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Mr and Mrs Smith - Case Study

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Added on  2019-12-18

Mr and Mrs Smith - Case Study

   Added on 2019-12-18

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CASE STUDYCarefully review the following scenario and answer the related questions. Refer to themarking guide to frame the preparation and setting out of your answers. This task requiresyou to bring together your nursing knowledge across a range of subjects within this courseand then apply these. In brief your paper needs to demonstrate you will be able toappropriately assess, plan, implement and evaluate your care for Mr & Mrs Smith ScenarioMr Sebastian Smith, a plumber aged 58, lives with his wife in their house at 21 Sunset Strip,Sunshine Bay. The house has 2 steps to the front door and 6 steps to the back door. He hashad one episode of Transient Ischemic Attack (TIA) about 2 months ago. At 0800hours hiswife finds him unconscious on the floor of his garden shed. She immediately rings for anambulance which arrives 20 minutes later. Mr Smith is transferred by ambulance to thenearest hospital. After initial examination in the Emergency Department, he is transferred tothe ward with a medical diagnosis of Left Sided Stroke. His conscious state improves overthe next 3 hours. He is moving his left arm and his left leg, but there is no movement on his right side.The doctor suspects a possible hemiparesis of his right arm and right leg. He is also poolingsaliva in his mouth. The doctor has written in the medical records that Mr Smith has no gagreflex. The doctor orders a speech assessment by the speech pathologist to be carried out assoon as possible. On day 2, Mr Smith appears very alert, talking only with a slight slurring ofhis words and some dysphagia. He correctly states who he is, where he is and what day it is.The doctor orders another speech assessment (other than for speech, consider why Mr Smithwould be having an assessment by a speech pathologist). On day 8, the doctor advises thenursing staff that Mr Smith will be discharged home in two days to the care of his wife. MrSmith will be discharged on `Texture A` soft diet and a `level 150` mildly thick fluid. He is fully continent. His right arm hemiparesis has now almost totally resolved andhe can manage to cut his food, dress himself and do most of his daily hygiene. He still hassome right leg weakness and uses a walking frame (four wheel walker) to assist his mobility.It is taking him some time to regain his balance and has expressed a fear of falling at home.Mrs Smith tells you she is concerned about caring for her husband at home and has requestedhelp with cleaning and shopping. He will be discharged with daily Clexane injections to beperformed by RDNS. He will need a neurology outpatient appointment in 6 weeks, a speechtherapist appointment in 2 weeks and a GP appointment in a week. An urgent referral hasbeen made for the O.T. to do a home visit tomorrow before Mr Smith is discharged the nextday. Mrs. Smith who lives with Mr. Smith and willing to be a carer for Mr. Smith is 54 years
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old who has been diagnosed with Rheumatoid arthritis and Type 2 diabetes, diet control. Dueto her medical condition she finds it difficult to turn shower taps, food preparation and walklong distances.Questions 1. Discuss the Day 8 nursing assessments you will use to frame Mr Smith’s Discharge PlanVital signs: Identify and discuss what vital signs will be taken and the importance inrelation to Mr. to Smith’s Condition. (4 marks)2. Neurological observations: In addition to vital signs, what neurological observations wouldyou take and justify your answer and relate back to Mr Smith’s condition. (4 marks)3. Describe 3 targeted questions to wife and / or patient e.g. (approx. 150 words). In order toget full marks describe why you are asking the question and what can be done about theidentified issue. In order to obtain full marks you need to address the following:4. What is the relevance to the case study of your question?5. What can be done to fix the problem?6. To whom can you refer the client to? For all three sections below you must address all of these criteria in order to obtain the fullmarks for each section About the layout of their house (why is this important?) excludingallied health 7.what are the possible risks to Mr. Smith? 8.What could be done to reduce the identified risk? (4 marks) 9.About any physical issues affecting her ability to care for him (4 marks) - About herconcerns regarding his return home (4 marks) 10. Patient Education Session It is Day 9 and you have been allocated to care for Mr Smith.Part of your activities today is a 30 minute patient education session with Mr & Mrs Smith onsafely managing his food and fluid intake, to reduce the risk of aspiration pneumonia.Suggested Content of Patient Education Session a. Impact of disease process on swallowing b. Signs of impaired swallowing
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c. What are the risks of impaired swallowing Strategies to reduce this risk What to do if MrSmith d. shows signs of impaired swallowing and /or chest infectionThis is what I have submitted and the teacher and she failed me, please helpAssessment 2 answersQ1. Discuss the Day 8 nursing assessments you will use to frame Mr Smith’s Discharge Plan Vital signs: Identify and discuss what vital signs will be taken and the importance in relation to Mr. to Smith’s ConditionVital signs that need to be monitored during Mr. Smith’s treatment are his temperature, bloodpressure, oxygen level and coherence. These are all indicators of increased risks in strokes,and must be monitored at least every 30 minutes while he is in critical condition. Hisawareness and coherence are especially important as they indicate the severity of hiscondition as well as how well he is recovering. Currently, Mr. Smith is having left sidedstroke. Further, has a slight slurring of his words and some dysphagia. Q2. what neurological observations would you take and justify your answer and relate back to Mr Smith’s conditionNeurological observations: Neurological signs that must be monitored during Mr.Smith’s treatment are his pupillary reactions, his level of consciousness, his sensory function,motor skills, and verbal capabilities. Improvement in these areas would indicate that theeffects of his stroke are receding. These are often the most indicative signs that a stroke hashappened, and are also the most crucial areas which need improvement in such a case. As perthe medical diagnosis, Mr. Smith is having a left sided stoke. Q3 targeted questions to wife and / or patient e.g. (approx. 150 words). In order to get full marks describe why you are asking the question and what can be done about the identified issueThree questions that I can ask either Mr. or Mrs Smith are: how well have his speech,senses, and cognitive abilities been intact prior to the incident? Has there been a history ofstrokes or other related health issues in Mr. Smith’s family? Does Mr. Smith seem to be ingood spirits on most typical days, or does he appear to be under constant stress? Q4. What is the relevance to the case study of your questionThe reasons that these questions would pose relevance to Mr. Smith’s conditionbecause of some signs dur to stroke (slurred or jumble speech, loss of awareness, signs ofsensory deprivation, lack of mental processing and or a mental fatigue and cognitive deficits
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