Written Assignment Task 3 – Reflective Case Study

Aim: The aim of this reflective case study is for you to apply clinical judgement to, and reflect upon, the care of acutely ill patients. You will be required to reflect upon a patient incident and analyse the care that this acutely ill patient received. 

Task description

For this task you need to write an essay that:

• Presents your patient case study and provides an overview of the presenting condition, including the aetiology and pathophysiology of the condition or disorder (400 words). 
• Reflects upon the care the patient received and the outcome of their illness (400 words).
• Analyses the management, including positive and negative issues. You should also refer to legal and ethical issues with reference to appropriate literature (400 words). 

Makes 2 recommendations for practice that registered nurses can implement to improve the outcomes of an acutely ill patient with this condition. You must make clear links to at least 2 of the NMBA Registered Nurse Standards of Practice (400 words).

This reflective case study presents a clinical scenario of a stroke-affected patient requiring multidisciplinary care and treatment interventions in the context of increasing her survival probability and reducing the intensity of adverse clinical manifestations experienced by her during the postoperative tenure in the hospital setting. The stroke pathophysiology, causative factors and treatment complications as well as various legal and ethical discrepancies related to the case study are thoroughly discussed while emphasizing the requirement of utilizing NMBA standards for improving the quality of healthcare interventions for the stroke-affected patient. 

Kelly, a 75 years old womon reported to the emergency department with symptoms of dizziness, confusion, headache, numbness and weakness in both upper as well as lower extremities that she experienced since the past two days. The patient had a recent medical history of MI (Myocardial Infarction), angina, anticoagulation therapy, and underwent coronary angioplasty and stent placement two years ago. She also experienced problems related to coordination, communication, speech, and vision and swallowing. She appeared confused and complained of a severe headache during the systemic examination by the medical practitioner. Kelly also exhibited the pattern of inappropriate emotions and debility, as revealed by the physical assessment findings of the medical team. The physician ordered an MRI scan that evidentially revealed the pattern of hemorrhagic infarction of the thalamic region of the patient’s brain. During the course of clinical evaluation, the patient experienced a loss of consciousness and eventually transferred to the critical-care unit for further management. The whole body MRI intervention revealed the appearance of vasculitis with systemic engagement. IV thrombolytic therapy at this point of time did not bring many results, and eventually, the patient underwent surgical intervention by the medical team for the effective removal of the hemorrhagic infarct. The patient experienced severe dysphagia, the lower extremities hemiparesis, aphasia and loss of sensation in the upper extremities during the postoperative period. The patient received nursing care throughout the length of her stay in the hospital ward following the surgical intervention and could not recover completely from the pattern of hemiplegia, dysphagia and aphasia until her discharge from the hospital unit. 

The evidence-based findings from (Zhang, Yang, Sun, & Xing, 2014) indicate the development of hemorrhagic transformation following the occurrence of the acute ischemic stroke among the affected patients. The presented case study indicates the development of massive cerebral infarction affecting the systemic vasculature of the patient. The research findings by (Adrià & Alióc, 2012) indicate the influence of cardiac conditions on the predisposition of the individuals towards the development of cerebral infarction. The patient in the presented clinical scenario exhibited the history of cardiovascular diseases and associated treatment interventions that might have facilitated the development of hemorrhagic thalamic infarct in the affected patient. Clinical findings in (Geukens, Duprez, & Hantson, 2012) indicate the arteriovenous origin of the thalamic brain infarctions. The thalamic infarct is a type of rare condition that constitutes 0.6% of the entire cerebral infarction episodes. The pattern of ischemia in thalamic infarction results from the stenosis and obstruction of the basilar artery that leads to the development of arterial ischemia. Furthermore, the occlusion of the posterior thalamic veins results in the development of partial cerebrovascular infarct in the affected patient. The episode of hemorrhagic cerebral infarction might also develop because of a previously executed surgical intervention that might lead to the development of circulatory system complications and associated clinical manifestations (Hayasaka, et al., 2015). In the presented clinical scenario, the patient has a history of angioplasty intervention that might have contributed to the existing state of her thalamic infarction. The research findings by (Simard, Sahuquillo, Sheth, Kahle, & Walcott, 2011) indicate the predisposition of the patients affected with cerebral infarction in terms of developing cerebral oedema that might lead to their permanent neurophysiological disability and eventual reduction of life expectancy under the influence of complex clinical manifestations. The pattern of intraventricular injury, vascular malformation and aneurysm also contribute to the development of hemorrhagic cerebral infarction and its associated symptoms (Hinson & Hanley, 2010). The neurological defects among the elderly individuals predispose themselves towards the development of poor prognostic outcomes related to their cerebral infarction episode (Dharmasaroja, Watcharakorn, & Chaumrattanakul, 2015). The complex phenomenology of hemorrhagic cerebral infarction yet requires further investigation by the scientific community (Zhang, Yang, Sun, & Xing, 2014). The presently explored findings reveal the substantial reduction in ATP following the initial episode of cerebral ischemia leading to the sustained defects in the functionality of Na+-K+ ATPase. The disrupted activity of Na+-K+ ATPase leads to the dysfunction of the blood-brain barrier (Zhang, Yang, Sun, & Xing, 2014). The pattern of cerebral ischemia results in the development of severe inflammatory response that considerably disrupts the functionality and structure of the cerebrovascular system (Zhang, Yang, Sun, & Xing, 2014). Eventually, the distorted autoregulatory mechanism of the cerebral vasculature leads to the process of extravasation following the reperfusion of the ischemic tissue of the brain (Zhang, Yang, Sun, & Xing, 2014). The extent of the cerebrovascular disruption is determined by the duration of the episode of cerebral ischemia (Zhang, Yang, Sun, & Xing, 2014).