Guided Case Analysis: Deteriorating Patient

Running head: GUIDED CASE ANALYSIS: DETERIORATING PATIENT
GUIDED CASE ANALYSIS: DETERIORATING PATIENT
Name of the Student
Name of the university
Author’s note

1GUIDED CASE ANALYSIS: DETERIORATING PATIENT
CASE STUDY ANALYSIS
INTRODUCTION
This case study is about an 84 years old gentleman Mr. Orkins, who had been admitted to
the unit after she has collapsed at home. Mr. Orkins belongs to an aboriginal family and lives in
Broken hills. He had a past history of type 2 diabetes mellitus, hyperlipidemia and hypertension.
It is evident from the case study that the blood sugar level is 10.4 mmol/mL, which is more than
the standard value to the blood sugar level. Hence, one of the clinical priority that can be
identified for Mr. Orkins is that he might have went in to diabetic shock or coma and the second
identified clinical priority is that the patient might undergone from ischemic stroke, evidenced
from the face drooping, slurred speech and saliva drooling from the mouth. Furthermore, the
patient also had past history of hypertension and obesity which can be a predisposing factor for
stroke.
However, this report will point out the clinical priorities of Mr. Orkins and will discuss in
details, the primary, secondary and specific assessment related to the patient along with a plan of
care guided by some evidence based rationale.
BODY
Primary, secondary and other patient focused assessment
The case study reveals that the patient had high blood sugar level, which might have
caused a diabetic shock in patient, due to which he had collapsed and probably might have
suffered from a traumatic injury.

2GUIDED CASE ANALYSIS: DETERIORATING PATIENT
The secondary assessment and a significant goal for this assessment is the identification of a
triggering factor for the condition, especially the presence of a reversible cause. Primary
Assessment should include a detailed clinical history evaluation and physical examination of the
patient as well as he venous blood gas measurement, a complete blood count and the basic
metabolic panel of the patient (Nolte & Audebert, 2015).
The patients should be immediately assessed and airways and the hemodynamic status
should be stabilized. Special Stroke assessment tools are useful for assessing 100 areas like LOC,
facial palsy, visual fields and gaze, motor arm, motor leg, sensation, language, limb ataxia,
aphasia and inattention (Fothergill et al., 2016). Immediate evaluation might also include placing
the client on oxygen, measuring the oxygen status and the oxygen saturation of the patients along
with cardiac monitoring as well as the obtaining the vital signs, and 12 lead electrocardiogram
for evaluating the presence of any arrhythmias (Ergul et al., 2013). At the time of assessing the
patient, it is necessary to consider the differential diagnosis like infection, indiscretion (drug use
and insulin lack).
Again, it is evident from the case study that the client had a slurred speech and
disoriented gaze, which can be the sign of a transient ischemic attack. In such a case the patient
can be referred with some tests like CT or MRI scan of the brain or an angiogram and an
echocardiogram (Lang, et al, 2013).
Since, the GCS scale of the patient has been found to be 13 with a slurred speech, a
neurological assessment of the patient is required which involves examination of the sympathetic
and the parasympathetic division by assessing the respiratory rate, heart rate dilation and the
constriction of the pupils, salivation and others (Nolte & Audebert, 2015). The working of the