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Case Study
Mrs. Amelia Middleton is a 68 year old retired receptionist who is bought in by ambulance to the emergency department (ED) of her local hospital. Her son Paul is with her. Paul had called the ambulance service earlier stating that his mother woke this morning complaining of a headache and is now unable to lift her right arm and has been having difficulty speaking.
On examination Mrs. Middleton has a BP of 200/110, pulse 78 and irregular, respiratory rate 16, SpO2 98%, Glasgow Coma Scale 12, and Temp 36.8. Her blood sugar level is 4.8mmol/L. She also has paralysis of the right arm and face and loss of sensation to touch on the right side of her face and right arm. She appears to understand what is being said to her but cannot respond verbally. Mrs. Middleton’s history includes depression and lower gastrointestinal bleeding associated with haemorrhoids. She has no known allergies. Mrs. Middleton is an only child. Her father died of an anterior myocardial infarction at age 57 and her mother died of breast cancer at age 72.
Mrs. Middleton currently lives with her son after the recent death of her husband, Geoff. She is in the process of trying to sell the family home. She has three other children, all of whom live
interstate.
Amelia Middleton’s current medications are:
Sertraline 100mg mane
Rectinol HC topically as required
At the time of arrival Mrs. Middleton had a provisional diagnosis of CVA/stroke.
Mrs. Middleton was ordered a CT scan which was conducted 6 hours after her arrival to ED, the
results excluded the presence of a haemorrhagic stroke but indicated ischaemic stroke.
A 12 lead ECG was also conducted on arrival and Mrs. Middleton was found to be in atrial
fibrillation.
Directions
This assessment task requires you to apply the Clinical Reasoning Cycle (CRC) to the above case study, using the following questions/instructions to guide and organise your response. Your answers should be presented in an integrated essay-format (rather than short-answer responses) and be informed and supported by your reading of current research and literature.
1) What additional data/cues would you gather in regard to this case, and how and why would this be performed?
2) Draw upon existing knowledge and relevant scholarly literature to process the above information.
3) Given that the diagnosis of ischaemic stroke has already been confirmed, identify and explain two other issues/problems for Mrs Middleton that emerge from your analysis of the data (remember, these do not necessarily have to be other specific diagnoses/conditions, but could be particular problems that arise due to the stroke).
4) Select one of these issues/problems and establish a clear goal for your care.
5) Discuss your key actions/interventions for achieving this goal, drawing upon appropriate practice literature.
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Appendix B
Helpful Hints for Assessment 1 – Case Study
• This assessment is to be presented in an essay format, and therefore it is appropriate to write a very brief introduction and conclusion (at most one or two sentences). You may want to briefly state the patient situation/context, but do not re-write the entire case study in your introduction.
• Please respond to the questions/instructions in a logical format. You may use headings to help organise your response.
• Dot points and charts are not acceptable.
• References must be current, preferably from the past five years. Your referencing should demonstrate wide-reading from a variety of sources, such as texts, journals and clinical practice guidelines.
• Consider the quality rather than the quantity of the references you use. Wikipedia, Better Health Channel and other generic websites are not acceptable scholarly references. At this point in your BN we expect you to engage with credible practice literature.
• Spelling, grammar and correct terminology are very important and therefore it is advised to carefully read/review your essay prior to submission (or have another person read it).
• Request for extension must be in accordance with the SHS Assessment Policy (please see the SHS webpage). No extensions will be granted if requested within 24 hours of the due date.
• You will submit your paper online via Dropbox. It is recommended that you use Turnitin to assist in the review of your draft before submitting the final version. Your grade and feedback will be provided through MyLO.

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