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Acute Brian Nolan Case Study – Medical Science Assignment Help

CASE STUDY 1: Acute case study

Brian Nolan is an 80-year-old man who has been admitted to the stroke unit overnight after having a left sided cerebral vascular accident (CVA). He was found by relatives on the floor of his home, where he had been lying for an estimated 6 hours prior to being found. A computed tomography (CT) scan showed an ischaemic stroke that infarcted a significant area of the brain.

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Brian has a past medical history of Chronic Obstructive Pulmonary Disease (COPD) which he developed from a lifelong smoking habit. He continues to smoke one pack of cigarettes each day which may have contributed to his CVA. From nursing handover, you are informed that Brian has been grumpy and annoyed all night. He arrived onto the ward quite late in the evening and consequently has not been seen by any allied health team members yet. He was briefly reviewed by the junior doctor who prescribed 1g of Paracetamol every 6 hours for pain; no other medication orders or plans of medical care have been noted.

When you meet Brian, he is laying almost completely flat and has a pronounced right sided (his dominant side) hemiplegia with no movement on that side of his body. He lets you know he is uncomfortable and wants to use the toilet. You notice his speech is slurred, a gurglinsound in his throat with each breath, and he has some saliva coming from the right side of his mouth. The kitchen staff have left his breakfast of porridge and orange juice on the table at the end of the bed. It is untouched. On closer examination you notice that Brian’s right calf is slightly larger than the left, hot to touch and Brian states it is painful when touched. His calf measurements are right leg 36cm widest part of calf, 39cm from heel to bend of knee, and left leg, 33cm widest part of calf, 39cm from heel to bend of knee. His last set of observations showed BP of 124/68mmHg, regular pulse of 78 beats per minute, SpO2 95% and a respiratory rate of 18 breaths per minute. His temperature is 36.9 degrees Celsius.

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