
interpolations that will translate to amplified independence together with the needed current support to counter any
existing dependency. Some of the ADLs to be subjected to assessment include communication, sleeping, working as
well as playing golf among other activities. According to Roper, nurses should not use the model as a checklist. She
also added that using the model thoroughly will benevolently help the victim. “The patient is the patient, they are
not a different patient because they are in a different clinical area. Their needs are the same- it’s who will meet
those needs that change” (Roper, 2014, 053). The use of the model informed my decision-making in the planning of
the care by enabled me to categorise the sightings into activities of living via comprehensive assessment that ends
up in actions or interventions suitable for my client. Waterlow was embraced in Critical appraisal of decision
making in assessment areas such as mobility, tissue malnutrition, and body weight among others. The factors that
influence the care planned for the patient include socio-economic factors. Normally, some patients may desire to
have the best medical services yet they may not afford them.
Conclusion
In conclusion, the evaluation of the nursing care indicates positive results and hence achievements. Some
positive indicators concerning the interventions include the ability of the patient to take part in ADLs like garden
activities as well as other desired activities, maintained and amplified function and strength of the affected side of
the body, verbalized understanding of the health condition and personal treatment regime together with safety
measures. Furthermore, the patient indicated an improved attention span and interaction with people such as family
and friends, better sleep and decreased depression. Evaluation of nursing care is fundamental since it offers
significant support for an evidence-based approach to delivery practices. As a matter of fact, this evaluation is
employed in judging how well something is doing. Generally, nurses are said to be well placed in evaluating their

CASE SCENERIO ABOUT SYLVESTER CHARLES 8
practices and services hence developing evidence bases to deliver effective health care. The major goal in ischemic
stroke therapy is to bring back the flow of blood to the left side of the patient’s body that has been affected by
stroke in the shortest time possible. However, the central goal in the cure of type 2 diabetes is to reduce the chances
of acute decompensation, prevention or delays of the manifestation of complications of the late disease, prevent the
loss of life as well as maintaining a good quality life. Evaluation of nursing care effectiveness is, therefore, crucial
for the development of concrete knowledge bases which help in guiding the nursing practices. Evaluation is
benevolent in the determination of whether various nursing interventions should be altered, continued or terminated.
Evaluation determines the effectiveness of the entire nursing process and it is normally the fifth and the concluding
phase of the nursing practice.

CASE SCENERIO ABOUT SYLVESTER CHARLES 9
References
Bath, P., 2014. High blood pressure as risk factor and prognostic predictor in acute ischaemic stroke: when
and how to treat it? Cerebrovascular Diseases, 17(Suppl. 1), pp.51-57.
Bath, P.M., Lindenstrom, E., Boysen, G., De Deyn, P., Friis, P., Leys, D., Marttila, R., Olsson, J.E., O'Neill,
D., Orgogozo, J.M. and Ringelstein, B., 2011. Tinzaparin in acute ischaemic stroke (TAIST): a randomised
aspirin-controlled trial. The Lancet, 358(9283), pp.702-710.
Bos, M.J., Lindén, T., Koudstaal, P.J., Hofman, A., Skoog, I., Breteler, M.M. and Tiemeier, H., 2018.
Depressive symptoms and risk of stroke: the Rotterdam Study. Journal of Neurology, Neurosurgery &
Psychiatry, 79(9), pp.997-1001.
Campbell, B.C., De Silva, D.A., Macleod, M.R., Coutts, S.B., Schwamm, L.H., Davis, S.M. and Donnan,
G.A., 2019. Ischaemic stroke. Nature Reviews Disease Primers, 5(1), pp.1-22.
Chatterjee, S., Khunti, K. and Davies, M.J., 2017. Type 2 diabetes. The Lancet, 389(10085), pp.2239-2251.
Clarke, D.J. (2013). The role of multidisciplinary team care in stroke rehabilitation. Progress in Neurology
and Psychiatry, 17(4), pp.5–8.
Dichgans, M., 2017. Genetics of ischaemic stroke. The Lancet Neurology, 6(2), pp.149-161.
Dirnagl, U., Iadecola, C. and Moskowitz, M.A., 2019. Pathobiology of ischaemic stroke: an integrated
view. Trends in neurosciences, 22(9), pp.391-397.
Gaspardone, A. and Area, M., 2017. Atorvastatin. Drugs, 67(1), pp.55-62.
Gerstein, H.C., Colhoun, H.M., Dagenais, G.R., Diaz, R., Lakshmanan, M., Pais, P., Probstfield, J.,
Riesmeyer, J.S., Riddle, M.C., Rydén, L. and Xavier, D., 2019. Dulaglutide and cardiovascular outcomes in

CASE SCENERIO ABOUT SYLVESTER CHARLES 10
type 2 diabetes (REWIND): a double-blind, randomised placebo-controlled trial. The Lancet, 394(10193),
pp.121-130.
Guyatt, G., 2018. Clopidogrel plus aspirin versus aspirin alone for the treatment of acute minor ischemic
stroke or high-risk TIA: A systematic review and meta-analysis.
Hankey, G.J., 2013. Long-term outcome after ischaemic stroke/transient ischaemic attack. Cerebrovascular
diseases, 16(Suppl. 1), pp.14-19.
Hankey, G.J., 2016. Smoking and risk of stroke. Journal of cardiovascular risk, 6(4), pp.207-211.
Hassan, A. and Markus, H.S., 2016. Genetics and ischaemic stroke. Brain, 123(9), pp.1784-1812.
Keswani, P. and Sharma, S., 2019. Diabetes and Stroke. RSSDI Diabetes Update 2018, p.43.
Kim, T.J., Lee, J.S., Kang, M.K., Nam, K.W., Lee, C.H., Mo, H., Jeong, H.Y., Yoon, B.W. and Ko, S.B.,
2019. Clopidogrel may decrease the risk of post‐stroke infection after ischaemic stroke. European journal of
neurology, 26(2), pp.261-267.
Roper, N., 2014. Nursing based on a model for living. Colledge and Jones.
Roper, N., Logan, W. and Tierney, A., 2016. A model for nursing based on a model living. Newyork:
Churcill Living Stone Publish, pp.15-200.
Sacco, R.L., 2012. Reducing the risk of stroke in diabetes: what have we learned that is new? Diabetes,
Obesity and Metabolism, 4, pp.27-34.
Warner, G.T. and Perry, C.M., 2012. Ramipril. Drugs, 62(9), pp.1381-1405.

CASE SCENERIO ABOUT SYLVESTER CHARLES 11
Appendix

CASE SCENERIO ABOUT SYLVESTER CHARLES 12
Care plan Template
Patient Name: Sylvester Charles
Date of Birth: 01.01.1062
Assessment Nursing Diagnosis/Problem (remember
‘PES’)
Goal ( SMART) Interventions with rational ( what actions will be required to address the identified problem)
Intermitted confusion, poor
attention span, poor
interaction, lack of interest
for garden activities, lack of
interact for meeting with
family and friends, lack of
proper sleep at night which
forces him spend his daytime
dozing in his chair and he is
depressed.
High blood pressure,
difficulty in walking, troubles
in speaking as well as
understanding what other
people are saying that
occurred du to stroke.
left sided ischaemic stroke related to
inability to move the right side of the body
as evidenced by Intermitted confusion, poor
attention span, poor interaction, lack of
interest for garden activities, lack of interact
for meeting with family and friends, lack of
proper sleep at night
Diabetes type 2 related to hypertension as
evidenced by difficulty in walking, troubles
in speaking as well as understanding what
other people are saying, occurring due to
stroke.
To restore the flow of blood to the
left side of the patient’s body that
has been affected by stroke in the
shortest time possible.
To reduce chances of acute
decompensation, prevention or
delays of the manifestation of
complications of late disease,
prevent the loss of life as well as
maintaining a good quality life.
Employ ambulatory devices in case the patient shows limb weakness, initiation of DVT prophylaxis whether chemical or
mechanical thus reducing the chances for any subsequent stroke since the patient will not be as mobile as he was at baseline
Prevention of aspiration, promote adequate nutrition, prevention of contractions enhancing cluster care hence rest promotion and
proper monitoring of vital signs and knowing of the BP limits to attain an appropriate CPP
Prevent edema by limb elevation and the use of compression stockings when necessary and promote self-care as well as
facilitating communication that include the promotion of family coping and communication because having ischaemic stroke
is an event in life.
Improving the patient’s nutrition to assess present timing as well as the content of the meals
Teaching the patient about insulin to help in reducing fear of injection
Close monitoring of the levels of blood glucose hence the prevention of secondary injuries to hypoglycaemia
Advising the patient to assess the level of blood glucose after strenuous exercise to improve activity tolerance.
Evaluation- Taking part in ADLs like garden activities as well as other desired activities, maintained and amplified function and strength of the affected side of the body, verbalized understanding of the health condition and personal treatment regime
together with safety measures. Improved attention span and interaction with people such as family and friends, better sleep and decreased depression.

CASE SCENERIO ABOUT SYLVESTER CHARLES 13