Nursing Case Study
I. Health HistoryThe subject of my case study is W. K. W.K. is a 95 year old white male who was admitted to Moses Cone Hospital on November 23, 2002. Prior to being admitted to the hospital, W. K. had been in excellent health. His troubles apparently began three weeks prior to being admitted. On November 23, W. K.’s son found him lying on the floor confused, and soaked in urine. Mr. K. was diagnosed as having an acute cerebral vascular accident. This disorder can also be described as a “stroke”. It occurs when there is an interruption of normal blood flow in one or more of the blood vessels that supply the brain. Thrombosis, embolism, and hemorrhage are the primary causes of a CVA. (Sommers and Johnson 2002) The tissues of the brain become ischemic, leading to hypoxia or anoxia with destruction or necrosis of the neurons, glia, and vasculature. Complications of CVA include unstable blood pressure, sensory and motor impairment, infection, pneumonia, contractures, and pulmonary emboli. CVA is the third leading cause of death in the United States and affects more than 500,000 Americans annually. (Sommers and Johnson 2002) He was widowed in October of 2001, one daughter has coronary artery disease, one son died of an MI at age 37, and one son died with lung cancer at 57. He had been the primary care giver of his daughter until she was admitted to the hospital three weeks ago. She is dying with a short bowel syndrome and cirrhosis and is now being taken care of in hospice. Soon after being left alone, Mr. K.’s appetite decreased and he had become congested. He was placed on Paxil to treat symptoms of depression. He had also been taking Cipro for congestion. Also his family noticed that he was suffering from confusion. As a result, they brought him into the Emergency Room for evaluation. The Emergency Room doctors performed a CT scan of the brain which revealed evidence of old strokes. The doctors stopped the Cipro and placed him on Z-pack. This seemed to improve his state of confusion, as well as reduce his symptoms of congestion. On the 22nd, he was seen for the congestion. The doctor examined him thoroughly. This exam included giving him a chest x-ray. The chest x-ray proved to be normal. His white blood count was elevated and he was found to be mildly dehydrated. He was prescribed Amoxicillin 500 three times a day, and Guaifenesin. His past medical history is short including depression, stroke, and presbyacusis. He has not had any prior surgery and there are no known allergies. II. Diagnostic MeasuresOn November 25, 2002 W. K. under went several diagnostic studies in order to confirm that he indeed had suffered a stroke on November 23. A MRI scan without contrast, of the brain was performed; these results were compared to a similar scan performed on November 23. The scan revealed bilateral acute infracts; the largest was located in the left superior cerebellum. Atrophy and chronic ischemic change was also evident. The MRA scan, without contrast, of the intracranial region showed significant intracranial atherosclerotic disease in one or two occluded branches of the right middle cerebral. On the same day, W. K. had his first DG swallow function test. Under lateral video fluoroscopic observation, various consistencies of oral barium blouses were administered to the patient. The video tape recording revealed Frank Tracheal Aspiration with thin liquid, nectar, thick liquid and honey thick consistency barium solutions as well as vallecular pooling. These findings explain the source of Mr. K.’s congestion. Finally, a DG chest portable 1V test was performed. The results of this test were compared to a similar test performed on November 12. There was found to be mild improvement in W. K.’s interstitial prominence. There was no pneumonia or faxal infiltrates found. When W. K. was admitted to the hospital, his abnormal laboratory findings included a low potassium level of 3.1 mEq/Lh, a low lymphocyte count of 3%,...
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