A Detailed Case Study on Patient Scenarios, Diagnoses, and Healthcare

This case study presents several patient scenarios requiring diagnosis and treatment, with a particular focus on an elderly patient, Georgia, who experienced a fall and subsequent health issues, including frequent urination and a strong odor. The analysis explores potential causes such as nocturia and bladder injury, detailing diagnostic methods like laboratory tests (urinalysis, serum creatinine levels), CT scans, and cystography. It emphasizes the importance of sharing patient information among healthcare staff through effective communication channels, including on-call, face-to-face discussions, and documentation, to ensure coordinated care and positive patient outcomes. The study also highlights the significance of considering comorbid conditions and risk factors in elderly patients to prevent falls and manage related complications. The role of healthcare providers is vital in accurately diagnosing and addressing the underlying causes of the patient's symptoms, enhancing their quality of life. Desklib provides this case study along with a variety of other solved assignments and study resources for students.

SCENARIOS
0
Patient case studies
student

SCENARIOS
1
Table of Contents
Assessment Task one; Table
Assessment task 2
Assessment task 3
References

SCENARIOS
2
Assessment Task one; Table
Client notes Diagnosis body systems or
systems or relates to
Dizziness after getting up
from bed
medical history, review your
symptoms and physical
examination, blood tests, ECH
or EKG, and tilt table test
(Fife, 2012)
Circulatory system
Transient ischaemic attack Physical examinations, carotid
ultrasonography, CT scan,
CTA scanning, MRI, MRA,
Echocardiography, and
arteriography (Johnston et al.,
2007)
Circulatory system,
nervous system
BP reading on sitting 120
mmHg
Ambulatory blood pressure
monitoring (ABPM) (Head, et
al., 2010)
Normal BP
Circulatory system
Resps on sitting were 18
bpm
Counting the number of times
the chest rises in 1 minute
(Rawlings-Anderson, &
Respiratory system

SCENARIOS
3
Hunter, 2008)
Normal RR
BSL 5.4 before breakfast Random test for blood sugar
blood sugar test before eating
Oral glucose tolerance
examination
Normal BSL (American
Diabetes Association, 2010)
Circulatory system
Digestive system
Urinary system
COAD Lung function test
Chest X-ray
CT scan
Arterial blood gas analysis
(Pauwels et al., 2019)
Musculoskeletal system
Digestive system
Circulatory system
Nervous system
Assessment task 2
Patient scenario one
In the given case scenario the patient is having a declined health due to a fall she had
overnight. Before that fall she was able to reach the dining room for meals without the help,
but after the fall she is facing issues in relation to her balance. Some of the other issues that
arise after fall are frequent toilet use and strong odour. A fall is distinct as the incident that
leads to the individual impending to rest inadvertently on the floor or any other level. It may

SCENARIOS
4
lead to an injury, and these types of injuries are fatal or non-fatal (Schwendimann, Bühler, De
Geest, & Milisen, 2006). According to a study published by Australian Institute of health and
welfare (2018), in 2015–16, there were higher than 34 thousand separations in which a
diseased person was cured for damages arising from a drop in a hospital percentage of 3.2 per
1,000 partings. This rate might be undervalued, as the place of incidence was not identified
for 18% of partings linking falls, however, some falls that happened in health upkeep settings
other than a clinic are also comprised due to the method the statistics are coded.
The drops rates are improved in Australia by means of 0.8 per 1,000 separations in
the middle of 2009–10 and 2015–16 (Bauer, Isenring, Torma, Horsley, & Martineau, 2007).
This alteration may redirect altering patient summaries and/or a growing concentration on the
protection and quality of clinic care and decent reporting of pertinent data throughout this
period (Bauer, Isenring, Torma, Horsley, & Martineau, 2007). An advanced rate of drops was
described for public clinics than for private hospitals in between 2016–17 (4.6 matched with
1.3 drops per 1,000 separations) (Nurmi, & Lüthje, 2002). For all clinics joint, people who
were 85 years old and above had the uppermost age-specific number of falls inside the
hospital (13 falls in every 1,000 separations) (Nurmi, & Lüthje, 2002).
There are two health conditions that might be the reason of frequent urination and a
strong odour in Georgia's case; one is Nocturia (Marinkovic, Gillen, & Stanton, 2004) and
another overactive bladder (Corriere, & Sandler, 2006). Nocturia is the condition that must be
sought out by the health providers and managed in elderly patients. It adversely affects can
even cause death (mostly because of falls). The older adults are often suffering from urine
associated problems as the age (Marinkovic, Gillen, & Stanton, 2004). Nocturia is a
multifactorial situation that is caused by the factors that may increase the urine making and
others that reduce the ability of the bladder to hold urine (Marinkovic, Gillen, & Stanton,

SCENARIOS
5
2004). Falls might increase these condition as the old ones are very sensitive to fall and the
outcomes of falls may more disastrous in elderly compared to youngsters.
The older people's kidney is less capable to concentrate urine and also implicated
histologic alterations in the detrusor muscles that ultimately lead to the reduced bladder
passivity, this results in urinary frequency and strong odour (Hu, Wagner, Bentkover,
Leblanc, Zhou, & Hunt, 2004). The falls may also cause the stomach muscle damage that
also might be the reason of frequent urination in Georgia’s case. Falls cannot result from de
novo and individuals do not fall just for the reason that they are aging. Frequently more than
one principal comorbid situation or threat factor comprises in a fall. As the different risk
factors rise, so does the probability of falling (Hu et al., 2004). Different falls are associated
with an individual's physical health condition or a medical issue, like arthritis, benign prostate
hyperplasia, or over-reactive bladder. In the case of Georgia when she falls her bladder injury
might have occurred. The most mutual symptoms of bladder damage are noticeable blood in
the urine, trouble in urinating, and aching in the pelvis and inferior abdomen or in the course
of urination (Wein, & Rackley, 2006). If the lowest part of the bladder (where the body
muscle that assists to regulate urination is situated) has been damaged, the person might
experience recurrent urination or urinary incontinence. Among old patient who falls
sometimes face leukocyte esterase and traces of blood might be there in urine that results in a
strong odour and frequent urination. The bacterial infection is another problem that often
occurs with this health condition (Wein, & Rackley, 2006).
How to determine
To determine that the frequent urination and strong odour occur die to bladder injury
and Nuctoria, first of all, I will discuss the symptoms with the physician as they can suggest

SCENARIOS
6
and confirm more than anyone else. My previous experience might also help me to be sure
that the adverse conditions occur due to the above-mentioned problems. The patient falls has
been discussed and argues by various researchers and the discussed the negative impacts of
patient’s fall. According to Soliman, Meyer, & Baum (2016), many patient falls are linked to
the over-reactive bladder. And as I mentioned above the over-reactive bladder is the leading
cause of frequent urination after fall. I may also discuss with my health team members about
the fall and the following symptoms associated with urination. Some of the tests can be
performed to diagnose the issue.
Laboratory tests (e.g. urinalysis)
Laboratory tests can be performed to confirm the over-reactive and injured bladder.
In the subacute setting, the level of blood serum creatinine can help in the analysis of bladder
injury (Wein, & Rackley, 2006). In the lack of acute kidney damage and urinary tract
obstacle, elevated serum creatinine can be indicative of a urinary tract leak with systemic
reabsorption of the defecated creatinine. Level of creatinine alone is not analytic, however,
and further diagnosis is required when medical suspicion for bladder leakage exists (Wein,
2003). The urine sample can also be taken from the patient, which is tested for aberrations.
The existence of blood or glucose may identify the conditions that have indications similar to
OAB. The existence of bacteria may specify urinary tract contamination (UTI). This illness
can cause feelings of urgency. Recurrent urination can also be a symbol of diabetes (Wein,
2003).
Computed Tomography Imaging
Frequently, computed tomography (CT) is the major test accomplished in patients
with bladder injury due to fall. Cross-sectional pictures through the pelvis deliver information
on the position of both the pelvic structures and bony organizations. This modality, and

SCENARIOS
7
precisely CT cystography, has likewise largely substituted conservative plain film or
fluoroscopic cystography as the greatest sensitive means for recognizing bladder puncture
(Quagliano, Delair, & Malhotra, 2006). A CT cystogram is implemented by filling the
urinary bladder with contrast through a urethral tube (once urethral damage has been
debarred) and carrying out a non-contrast abdominopelvic CT scan to evaluate for
extravasations. Imaging with this method is capable to identify even subtle damages and can
frequently clearly describe whether the leakages are extra-peritoneal or intra-peritoneal
(Quagliano, Delair, & Malhotra, 2006).
Cystography
The historic customary for imaging supposed bladder damage is well-implemented
cystography. Though the ideal inspection is executed under fluoroscopy, medical
circumstances frequently do not allow this. In such scenarios, basic film cystography is
implemented. The examination can simply be accomplished at the bedside using movable
imaging tools (Vaccaro, & Brody, 2000). While maximum trauma patients with bladder
damage have numerous damages and CT imaging is the consistent part of the trauma
assessment, this does not prevent obtaining a distinct cystogram if bladder results on the CT
scan are vague. A correctly implemented cystogram contains an opening kidney-ureter-
bladder (KUB) film tailed by both anteroposterior (AP) and slanted views of the bladder
occupied with contrast as well as another AP film attained after contrast drainage (Vaccaro,
& Brody, 2000).
Patient information sharing with other staff
As discussed in the case study the patient has been providing with home care,
therefore any issue or circumstances occur at any time should be immediately reported to the
doctor and other concerning health staff so the emergency and essential services can be

SCENARIOS
8
delivered easily and on the time. The first professional duty of any health professional is to
analyze the symptoms of patient record them on the patient health record sheet to maintain
the history of the patient health condition. The information noted about the patient can be
shared by 3 different ways that are; on call, orally (face-to-face), and document. It depends
upon where the patient is admitted, if the injured persons cared at home then the information
can be shared on phone calls, however, the record should be maintained on the recording
sheet for later use. Documentation is considered to carry out a patient’s condition to other
health-care workers, backing in making a plan of upkeep, assess the plan and deliver
continuity of care. Unpredictable documentation is recognized as an issue.
The effective communication must be built in relation to proper information
exchange. Effective communication between healthcare workers is the important driver for
the success of the treatment or care provided to the patient (Leonard, Graham, & Bonacum,
2004). All the choices related to patient care determined by effective communication between
healthcare suppliers. Communication and co-operation are the pillars of the organization and
supports to safeguard patients’ care. In healthcare systems, the kind of nurse-physician
association and efficiency of interior communication is one of the critical features in deciding
the excellence of patient upkeep. Furthermore, effective communication aids to make
cooperative decisions toward patient-centered care and encourage positive outcome (Leonard,
Graham, & Bonacum, 2004).
Communication network: The network is the ‘pipe’ by which a message is transported, and
there are an extensive variety of dissimilar communication networks available, from simple
face-to-face discussion, over telecommunication passages like the phone or e-mail, and
computational stations like the health record. Channels have qualities like capability and
noise, which regulate their appropriateness for diverse tasks. When two different parties

SCENARIOS
9
interchange messages through a channel at the similar time, this is recognized as synchronous
communication. Phones are one of the maximum mutual two-way synchronous systems
(Haller, Ferek-Petric, & Donders, 2004). Nurses visited different homes to provide home care
to the patient, therefore using mobile or landlines is the fastest and safest way to share the
symptoms noticed in the patients. I would firstly contact with the other staff and confirm their
identity by asking their name and identity code to ensure that I am delivering the information
to the correct person. This is because if the patient information might be delivered to the
wrong people, and the confidentially and security rule might be breached. However, I would
consider face to face conversation with the staff and physician to ensure that the patient’s
symptoms are delivering to the right person.
The telephonic discussion sometimes interrupted due to the network issues or other
technical problems and the information may not deliver clearly and correctly. Poor
cooperation and communication in healthcare groups have been connected to adverse actions
and higher patient illness and mortality. However, detailed perception into the connection
between team communication and health error is still missing. Therefore the face to face
interaction will be preferred as it ensures that the information is shared with the right person
and sent in the right manner (Haller, Ferek-Petric, & Donders, 2004). The information of the
severity of symptoms can be shared more effectively by this method. At the time of
discussion with the health professional, the information will be checked twice and the
medical record sheet will be in front of the eyes to make sure the each and every information
about the symptoms are shared. Every symptom associated with the patient’s conditions will
be marked checked to confirm that the information has been delivered successfully to the
doctor and other team members.
Scenario two

SCENARIOS
10
The symptoms described in the case scenarios are more similar to Bell's palsy which is
unexpected faintness or paralysis on the single side of the face that makes it difficult for the
individual to move the mouth. Bell's palsy is the infrequent disease that causes difficulty with
the nerves in an individual's face. This type of nerve suffering can paralyze any side of the
face and make the person’s appearance changed as that one side is solid or hanging
(Tiemstra, & Khatkhate, 2007). The illness might cause pain and it may also make the person
sense uncomfortable for his or her look.
Only a minor number of children develop Bell's palsy, and not various grownups
develop it, either. For individuals who do develop it, the favorable update is that typically
cure on its own with time. Bell's palsy can grow over time. As it can happen unexpectedly,
somebody might consider the condition is a stroke; when the blood vessel present in the brain
becomes clogged or ruptures (Gilden, 2004). Similar to Bell's palsy, a stroke also paralyze an
individual's face. Nonetheless, Bell's palsy is triggered by nerve concern and is not as severe
as a stroke. Bell's palsy might be scary, nonetheless, it usually does not remain for long and
goes away deprived of cure. Bell's palsy disease was actually called after a Scottish
physician, Sir Charles Bell, who learned about the double facial nerves that regulate how the
human face moves. Humans have a single facial nerve for every side of the face. These type
of nerves deliver messages from the brain part to the face. By these signals, the nerves of the
face regulate the muscles of the face, neck, and forehead. Facial nerves regulate the
expressions people make; like directing the eyebrows, squeezing the eyes shut, or laughing
(Gilden, 2004).
Every facial nerve initiates in the mind, goes throughput the head in a contracted duct
of bone, and departures the head behind the ear part, from here, it ruptures into minor
divisions of nerves that linked to the facial muscles, ear, and neck (Sullivan, Swan, Donnan,

SCENARIOS
11
Smith, McKinstry, & Hayavi, 2007). Other minor nerve subdivision goes to the glands that
create saliva, the tears making glands, and the interior of the tongue part. The nerve of the
face regulates most of the facial muscles and areas of the ear. The nerve of the face goes via a
contracted opening of bone from the brain part to the face. If the nerve of the face is swollen,
it will push against the bone of cheek or may tweak in the fine gap. This can outcome in
injury to the defensive covering of the nerve. If the defensive covering of the nerve develops
damaged, the indications that mobile from the brain part to the facial muscles may not be
transferred appropriately, leading to debilitated or paralyzed the facial muscles. This is Bell's
palsy (Sullivan et al., 2007).
Causes
The precise reason why this occurs is uncertain. It may happen when a virus,
typically the herpes virus, exacerbates the nerve. This is the similar virus that also causes cold
wounds and genital herpes. Additional micro-organisms that have been related to Bell's palsy
comprise shingles and chickenpox virus, genital herpes virus and cold sores, Epstein-Barr
virus, accountable for mononucleosis, mumps virus, influenza B, cytomegalovirus, and hand-
foot-and-mouth illness (coxsackievirus) (Linder, Bossart, & Bodmer, 2005).
Bell's palsy frequently comes on unexpectedly, without cautionary, over several
hours, topping at 72 hours. In around eight out of ten disease cases, regaining may take place
in weeks or months. Some of the symptoms associated with Bell’s palsy includes: Incomplete
or complete paralysis of (typically) one 50 per cent of the face (counting the incapability to
close the exaggerated eye), sometimes supplemented by a ‘drooping’ of the pretentious side
of the mouth, contingent on the seriousness of the nerve injury, In about one percent of
disease cases, both the sides of the face are exaggerated, severe pain in the internal ear