Unfolding Case Study for Public Health Course

Requirements for Students:

· Provide answers to all Case Study Questions.

· Utilize evidence-based resources such as textbooks, reliable websites like .gov, .org, and .edu, and/or peer-reviewed/scholarly journal articles. Provided information must be up to date (within 5-year period).

· Provide in-text citation and reference page in APA format.

· Submit the answers as per faculty instructions.

Case Study (Part 1)

RN position: case manager/field nurse at the home health agency.

The agency receives a phone call from the hospital social worker about a new referral. Patient will have to be admitted to home health after discharge from the hospital s/p embolic stroke for physical therapy, occupational therapy, speech therapy, social worker, skilled nursing and certified nurse assistant services. As per social worker, patient was offered but refused inpatient rehab facility admission and requested to be discharged home with home health services. After receiving a fax which includes patient demographic and insurance information as well as a brief history of hospitalization, the billing department acquires prior authorization for the ordered disciplines. The office manager contacts the patient who will be discharging from the hospital today to schedule an appointment for initial skilled nursing visit and to address all the questions that patient might have about home health care services. Patient’s homebound status is confirmed. Below is a brief information on history of present illness faxed from the hospital.

ER visit notes.

Chief Complaint: left-sided weakness, fatigue, headache, facial drooping

Admission diagnosis: Ischemic CVA

History of Present Illness: Johnathan Gray is 63 year-old male with past medical history of systolic and diastolic CHF, A-fib, DM type II, Gout, HTN, Depression, Osteoarthritis, Hyperlipidemia, CAD, Anxiety, Bipolar disorder, long-term use of anticoagulants who presented to the ER today with c/o left-sided weakness, headache, fatigue and facial drooping. Mr. Gray stated that the onset of symptoms was sudden and it happened while he was outside talking to the neighbor. The neighbor then called 911. Mr. Gray was brought to the ER by EMS. MRI results revealed right-sided ischemic stroke. At the time of admission, patient’s BP 170/90 mmHg, HR 98, RR 20, temp 97.6 F. O 2 saturation 94% on RA, INR 1.1, PT 13.5. Patient is full code. Mr. Gray has allergies to PCN (hives and difficulty breathing). At this time patient has left-sided (non-dominant) hemiparesis, dysphasia, dysphagia and facial drooping. Patient is alert and oriented to place, person and disoriented to time and situation. Treatment plan included administration of tissue plasminogen activator (t-PA) IV.

Past Medical History: Systolic and diastolic CHF, Osteoarthritis, CAD, A-fib, DM type II, gout, HTN, Depression, Anxiety, Bipolar disorder, Hyperlipidemia.

Past Surgical History: ORIF s/p fx of the femur (2015), quadruple bypass surgery (2018), appendectomy (2000).

Case Study Questions (Part 1)

1. Write comprehensive pathophysiology of CVA (include disease process, types, predisposing factors, signs and symptoms, complications, long-term management of residual effects).

2. Describe comorbidities from the past medical history. What do you think could have led to ischemic stroke? Analyze vital signs and lab results as well.

3. What s/s of CVA did patient exhibit upon admission to the hospital? What type of CVA was the patient diagnosed with? Are the symptoms exhibited by patient consistent with the s/s described in question 1 (pathophysiology of CVA)? Analyze the lab/diagnostic test results and vital signs data.

4. What residual effects does the patient have from CVA?

5. What disciplines do you think will have to be involved for care and therapy and why? Provide rationale.