Case Study For Mild Learning Difficulties Discussion
Case Study For Mild Learning Difficulties Discussion
Content for VIVA Examination
Scenario I: Debbie, 32 Year-Old with Mild Learning Difficulties
Debbie has mild learning difficulties but has suffered a fracture that requires internal fixation after surgery. The learning difficulty could be due to attention-deficit/ hyperactivity disorder or ADHD (Sadock et al. 2015). She has not passed urine for the past 6 hours, has a fever, tachypnea, and tachycardia but is alert and responsive. She is in a lot of pain as the pain score is 8/10. Case Study For Mild Learning Difficulties Discussion
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What Has Gone Wrong or Pathophysiological Meaning
With the tachypnea and tachycardia and given the fact that this patient is coming from surgery, the most likely event that has occurred is that she has suffered a pulmonary embolism or PE. This could be a clot or a bolus of fat from the broken femur. The anuria is also indicative of the possible fact that the same particles have been transported to the kidneys making them fail due to insufficient perfusion (Hammer & McPhee 2018)Case Study For Mild Learning Difficulties Discussion.
Clinical Interventions Supported by NICE Guidelines UK
The key interventions would be ruling out pulmonary embolism following the NICE criteria and also commencing thrombolytic therapy (NICE 2020). Even through the patient still has a good SpO2, supplemental oxygen should be commenced. The patient should also receive diuretics like furosemide intravenously in large doses to jolt the kidneys back to function. Definitely, if the oliguria continues further despite the diuretics, the patient will require renal replacement therapy in the form of dialysis to remove toxins such as urea and creatinine from the body.
Signs and Symptoms
The signs and symptoms of pulmonary embolism are dyspnea, tachypnea, tachycardia, and restlessness amongst others.
Nursing Approach
The nursing approach will be pain relief, administration of supplemental oxygen by mask or nasal prongs, propping the patient up, reassuring the patient, and administering thrombolytic therapy, antipyretics, and other medications like diuretics at once. The other intervention will be dialysis until the BUN, urea, and electrolytes return to normal. Case Study For Mild Learning Difficulties Discussion
Management of the Condition and Concerned Professionals
Management of the condition will involve ruling out pulmonary embolism, prescription of intravenous diuretics and antipyretics, and giving thrombolytic therapy. The concerned professionals include the registered nurses, the physicians, the pharmacists, and the healthcare assistant (HCA)Case Study For Mild Learning Difficulties Discussion.
References
Hammer D.G, & McPhee, S.J (Eds) 2018, Pathophysiology of disease: An introduction to clinical medicine, 8th ed, McGraw-Hill Education.
National Institute for Health and Care Excellence [NICE] 2020, Venous thromboembolic diseases: diagnosis, management and thrombophilia testing – NICE guideline [NG158], viewed 21 June 2022, https://www.nice.org.uk/guidance/ng158
Sadock, B.J, Sadock, V.A, & Ruiz, P 2015, Synopsis of psychiatry: Behavioral sciences clinical psychiatry, 11th ed, Wolters Kluwer Case Study For Mild Learning Difficulties Discussion
Scenario II: Alan, 72 Years Old with a History of CVA 24 Hours Ago
The patient is an elderly 72 year-old widower staying alone. He suffered a cerebrovascular accident (CVA) or stroke 24 hours ago and already has left-sided weakness or hemiparesis. He is not in much pain, has tachynoea and tachycardia, is afebrile, and has an oxygen saturation of 95%
What Has Gone Wrong or Pathophysiological Meaning
The patient has had an ischaemic stroke or a haemorrhagic stroke (if he was hypertensive). His current BP is high though. The stroke could have occurred as result of a blood vessel rupturing in the brain due to hypertension (hemorrhagic stroke); or due to a clot blocking one of the major arteries causing infarction (Hammer & McPhee 2018). The difficulty in speaking could be attributed to the stroke of a neurocognitive disorder (NCD) like dementia that he may have had already (Sadock et al. 2015)Case Study For Mild Learning Difficulties Discussion.
Clinical Interventions Supported by NICE Guidelines UK
The clinical interventions include thrombolytic therapy after ascertaining that it is a thromboembolic stroke (NICE 2022). He will also require assessment for the presence of a NCD. Apart from that, this patient requires assistance with activities of daily living such as:
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- Nutrition (feeding)
- Grooming
- Bathing
- Mobility
- And safety (he is at a high risk of falls).
Signs and Symptoms
These include weakness of the limbs on one side of the body, one-sided facial paralysis, difficulty swallowing, and speech difficulties amongst others.
Nursing Approach
Administering thrombolytic therapy, other prescribed drugs, and supplemental oxygen. Also assessment for comorbid conditions that may complicate his current status and making appropriate nursing diagnoses such as “risk of suffering falls related to frailty and cognitive impairment”.
Management of the Condition and Concerned Professionals
Management is thrombolysis, physical therapy for rehabilitation, and management of co-existing conditions. Those involved are nurses, healthcare assistants, physical therapists, physicians, and pharmacists amongst others.
References
Hammer D.G, & McPhee, S.J (Eds) 2018, Pathophysiology of disease: An introduction to clinical medicine, 8th ed, McGraw-Hill Education.
National Institute for Health and Care Excellence [NICE] 2022, Stroke and transient ischaemic attack in over 16s: diagnosis and initial management – NICE guideline [NG128], viewed 21 June 2022, https://www.nice.org.uk/guidance/ng128
Sadock, B.J, Sadock, V.A, & Ruiz, P 2015, Synopsis of psychiatry: Behavioral sciences clinical psychiatry, 11th ed, Wolters Kluwer. Case Study For Mild Learning Difficulties Discussion
Scenario III: Hardip, 14 Years Old with Persistent Diarrhoea and Vomiting
The patient is a 14 year-old girl who lives with her parents and two younger brothers aged 10 and 8 years old. She is alert and responsive with normal BP and oxygen saturations. However, she has marked tachypnoea and tachycardia and is febrile.
What Has Gone Wrong or Pathophysiological Meaning
This is infection of the gastrointestinal tract by pathogenic organism s such as possibly Salmonella typhi. The patient has lost a lot of fluids and electrolytes and could possibly be experiencing metabolic acidosis hence the tachypnoea and tachycardia (Hammer & McPhee 2018).
Clinical Interventions Supported by NICE Guidelines UK
This will include the prescription and administration of antibiotics, antipyretics, and intravenous fluids to replace the lost fluids and electrolytes. Also needed will be probiotics (Hammer & McPhee 2018; NICE 2009). The nurses will also have to five health education on handwashing and proper food hygiene to the parents.
Signs and Symptoms
Dehydration, tachycardia, nausea, vomiting, lethargy, and fever amongst others.
Nursing Approach
This will include tepid sponging, giving antipyretics, probiotics, antibiotics prescribed, and administering intravenous fluids. Then a fluid and electrolyte chart will be kept too. The other intervention will be health promotion and education on proper hand hygiene to prevent gastrointestinal infections.
Management of the Condition and Concerned Professionals
Management involves antibiotics, antipyretics, probiotics, health education, and intravenous fluids. Those concerned are registered nurses, physicians, healthcare assistants, the parents, and pharmacists. Case Study For Mild Learning Difficulties Discussion
References
Hammer D.G, & McPhee, S.J (Eds) 2018, Pathophysiology of disease: An introduction to clinical medicine, 8th ed, McGraw-Hill Education.
National Institute for Health and Care Excellence [NICE] 2009, Diarrhoea and vomiting caused by gastroenteritis in under 5s: diagnosis and management – Clinical guideline [CG84], viewed 21 June 2022, https://www.nice.org.uk/guidance/cg84
Scenario IV: Lucasz, 26 Years Old with Poor Medication Compliance and an Infected Old Wound
The patient is a 26 year-old male who lives with his girlfriend and their six month old daughter. He is a psychiatric patient who is not complying with medications. He looks fatigued and anxious and has old scars that point to self mutilation or self-injury characteristic of depressive disorders (Sadock et al. 2015). He has tachypnoea and tachycardia which are probably due to his anxiety.
What Has Gone Wrong or Pathophysiological Meaning
This is a patient that is possibly suffering from a depressive disorder such as major depressive disorder or cyclothymic disorder on medications. He is getting home visitation because he is not complying with medications. The old wound that is opening up is an indication of a lack of self-care which is a major dysfunction (Sadock et al. 2015)Case Study For Mild Learning Difficulties Discussion.
Clinical Interventions Supported by NICE Guidelines UK
These will include supervised medication to ensure compliance, family therapy for the patient and his girlfriend, as well as individual cognitive behavioral therapy or CBT (NICE 2009; Sadock et al. 2015). Because of the depression and apparent self-harm behavior, this patient is possibly suicidal and will require involuntary admission until he is safe and also taking medications as required.
Signs and Symptoms
These include dysfunction in terms of self-care, self-injury (suicidal ideation), depressed mood, and a feeling of worthlessness amongst others.
Nursing Approach
This will entail giving psychoeducation as well as health education to the girlfriend to act as a caregiver at home and ensure medication compliance. The administration of medications will also need to be supervised to ensure that the patient complies fully.
Management of the Condition and Concerned Professionals
Psychotherapy and medications are the standard management for this patient. He will also need to have his wound cared for including proper dressing to further prevent infections (Hammer & McPhee 2018)Case Study For Mild Learning Difficulties Discussion. Those involved here are the community psychiatric nurse (CPN), the healthcare assistant, the social worker, the psychiatrist, and the patient’s family.
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References
Hammer D.G, & McPhee, S.J (Eds) 2018, Pathophysiology of disease: An introduction to clinical medicine, 8th ed, McGraw-Hill Education.
National Institute for Health and Care Excellence [NICE] 2009, Depression in adults: recognition and management – Clinical guideline [CG90], viewed 21 June 2022, https://www.nice.org.uk/guidance/cg90
Sadock, B.J, Sadock, V.A, & Ruiz, P 2015, Synopsis of psychiatry: Behavioral sciences clinical psychiatry, 11th ed, Wolters Kluwer Case Study For Mild Learning Difficulties Discussion