Case Based Presentation

By Wilson

04/10/23 wilson chaman 1

Objectives

• By the end of my case study presentation, listeners will be able to,

• Discuss the significance of this case study presentation• Discuss patient's data• Discuss evidence based Nursing diagnosis and

interventions• Develop a teaching plan.

04/10/23 wilson chaman 2

Cont…

• Conclude the case study

04/10/23 wilson chaman 3

Significance of the Case Study

I selected this patient for case study because of the following reasons:

• Her case was interesting in relation to disease process. • The case was important from Nursing Care point of view.• Moreover the prevalence of stroke in South Asia and

particularly Pakistan is vey high.

04/10/23 wilson chaman 4

Significance…..

• Stroke is the third most common cause of death and the first leading cause of disability in developed and developing countries.

• According to World Health Organization estimates, 5.5 million people died of stroke in 2002, and roughly 20% of these deaths occurred in South Asia.

04/10/23 wilson chaman 5

Incidence of stroke in Pakistan

• Estimated annual incidence is 250/100,000, translating to 350,000 new cases every year.

• At a major University hospital with a busy Neurology service in Karachi, 519 patients with stroke were admitted over a 22 month period. 

• In a retrospective analysis of patients admitted with stroke in two major hospitals over an 8 years period, 796/12,454 (6.4%) of consecutive cases admitted in medical units had stroke.

• Bhojo A. Khealani  ( Department of Medicine, Aga Khan University Hospital, Karachi, ) Bilal Hameed,Uzma U. Mapari  ( Department of Medicine, University of Alberta, Edmonton, Alberta, Canada. ) , Stroke in Pakistan.

http://www.jpma.org.pk/full_article_text.php?article_id=1444

04/10/23 wilson chaman 6

Scenario

• My pt was 50 year old female. • GCS

E:4, M:5, V:1 = 10/15• She was house wife . She had history of DM and HTN.

She came to hospital with chief complain of right side stroke and was not able to eat , speak ,difficulty in chewing and to do other activities.

• Family history she had a family history of DM and HTN.

04/10/23 wilson chaman 7

Genral Survey

• Pt lying on bed in Rt. lateral position, was looking lethargic with hemiplegia. Overall skin was pinkish and physically looking overweight.

04/10/23 wilson chaman 8

A-G assesment

• A- air way clear • B- breathing spontaneously at room air• C- capillary refill 2/sec• D- on soft diet• E- Foleys catheter implaced• F- aminovel @ 30 drops/mint• G- pt looks lethargic and uncomfortable

04/10/23 wilson chaman 9

04/10/23 wilson chaman 10

Stroke?

04/10/23 wilson chaman 11

WHO defined stroke as ‘rapidly developed clinical signs of disturbance of cerebral (brain) function, lasting more than 24 hrs or leading to death, with no apparent cause other than vascular origin.

04/10/23 wilson chaman 12

04/10/23 wilson chaman 13

causes

• Artery blockage • HTN• High cholesterol• Diabetes • Smoking• Obesity • Embolism

04/10/23 wilson chaman 14

S/S

• Weakness• Confusion• Walking trouble• Lack of coordination • Lack of swallowing• Severe headache • G.I disturbance • Urine incontinence

04/10/23 wilson chaman 15

Diagnosis and labs…

• CT scan

Shows the right hemiplegic stroke and damage left temporal region of the brain.

• BSR <200mg/dl

(blood sugar was high) • BSF 312

(Normal =60-100)

04/10/23 wilson chaman 16

Nursing Diagnosis AndNursing Care

04/10/23 wilson chaman 17

N. Diagnose and Interventions

• Self care deficit related to lack of coordination secondary to stroke.

• Interventions • Provide sponge bath• Provide hand and foot care• Provide back care• Provide bed pan and urinal• Provide N/g feed as prescribed

04/10/23 wilson chaman 18

N. Diagnose and Interventions

• Impaired physical Mobility r/t Deceased muscle strength and endurance s/t Paralysis

• Interventions • Perform ROM• Change position every 1 or 2 hrly

04/10/23 wilson chaman 19

N. Diagnose and Interventions

• Impaired skin integrity r/t immobility s/t Comatose state

• Interventions • Teach family members to provide back care and massage the

vulnerable sites• Increase fluid intake• Change position every 2-3 hrly• Provide air mattress beneath the bed sheet• Put water filled gloves at the bony prominences of limbs

04/10/23 wilson chaman 20

Teaching plan

• Stroke rehabilitation program. -ROM (active and passive)

-Assist in daily life activity-Foot drop prevention

• Control of HTN. -Diet-Exercise

04/10/23 wilson chaman 21

Cont…

• Diabetic diet chart.

Teach about glucose monitoring and normal ranges.

• Speech therapy

04/10/23 wilson chaman 22

04/10/23 wilson chaman 23

Conclusion

In conclusion stroke is one of the most debilitating issues of the older people. Being nurses we should have the knowledge and skills to handle a patient with stroke. My patient suffered stroke because of diabetes and hypertension. These are the most commonest causes. In order to prevent stroke the prevention of theses diseases is essential.

04/10/23 wilson chaman 24

04/10/23 wilson chaman 25

Refrences:

• http://www.medicinenet.com/stroke/page3.htm• http://www.ajmc.com/publications/supplement/2008/2008-06-vol14-

n7suppl/jun08-3376ps204-s211• Bhojo A. Khealani  ( Department of Medicine, Aga Khan University

Hospital, Karachi, ) Bilal Hameed,Uzma U. Mapari  ( Department of Medicine, University of Alberta, Edmonton, Alberta, Canada. ) , Stroke in Pakistan.

http://www.jpma.org.pk/full_article_text.php?article_id=1444

04/10/23 wilson chaman 26