Nursing Case Study

Nursing Case Study
Name of the Student
Name of the University
Author Note

Introduction
In this case study, the case of Mr. Sam Kwon is described. The patient is a 74 year old man
and he was admitted to the hospital by the health care paramedics along with the problems of right-
sided hemiparalysis, aphasia and facial drooping. Along with this, it is depicted in the case study
that, the patient had a history of hypertension, type 2 diabetes mellitus and congestive heart failure.
In order to manage the condition of the diabetes type 2 mellitus, Sam used to take oral
hypoglycaemic agents. However, Sam was a chain smoker and he smoked a pack of cigarettes a day
for almost 40 years. The blood pressure of the patient is also very high and he had the systolic and
diastolic blood pressure of 140 mm hg and 105 mm hg respectively and he had the pulse rate of 98
bpm. The oxygen saturation rate of the patient was almost 96% at the room temperature.
From the test results of Mr. Sam Kwon, it can be observed that, that there was a sign of a left
cerebrovascular accident, along with amplified density in the left middle and cerebral artery (from
the CT scan result). These symptoms indicated that oedema may happen due to this enhanced
density in the left middle and cerebral artery. Apart from that, there are various signs of aphasic
and he also faced difficulty in communication process.
In this essay, the analysis of the condition of the patient, management care plan for the
patient and the discharge plan of the patient are briefly.
Analysis of the Patient Condition
The CT scan of the patients suggested that, there might be left cerebrovascular accident and
it might cause the enhancement of the density of the cerebral artery and left middle artery.
According to the study of Liebeskind, Malhotra and Hinman (2017), it is reported that, the
cerebrovascular accident is also referred to as stroke and the condition is characterized by the
disruption of blood flow to specific part of the brain due to the blockage or any other rupture in the
blood vessels. The assessment of the patient depicted that the patient had hyperdense middle
cerebral artery (MCA) and the condition is associated with the thrombosis of the M1 middle
cerebral artery segment. According to the study of Zhang, Yang, Sun, and Xing (2014), it is

reported that the enhanced of middle cerebral artery (MCA) density during the performances of
the non- contrast CT is one of the major signs of the hyperdense MCA and this condition can only
happen due to intravascular clots in the vessels of the brain region. In case of Sam this may happen
and due to this disrupted blood supply to the brain region, the stroke may take place. Along with
this, it can be interpreted that, due to the stroke, the face dropping symptoms in the patient may
occur (Walcott et al., 2014). According to the study of Burke Quinlan et al. (2015), it is stated
that, the any kind of damage in the motor cortex region of the brain such as ischemic strokes may
cause contralateral facial weakness of the facial muscles. However, even after the weakness of the
lower part of the facial muscles the voluntary control of the upper muscle of the faces remain
unchanged. In such condition, the individual will able to nod the head and also can close the eyes
voluntarily (Grefkes & Fink, 2014). In the case study, it is reported that, the patient had the
problem of facial drop but he was able to nod his head in response to any close ended questions.
On the other hand, it can be interpreted that, the patient had the damage in his left region of his
brain as the effect of facial nerve damage is depicted the effect in a contralateral manner.
Not only this, but the patient also had the problem of aphasia that refers to a communication
disorder due to any kind of injury in the language region of the brain. According to the study of
Cahana-Amitay and Albert (2015), it is reported that, the damage to the language region of the
brain is very common among the older adults and the main reason behind this problem is stroke. In
this study, it was also reported that, aphasia can alter the speech of the patients with problem of
aphasia. Therefore, it can be stated that, the problem of aphasia in Sam was due to the cerebral
stroke. Apart from this problem, the patient also had the problem of homonymous hemianopia that
is associated with the alteration of the vision of the patient. According to the study of Jindal (2015),
it is reported that, the any kind of damage in the left part of the brain can cause loss of the right
half of the vision of the individual. In another study by Goodwin (2014), it is reported that, the
stroke is the most common cause of this homonymous hemianopia and this problem involves the
vision loss of the visual fields on the same side in both of the eyes. It can be stated that, the issue of

vision loss is the sign of lesion in the visual pathway posterior to the chiasm (Philip & Dutton,
2014).
In case of Sam, it is reported that, the individual had right sided hemiparalysis that is the
sign of left brain damage and the homonymous hemianopia is also due to this left brain damage.
Therefore, it can be easily interpreted that, the left side of Sam’s brain was damaged due to the
cerebrovascular stroke. The blood glucose level of the patient is indicating the issue of diabetes
mellitus type 2 and the blood glucose level of the patients is almost 9.4 mmol/L. The patient also
had basal crackles and it is reported that, the cause of crackles is associated with the problem of
accumulation of fluids in the alveoli due to cardiovascular problem (Busl & Bleck, 2015).
In case of Sam, the cerebrovascular problems and crackles may occur in the patient. For
improving this condition in Sam, oxygen therapy was applied. Along with this, in order to remove
the clot from the blood vessels of the patient’s body, crystalloid fluid was delivered through the IV
catheter. According to the study of Chatrath , Khetarpal and Ahuja (2015), it is reported that, in
order to enhance the intravascular volume of the body fluids, the application of the crystalloid fluids
are very effective. The study also reported that, reduction in body fluids may happen due to the
haemorrhage in the blood vessels of the body and thereby reduce the overall volume of the body
fluids. In this case study, Sam had the problem of blood clot in the blood vessels of the brain region
and thus it is very crucial to enhance the body fluids of the patient. For this reason, Sam had been
given the crystalloid fluid as a part of the medication (Reddy, Weinberg, & Young, 2015).
Interprofessional Care and Management Plan
Based on the analysis of the case study of Sam, it is reported that, the patient had the
problems in respiration, problem of diabetes mellitus type 2, right side hemiparalysis, and
homonymous hemianopia. For the aforesaid problems, in the management team of the patient, there
must be a physiotherapist, a nutritionist, occupational therapist counsellor, eye specialists and
neurologist, speech therapist in the interdisciplinary team of the patient (Bhogal et al., 2017). In the
inter discipline team for managing the condition of the patient, the neurologist will try to address