Assessment Task: Acute Stroke and Multimorbidity Case Study

Assessment Task: Acute Stroke and Multimorbidity Case Study

Course: NRSG2025: Chronic Illness and Palliative Care Nursing

Assessment Type: Case Study Analysis

Word Count: 2000 words (+/- 10%)

Weighting: 40%

Due Date: [Insert Date]

Submission: Via Turnitin

Case Study: Mrs. Soo Hui

Mrs. Soo Hui is a 46-year-old female (she/her) admitted to St. Elsewhere Hospital following an episode of blurred vision, right-sided numbness, and a severe headache. She was found by a neighbor, unable to move or speak.

Diagnosis: Left-sided ischemic cerebrovascular accident (CVA). She has been commenced on anticoagulant therapy.

Family and Social History:

• Born in Australia to Thai parents.
• Practices Buddhism and is bilingual (Thai and English).
• Lives with her husband, two children (ages 13 and 5), and her frail 82-year-old father.

Medical History:

• Hypertension
• Type 2 Diabetes
• Asthma
• Depression
• Hearing aid (left ear)
• Bi-focal glasses (broken during her fall)
• Upper dental partial plate

Current Medications:

• Amlodipine
• Metformin
• Salbutamol

Admission Observations:

• BP: 150/90 mmHg
• PR: 85 bpm (regular)
• RR: 24 breaths/min
• T°: 36.9°C
• SpO₂: 96% on room air
• BGL: 8.4 mmol/L
• Weight: 69 kg
• Height: 162 cm
• GCS: 14 (Eyes open to speech, oriented, slurred speech)
• Neurological: Right hemiparesis, PERL
• Pain: 7/10 in the right hip and shoulder on movement
• Integumentary: Large hematoma on the right hip, 5cm skin tear on the right elbow
• Other: Dysphasia, dysphagia, right-sided facial droop, mild right-side hemiplegia

Initial Medical Orders:

• Rest in bed (RIB)
• 2nd hourly neurological observations
• Nil by mouth (NBM) until Speech Pathologist review
• Physiotherapist review
• Full assistance with hygiene
• Indwelling urinary catheter (IDC) in situ
• Intravenous therapy via cannula in the left forearm

Discharge Plan:

Mrs. Soo Hui will remain in the acute care setting for approximately two weeks and will then be transferred to a rehabilitation unit. The discharge planning team and community services have been engaged.

Assignment Questions

You are to provide a comprehensive response to each of the following questions, integrating evidence-based practice and scholarly literature.

1. Patient-Centered Room Preparation: Describe how you would prepare Mrs. Hui’s hospital room, considering her specific clinical needs and cultural background.
2. Initial Assessment Equipment: List and justify four essential pieces of equipment you would use to conduct a thorough initial nursing assessment for Mrs. Hui.
3. Principles of Nursing Documentation: Identify and explain four key principles of high-quality nursing documentation in both written and electronic formats.
4. Clinical Significance of Anthropometric Measurements: Explain the clinical importance of accurately measuring and recording a patient’s weight and height on admission.
5. ISBAR Handover: Construct a detailed ISBAR handover for Mrs. Hui, providing the information you would give to the nursing team on the next shift.
6. Cerebrovascular Accident Pathophysiology and Presentation:
   • Explain the two primary types of CVA, including their causes and the affected areas of the brain.
   • Identify four clinical manifestations of a left-sided CVA, with reference to Mrs. Hui’s presentation.
   • List Mrs. Hui’s comorbidities and briefly explain how each may impact her recovery.
7. Psychosocial Impact of Stroke: Discuss the potential impact of depression on a middle-aged adult, such as Mrs. Hui, in the context of a new, life-altering diagnosis.
8. Nursing Care Plan: For each of the four nursing diagnoses provided by the Registered Nurse, develop two nursing interventions, a rationale for each intervention, and one evaluation for each.

References (APA 7th Edition)

1. Phan, H. T., Blizzard, L., Reeves, M. J., Thrift, A. G., Cadilhac, D., Sturm, J., … & Gall, S. L. (2019). Sex differences in long-term trends in stroke incidence and survival in a MONICA-registered population. Stroke, 50(11), 3099-3106.
2. Powers, W. J., Rabinstein, A. A., Ackerson, T., Adeoye, O. M., Bambakidis, N. C., Becker, K., … & Jauch, E. C. (2019). Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 50(12), e344-e418.
3. Skolarus, L. E., Burke, J. F., Brown, D. L., & Freedman, B. A. (2020). The complex role of comorbidities in personalizing stroke prevention. Stroke, 51(1), 323-329.
4. Teasell, R., Salbach, N. M., Foley, N., Bitensky, J., & Meyer, M. J. (2020). Canadian stroke best practice recommendations: Rehabilitation, recovery, and community participation following stroke. Part one: Rehabilitation and recovery following stroke, 6th edition. International Journal of Stroke, 15(7), 763-788.
5. Winstein, C. J., Stein, J., Arena, R., Bates, B., Cherney, L. R., Cramer, S. C., … & Zorowitz, R. D. (2016). Guidelines for adult stroke rehabilitation and recovery: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 47(6), e98-e169.