Reference no: EM133287335
Question - Arlene is a 58-year-old woman originally from South Africa. She has been living in Australia for the past 12 years. Arlene was transferred by ambulance to the ED for assessment of blurred vision and an episode of left-sided weakness that lasted approximately 5 minutes. She has a strong family history of CVA, and her father suffered a CVA age 53 and died. This was a big shock to the family. Other than hypertension, Arlene states that she has been generally healthy until the blurred vision and left-sided weakness today. She denies any history of diabetes but states she apparently snores and "I drive my husband crazy, but he loves me!". She wakes up with a sore throat and a headache most days. Arlene has been using an anti-snoring mouthguard for the last three months with minimal reduction in symptoms.
On assessment, she weighs 98 kg with a body mass index (BMI) of 37.3. Arlene tells you that she has seen dietitians in the past; however, it was not the right time as she was busy with two teenage children, and she did not consider the effect her diet could have on her vessel health. Following her father's death, she has been more conscious about her health. Her partner and children who rely on her at home have encouraged her to prioritise her health more. She is very close to her mother "who keeps nagging" Arlene "to get moving and take your fat dog for a walk!". Arlene loves her Labrador but also admits that the dog is rather overweight and could do with a lap around the neighbourhood and one less biscuit or two but states that she would eat them if she didn't give them to the dog. She also adds: "she looks so cute with those begging eyes... I just can't say no!".
Arlene works part-time as an Administrative Assistance in a Nursing Home and "loves the oldies!". Her boss, Narelle, has suggested she utilise the EAP services advertised in the lunchroom. Arlene states that the last time she talked to anyone, they were judgemental and made her feel "dirty and lazy because of my weight" so she is not willing to "go for round two just yet!".
Physical assessment findings show Arlene is hypertensive, and an MRI scan and urgent blood tests indicate that Arlene has suffered a TIA. She is prescribed and administered aspirin. Doctors noted that her risk factors for CVA remain high.
While obtaining a further health history, you determine that Arlene has excessive calorie intake and limited physical activity. She drinks two to three standard units of alcohol daily and loves her iced mocha with whipped cream and ice cream. When you check for her skin integrity, you discover two patches: one overlapping the other.
Arlene is on the following medication:
Estalis Sequi - 50/250/TDD/Twice weekly
Semaglutide - 0.5mg/SC/per week
Nicotine - 114mg (21 mg/24 hr)/TDD/ [7]
Pantoprazole - 40mg/OD/Mane before 30 mins pre-meal
Venlafaxine - 37.5mg/PO/BD
Diazepam - 2 - 5mg/PO/PRN - Max 20mg/24hrs
Temazepam - 10mg/PO/Nocte-PRN
Paracetamol - 1330mg/PO/TDS
Identify all the stakeholders in the scenario and explain their role (minimum of 5).