Reference no: EM133435405
Neurological Case Study
R.B. is a 77 year old, right handed female whom arrives at the hospital with a new-onset weakness of the right side involving the right arm and leg. Face and arm weakness is disproportionate to leg weakness.
Dysarthria with tongue deviation. She has had hypertension for the past 10 years and hyperlipidemia for the past 2 years. Her 82 year old husband brought her to the hospital and stated "My wife woke up this morning with everything pretty normal, but in the middle of the morning, she became dizzy, and then she couldn't talk or move on the right of her body." She is started on an acute stroke protocol.
She is 5'2" tall and weighs 165 lbs. She wears upper and lower dentures. She is NPO except for meds. Her husband reports that his wife has a good appetite, and she has not been following any special diet, except avoiding fried foods, and not using salt at the table, which she changed several years ago.
According to her husband she ate the following yesterday:
Breakfast: 1 cup orange juice
1 cup raisin bran with 6 oz 2% milk
1 medium banana
8 oz coffee with 2 tbsp 2% milk and sweetener
Lunch: 2 cups chicken tortellini soup (cheese tortellini in chicken broth)
8 saltine crackers
1 fresh pear
6 oz iced tea with sweetener
Dinner: 4-6 oz grilled chicken (with skin)
1 medium baked potato with 2 tbsp margarine
1 cup steamed broccoli with 1 tsp margarine
½ cup fresh fruit salad (strawberries, blueberries, apples and melon and chopped nuts)
6 oz iced tea with sweetener
Snacks: 3 cups popcorn
1 cup strawberry ice cream
12 oz coke
R.B. takes a multivitamin mineral supplement daily and 500 mg calcium 3 x daily.
Case Questions:
1. Define stroke. Describe the differences between ischemic and hemorrhagic stroke.
2. What are the factors that place an individual at risk for stroke?
3. What specific signs and symptoms are noted in the patient's exam and history that are consistent
with her diagnosis?
4. Which symptoms from above may place the patient at nutritional risk? Explain your rationale.
5. Define dysphagia, aphasia and hemiparesis.
6. What is the primary nutrition implication of dysphagia?
7. She was evaluated for her ability to swallow, and it was determined that the patient is controlling her oral secretions spontaneously and exhibits mild dysphagia. Some aspiration of thin liquids but clear with cough. Based on the information, what level of NDD/DOSS/IDDSI do you think the Speech Language Pathologist will recommend?
8. Select two high-priority nutrition problems for the patient. For each, establish a goal (based on signs and symptoms) and an appropriate intervention (based on etiology).