Clinical Reasoning Report - Mrs Amari - Case Study - Assessment Answer

Clinical Reasoning Report Case Study Assignment

Case Scenario

Mrs Amari has been on the stroke ward for 24hrs. You have just begun your shift and receive the following handover;

In bed 10 we have Mrs Amari. She presented yesterday to the emergency department with dizziness and headaches, slurred speech and slight facial drooping on the right side. Her symptoms have resolved. There is no facial asymmetry and her complaint of numbness has subsided.

Assignment Task

a) Consider the patient situation (tells us what is significant about her age, culture, health specific issues, medical history and social history, making links to the presenting situation).

b) Collect cues and information by reviewing currentinformation, gathering new information (telling us what assessments are needed while linking this to a clear understanding of what is going on with the patient from a functional and structural perspective within the brain). Making these links requires you to recall knowledge of the bio scientific principles underlying the case.

c) Process the information by careful analyses identifying normal from abnormal. Discriminate by narrowing down to tell us what are the most important and relevant cues to Mrs Amari at this time (the current situation). Relate the cues collected to tell us which cues can be clustered together and ‘connect the dots’ to inform us that Mrs Amari is having a deterioration. Next infer -think about the cues collected and consider what Mrs Amari is experiencing.

A Case Study of Mrs. Amari

The focus of this paper is processing information in the case study of Mrs. Amari, a 59 year old woman who was taken to hospital by the husband after he observed that her face was drooping and she had slurred speech. The case looks at the clinical reasoning based on the information obtained from the case study.

Interpret

Mrs. Amari was taken to hospital by the husband after he observed that her face was drooping and she had slurred speech. Transient ischemic attack (TIA) is the result of lack of blood flow in some parts of the brain. Usually, there is a burst of a brain aneurysm or sometimes hemorrhagic which is normally described as a weakened blood vessel leakage. Despite the fact that TIA usually results in memory loss, Mrs. Amari is conscious and seems to be complaining of numbness, particularly down the right arm as well as on the right side of her face. These clinical issues observed and documented in the clinical case can be used in understanding the medical scenario hence providing appropriate solutions.

In adults, the normal ranges of vital clinical signs are: pulse 60 -100 beats per minute (bpm), respiration rate 10 -20 breaths per minute (bmp) temperature 35.8°C-37.5°C and BP less than 120/80 mm Hg.Assessment of Mrs. Amari was done immediately she checked into the hospital facility.Mrs. Amari’s temperature was within the normal range, but an elevated blood pressure of 148/97 mm Hg. Generally a BP of over 120/80 mm Hg is considered as hypertensive. Medical history has shown that Mrs. Amari’s family has a history of heart attack which is closely linked with hypertension. In this case study, the two major causes of BP decreased blood flow and lack of exercise to assist in the pumping of blood (Kernan et al. 2014).

Distinguish

Focusing on the patient’s situation, Mrs. Amari age is 59 years. Reports have shown that as one's age advances, there is the likelihood of stroke affecting the person, as was seen in Mrs. Amari’s case. Mrs. Amari’s family has a history of heart condition which is usually a precursor of stroke. The health history has significance in providing an explanation of the current health scenario of the patient. This is a clear indication that the family had a history of transient ischemic attack (TIA) and the implication was that it was more than probable that she had a TIA. Notably, Mrs. Amari was a habitual smoker 10 years ago, before she quit and studies have also shown that tobacco or smoking is a risk factor that is highly associated with TIA (Ritzenthaler et al. 2015). Smoking increases high blood pressure by reducing oxygen levels in the brain. Tobacco smoking leads causes hardening and narrowing of the arteries leading to a condition known as arteriosclerosis which is a predisposing factor for TIA. This was compounded by the failure to do regular exercise. It is known that regular exercise increases the heartbeat and reduces the chances of stroke affecting an individual. Mrs. Amari was disadvantaged in the sense that she had no well-structured exercise regime which may have aggravated the possibility of acquiring stroke. Both smoking of tobacco and lack of exercise are predisposing factors for stroke. It is important that further information should be gathered for concrete decision-making on Mrs. Amari. It was established that Mrs. Amari’s blood pressure was initially normal and no information is available as to whether this normal BP was maintained with medications (Das & Baheti 2013). It is imperative to confirm if she failed to take antihypertensive medication which might have had an effect on her BP. Moreover, her hydration status may easily be determined by inquiring about her fluid intake as well as output for the past 24 hours as well as assessing her urine color, skin turgor and mucous membrane (Cuinat et al. 2014).

Relate

The assessment that is needed to determine if indeed a person has TIA is the blood pressure. Blood pressure is due to lifestyle. In the case of Mrs. Amari, her blood pressure was recorded as the Blood 175/98 and the pulse rate was 90 which was above normal for a healthy person. Mrs. Amari high BP is attributed to high glucose level, which was 6.6mil. It is known that TIA differs from cerebrovascular accident since the latter is caused by bursting of the blood vessels in the brain while the former is due to clotting of blood within the brain that prevent free circulation (Adams et al. p. 1647). The characteristics of transient TIA include drooped mouth, slurred speech, dizziness and numbness that are clinical signs that were observed in Mrs. Amari. Therefore, the Mrs. Amari case fits a “typical” client with TIA. During her physical assessment, a nurse report that Mrs. Amari has carotid bruit. The nurse is concerned because carotid bruit is as a result of turbulent blood flow, especially in the arteries that supply the brain with blood. This is not good for a person suspected to have a TIA because it is likely to worsen the situation. The assessment that is normally undertaken for patients like Mrs. Amari who have changed neurological status include regular checking of blood pressure, respiratory rate and pulse rate. Transient ischemic attack usually share the similar underlying etiology with stroke, which is an interruption of CBF (cerebral blood flow). Like strokes, transient ischemic causes the same symptoms, for example, numbness, sudden weakness, as well as contralateral paralysis on the opposite side of the body (usually from the affected brain hemisphere). Mrs. Amari’s TIA caused loss of vision or sudden dimming, slurred speech, slight mental confusion and aphasia. The symptoms of transient ischemic in Mrs. Amari’s persisted for over 24 hours, giving an implication that it could be developed into the stroke. Notably, in severe transient ischemic brain injury can still occur, but lasts for a few minutes only. This raised the concern, if at all Mrs. Amari had a brain injury. In some cases, meningitis and cortical subarachnoid hemorrhage may form transient episodes of neurologic dysfunction that mimics transient ischemic. This becomes tricky, especially when assessing TIA

Infer

Mrs. Amari’s recent clinical signs of numbness resulting in drooping mouth and dizziness may be the primary cause of TIA, which might have led to the cascaded effect of slurred speech and increases respiratory rate. The failure to do regular exercise has actually aggravated Mrs. Amari condition. Regular exercise would have improved her right hand grasp of things even though the left hand was alight as expected in acute cases of TIA. By having a transient ischemic attack, Mrs. Amari, she has a neurological dysfunction that is generally caused by loss of blood flow or ischemia- either retinal, focal brain or spinal cord. This is a transient episode without tissue death, which can also be referred to as lack of acute infarction. In summary, having transient ischemic is a risk factor for eventually developing a silent or stroke.