Case study for subject Assessment & Care Planning

Case Study – Ms Singh

Ms Singh (Sangeeta) is a 69 year old retired secretary who lives ‘down the road’ from her daughter and grandchild. Her husband passed away 6 months ago and since then she has become socially

withdrawn; choosing to spend most of her time at home in the garden, or reading books. She wears bilateral hearing aids and reading glasses. Other than a permanent colostomy (resulting from

a large bowel infarction in 2005) she has had nil significant medical history to report. Ms Singh immigrated to Australia 20 years ago from India. English is her second language and she practices

the Hinduism religion.

Last night Ms Singh was brought in by ambulance (BIBA) to the emergency department after her daughter found her on her bathroom floor. Ambulance staff report that she was found naked and

unable to call for assistance for almost 18 hours. She was diagnosed as having had a cerebrovascular accident (CVA) with residual right (R) sided hemiplegia, dysphagia and dysphasia.
She is soon transferred to the acute medical ward where you work and is accompanied by her daughter (Nita) who is obviously quite distressed. Ms Singh appears quiet and drowsy. She is

currently Nil by Mouth (NBM) whilst awaiting a speech therapist review.

Her vital signs on arrival are:

• Temperature: 36.9 degrees Celsius

• Pulse: 115 beats per minute

• Respirations: 26 breaths per minute

• Oxygen Saturation (SpO2): 94%

• Blood Pressure 170/95.

1. What are the normal limits for Temperature?

2. What are the normal limits for Oxygen Saturations?

3. What are the normal limits for Blood Pressure?

4. What are the normal limits for respirations?

5. What are the normal limits for an Adult Pulse?

6. What is the correct terminology for high blood pressure?

7. When a patient is suffering from dysphagia what restrictions may be placed on their dietary and food intake

8. Ms Singh is very weak and unable to mobilise to the toilet. What are some nursing strategies (devices) that may be implemented to assist her with her urinary elimination?

9. Ms Singh has a colostomy as a result of a bowel infarction– what does this mean? What are other reasons people need colostomies?

10. What factors cause or contribute to the formation of pressure areas/decubitus ulcers?

11. What is an Advanced Health Directive?

12. Ms Singh is no longer NBM and has been placed on a modified diet. What are some strategies you could use to assist her in feeding?

13 Explain the diagnosis ‘aspiration pneumonia’ and the possible aetiologies given Ms Singh’s current condition.

14 You are alone in the room with Ms Singh and she starts complaining of a painful left hip and is requesting that you give her some pain relief. As a TAFE student are you able to administer

medications independently as per your scope of practice and legislative requirements?

15 In relation to the case study, discuss each of the deficits Ms Singh has presented with (150word limit & to be referenced in APA format)

16 In relation to the case study, discuss how the nurse can assess Ms Singh mobility capabilities (including risk of falling). You may use point form (150word limit & to be referenced in APA format)

17 In relation to the case study, as a result of the (R) sided hemiplegia, Ms Singh requires assistance to empty and change her colostomy bag. Explain (in point form) the steps involved in this

process and provide 2 specific educational points you can discuss with the patient (100word limit & to be referenced in APA format)

18 In relation to the case study, after 5 weeks – explain the concept of discharge planning and how it would apply in this situation. What are the likely discharge options available to Ms Singh?

(100word limit & to be referenced in APA format)

19 Ms Singh is a Hindu – Identify 3 ways you would respect Ms Singh’s cultural, spiritual and religious wishes (100word limit & to be referenced in APA format)

20 What strategies could you implement to prevent Ms Singh’s pressure area from worsening and to promote healing? (List at least 4) (100word limit & to be referenced in APA format)

21 In what ways can you demonstrate respect for Ms Singh’s decision to not actively be resuscitated? (List at least 3) (50word limit & to be referenced in APA format)

22 What is the correct terminology for each of the following abnormal vital signs?
A. Adult Pulse: below and above normal parameters
B. Adult Respirations: below and above normal parameters
C. Oxygen: below normal parameters
D. Adult Blood pressure: below and above normal parameters
E. Temperature: below and above normal parameters

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