Mr Sam Kwon is a 74-year-old man (Medical Record Number (MRN) 684421). He was brought in by paramedics with right-sided hemi-paralysis, aphasia and facial drooping. He has a history of hypertension, congestive cardiac failure, and type 2 diabetes mellitus.

He takes oral hypoglycaemic agents. He has also smoked a pack of cigarettes a day for approximately 40 years. His observations were as follows:  

Temperature

Heart rate

Respiration rate

Blood pressure

SpO2

36.8°C

98bpm

24/per minute

140/105mmHg

96% (room air)

 

A CT scan without contrast suggested a probable left cerebrovascular accident, with increased density in the left middle and cerebral artery and possible early signs of oedema.

From these results, it is expected that Mr Kwon may also be experiencing homonymous hemianopia, but communication is difficult at this stage.

As he is aphasic he requires a communication board, however, he can answer with a head nod to closed questions.

Mr Kwon’s BGL is 9.4mmol/L. He has basal crackles and has been placed on oxygen at 2L/min via nasal prongs. A swallow review has been booked for today; meanwhile he remains nil by mouth.

The time of the incident is currently unknown as his family have been out since early morning and did not find him until late last night.

The team were unable to dissolve the clot. Mr Kwon requires q2h turns, he has an IV catheter in situ and is receiving crystalloid fluids. He also requires q2h BGL tests at this stage he is for review later today.

Task Details

1. Analyse and interpret the assessment findings for Mr Kwon.

2. Based on your analysis and interpretation, develop an interprofessional care and management plan for Mr Kwan. In your plan, address:

Ethical and legal implications

Person-centred care

Health promotion strategies.

Support your plan with current evidence-based literature.

3. Over the next 14 days, Mr Kwon’s condition improves to a point where the doctor is happy to discharge him home.  His gait is steady and unaided, his speech has improved but still slurred. He has recovered some movement on his right side and it is likely a deficit will remain.  With this new information and your initial notes about his lifestyle/history, develop a discharge plan.  Complete the attached discharge plan form.

Justify your discharge plan decisions with reference to the literature.

Assessment Criteria

You will be assessed on your ability to:

Identify and analyse key case findings and draw logical conclusions. (30)

Develop and prioritise care strategies that flow from your analysis. (30)

Explain your decisions in a clear and logical way. (20)

Incorporate relevant ideas from the literature in your writing that support your argument. (10)

Use academic English, grammatically correct sentences and APA style for references. (10)

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