Case Study Analysis and Care Plan

This case study analysis and care plan discusses the medical diagnosis, age of individual, preparation for procedures, privacy and dignity, and risk identification for a patient who suffered a Cerebral Vascular Accident (CVA). The patient had several co-occurring disorders, including hypertension, obesity, past episode of TIA, type two diabetes, and osteoarthritis, which contributed to the CVA. The patient also suffered from residual pain, difficulty sleeping, and high blood glucose levels. The care plan includes interventions for pain management, insomnia, and blood glucose level control.

Running head: CASE STUDY ANALYSIS AND CARE PLAN
Case study analysis and care plan
Name of the student:
Name of the university:
Author note:

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CASE STUDY ANALYSIS AND CARE PLAN
Table of Contents
Part A:........................................................................................................................................3
Medical diagnosis:.................................................................................................................3
Age of individual:..................................................................................................................4
Preparation for procedures:....................................................................................................5
Privacy and dignity:...............................................................................................................5
Risk identification:.................................................................................................................5
Part B:.........................................................................................................................................6
References:...............................................................................................................................11

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CASE STUDY ANALYSIS AND CARE PLAN
Part A:
Medical diagnosis:
The case study represents the care of a patient named Natia Euta, who had been a 76
year old Samoan lady who presented to the facility with the complaints of right sided
headache, left-sided arm weakness and vertigo. The cerebral CT scan revealed the fact that
Mrs Euta had suffered a right sided thrombolic Cerebral Vascular Accident (CVA). The
presenting problems of the patient includes left-sided weakness and being nil by mouth.
Cerebrovascular accident is the medical terminology for stroke, which is caused by the blood
flow to the brain of the patient being blocked by a haemorrhage in the surrounding blood
vessels. Considering the past medical history of the patient, she had hypertension, obesity,
past episode of TIA, type two diabetes and osteoarthritis, and many of her part medical
history correspond to being considering risk factors for the CVA she suffered. For instance,
type two diabetes, high blood pressure and high blood cholesterol which is a common factor
of obesity are iconic risk factors for CVA. Hence, the patient having these conditions and the
lack of management of this co-occurring disorders had been the main contributor of the CVA
she suffered. It has to be mentioned in this context that the importance of the also have been
suffering from difficulty in sleeping, which indicates at the onset of post stroke insomnia or
obstructive sleep apnea, which has been reported to be a common challenge experienced by
stroke patients. As discussed by Aaronson et al. (2015), the issue of sleep deprivation is
associated with stalled recovery and exacerbations in stroke patients, hence there is need for
care interventions to address the issue faced by the patient. Another very important issue that
the patient had been suffering from includes residual pain from the right sided headache
which was the main reason for her to be admitted to the facility. Now it has to be mentioned
that the patient has suffered a cerebrovascular accident and headaches after a stroke is a not
uncommon, close to 15% of stroke survivors experience new persistent headaches.

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CASE STUDY ANALYSIS AND CARE PLAN
Elaborating further, the contributing pathophysiology behind the head ache is the internal
bleeding after the CVA, although persistent headache after CVA event can be caused by
effect of the drugs administered, especially dipyridamole and similar blood thinners, tension
resulted headaches, and migraine headaches. Hence, this is also a very important sign and
symptom which is associated with the CVA which needs to be addressed in this context as
well. Lastly, the patient also had very high blood glucose levels which contributed to higher
risk of several exacerbation events. Hence, it is also a very important concern that the patient
had been facing, which needed immediate interventions.
Age of individual:
The patient is a 76 year old which is a very delicate condition which is associated with
many co-morbid issues that the patient might suffer due to the CVA event. First and
foremost, the age related health challenges might act as a considerable challenge for better
life quality in the patient (Emberson et al., 2014). Elaborating further, considering her age,
complex medical condition and disorders and the recent CVA that she had suffered, the risk
of aphasia is extremely high. Aphasia is impairment of language which can affect the speech
of the patient drastically. Aphasia is more or less a common outcome after a stroke event. As
discussed by Ghotra et al. (2015), left or right sided cerebrovascular accident might easily
lead to global aphasia. In this case, it has to be mentioned that in this case, the patient had
already been facing speech issues for which speech pathology was requested for her, hence,
considering her age this can be a grave issue which will affect her quality of life in the future.
Along with that, the patient also had osteoarthritis which also is an age derived health
adversity. As mentioned by Albieri, Olsen and Andersen (2016), the impact of a CVA also
leads to mobility restrictions and limitation in the range of motion. Considering her age and
osteoarthritis this will also be a considerable issue for her. Lastly, with increasing age, the

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CASE STUDY ANALYSIS AND CARE PLAN
healing ability of the body also diminishes, hence, healing the brain atrophy after the stroke
will also be a challenging and time consuming factor.
Preparation for procedures:
A stroke patient has to be prepared for a varied range of different tests, assessments and
invasive procedures and there are number of different activities for which the patient needs to
be properly prepared for, such as ECG, EEG, inserting nasogastric tube, catheters and similar
procedures. In this case, first and foremost, the vitals should be checked and in case there is
any anomaly, it should be addressed before commencing with the procedure. The skin of the
patient should be cleaned, dried and comfortable before commencement of any assessment
like ECG and EEG. Informed consent should also be taken either from the patient or the
family members in case the patient is not conscious or coherently alert before beginning the
procedure as well (Weber et al., 2016).
Privacy and dignity:
Privacy and dignity are very important aspects in the care planning and
implementation and it should be addressed at all circumstances. In this case, care should be
taken that Mrs Yuta belongs to a culturally diverse background and her cultural identity and
her best understanding of privacy and dignity should be explored and respected. Care should
also be taken to inform her and take her consent in all of care activities should be taken and
her rights autonomy and confidentiality should be respected. For a culturally diverse patient
like her, care should also be taken to take her permission before entering her room, speaking
her and touching her, any activity that might violate her sense of privacy.
Risk identification:
There are various risks and factors that has the potential issues that might complicate
the recovery and quality of life as well. First and foremost, age and age related complexities

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CASE STUDY ANALYSIS AND CARE PLAN
will be a challenge for her, both physically and psychosocially. Along with that, the persistent
pain that she had been suffering from would also be the reason of complex care needs for her,
altering her response to the treatment and stalling her recovery (Jolkkonen & Kwakkel,
2016). The nutritional status will also affect her recovery, she already had affected appetite
which might get aggravated due to the invasive and complex treatment that the patient will be
going through. Due to her osteoarthritis, age and mobility restriction, maintaining a safe
environment, including risk prevention strategies will be a very important concern. For
instance she will have a considerable fall risk which will be difficult to manage for her. The
affected cognitive status and risk of internal bleeding due to her age and the CVA will also be
a notable challenge (Lip et al., 2015).
Part B:
Identify problem
/issue
Establish
Goal(with
Time Frame)
Take Action Evaluate
Outcomes
Reflect on
process
Pain from head
ache in the right
side which was
scored as 6/10
The patient
will be free
from the pain
that she is
feeling and
she will
verbalizes
being free
from the pain
within 24
hours
The patient should
be assessed for
pain assessment to
derive the exact
pain score at the
moment.
The patient will be
The assessment
will help in
understanding the
exact pain score
right before
administration of
interventions
which might help
in better
understanding of
apt intervention.
The interventions
helped reduce the
pain from 6/10 to
3/10 within 24
hours and the
patient relaxed
visibly. It helped
me understand the
impact of these
pain management
techniques on

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CASE STUDY ANALYSIS AND CARE PLAN
given the aid of
analgesic drugs
such as tricyclic
antidepressant
amitriptyline
given at 75mg/day
and
anticonvulsants
such as
gabapentin.
Along with that,
the patient will
also be given the
aid of non-
pharmacological
pain management
techniques such as
Transcutaneous
electrical nerve
stimulation,
cognitive
behavioural
therapy (CBT),
hypnosis,
attention-diversion
strategies,
biofeedback or
The anti-
depressants and
anticonvulsants
have been
reported to help in
post stroke
thalamic pain
drastically
(Harrison & Field,
2016).
The aid of non-
pharmacological
pain management
helped take the
attention away
from the pain and
helped the patient
relax.
such patients.

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CASE STUDY ANALYSIS AND CARE PLAN
stress management
and relaxation
techniques (Oh &
Seo, 2015).
Insomnia and
difficulty to sleep
throughout the
night
The patient
will be able to
retain normal
sleep cycle
and will be
free from the
obstructive
sleep patterns
within 24
hours.
The patient should
be given the aid of
psychotropic and
sedative drugs to
help her relax and
sleep better (Sterr
et al., 2018).
The aid of
soothing non-
pharmacological
interventions such
relaxation music,
aromatherapy
using lavender
will be given to
her.
The combination
of psychotropic
drugs and
sedatives helped
calm her anxiety
regarding her
husband and
family and helped
her fall asleep.
The soothing
music and
aromatherapy
helped calm her
nerves and helped
her relax.
The patient
showed better
signs of sleeping
without any major
disturbances
throughout the
night in the next
24 hours
Risk of
hyperglycaemic
attack due to high
blood glucose
The blood
glucose level
of the patient
will be
reduced to the
normal range
within 24-48
The patient will be
given medication
to lower her blood
sugar such as
intensive insulin
therapy.
The medication
will help in
lowering the blood
glucose levels and
evade the risk of
exacerbation such
as hyperglycaemic
The blood glucose
levels of the patent
reduced drastically
within 2
4-48 hours.

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CASE STUDY ANALYSIS AND CARE PLAN
hours.
Drugs such as
ulfonylurea agent
glibenclamide will
alos be given to
minimize the risk
of hyperglycaemia
(Savopoulos et al.,
2017).
attack
(Savopoulos et al.,
2017).
The
Glibenclamide
helped in
enhanced control
over BGL and
improved outcome
after large artery
stroke.
Risk of aphasia or
speech difficulty.
The patient
will evade the
risk of
complete
speech
impairment
and the risk of
aphasia will
be managed
within 48-72
hours.
The patient will be
given speech
therapy every 12
hours.
Drugs like
memantine
(Namenda) and
piracetam will
also be given to
aid in speech
retainment and
evading risk of
aphasia (Shrubsole
et al., 2017).
The speech
therapy helped in
improving the
speech of the
patient (Shrubsole
et al., 2017).
The drugs helped
in evading the risk
of aphasia
significantly.
The patient
benefitted greatly
by the
combination of
pharmacological
treatment and
therapies.

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CASE STUDY ANALYSIS AND CARE PLAN

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CASE STUDY ANALYSIS AND CARE PLAN
References:
Aaronson, J. A., van Bennekom, C. A., Hofman, W. F., van Bezeij, T., van den Aardweg, J.
G., Groet, E., ... & Schmand, B. (2015). Obstructive sleep apnea is related to impaired
cognitive and functional status after stroke. Sleep, 38(9), 1431-1437.
Albieri, V., Olsen, T. S., & Andersen, K. K. (2016). Risk of stroke in migraineurs using
triptans. Associations with age, sex, stroke severity and subtype. EBioMedicine, 6,
199-205.
Emberson, J., Lees, K. R., Lyden, P., Blackwell, L., Albers, G., Bluhmki, E., ... & Grotta, J.
(2014). Effect of treatment delay, age, and stroke severity on the effects of
intravenous thrombolysis with alteplase for acute ischaemic stroke: a meta-analysis of
individual patient data from randomised trials. The Lancet, 384(9958), 1929-1935.
Ghotra, S. K., Johnson, J. A., Qiu, W., Newton, A., Rasmussen, C., & Yager, J. Y. (2015).
Age at stroke onset influences the clinical outcome and health‐related quality of life in
pediatric ischemic stroke survivors. Developmental Medicine & Child
Neurology, 57(11), 1027-1034.
Harrison, R. A., & Field, T. S. (2015). Post stroke pain: identification, assessment, and
therapy. Cerebrovascular diseases, 39(3-4), 190-201.
Jolkkonen, J., & Kwakkel, G. (2016). Translational hurdles in stroke recovery
studies. Translational stroke research, 7(4), 331-342.
Lip, G. Y., Clementy, N., Pericart, L., Banerjee, A., & Fauchier, L. (2015). Stroke and major
bleeding risk in elderly patients aged≥ 75 years with atrial fibrillation: the Loire
Valley atrial fibrillation project. Stroke, 46(1), 143-150.

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CASE STUDY ANALYSIS AND CARE PLAN
Oh, H., & Seo, W. (2015). A comprehensive review of central post-stroke pain. Pain
Management Nursing, 16(5), 804-818.
Savopoulos, C., Kaiafa, G., Kanellos, I., Fountouki, A., Theofanidis, D., & Hatzitolios, A. I.
(2017). Is management of hyperglycaemia in acute phase stroke still a
dilemma?. Journal of endocrinological investigation, 40(5), 457-462.
Shrubsole, K., Worrall, L., Power, E., & O’Connor, D. A. (2017). Recommendations for
post-stroke aphasia rehabilitation: an updated systematic review and evaluation of
clinical practice guidelines. Aphasiology, 31(1), 1-24.
Sterr, A., Kuhn, M., Nissen, C., Ettine, D., Funk, S., Feige, B., ... & Riemann, D. (2018).
Post-stroke insomnia in community-dwelling patients with chronic motor stroke:
Physiological evidence and implications for stroke care. Scientific reports, 8.
Weber, R., Reimann, G., Weimar, C., Winkler, A., Berger, K., Nordmeyer, H., ... & Weber,
W. (2016). Outcome and periprocedural time management in referred versus directly
admitted stroke patients treated with thrombectomy. Therapeutic advances in
neurological disorders, 9(2), 79-84.