CASE STUDY: Wilma is an 84-year-old widow who lives independently alone, in her North Adelaide family home. Her two chil
Posted: Mon Jan 24, 2022 9:15 am
CASE STUDY: Wilma is an 84-year-old widow who lives
independently alone, in her North Adelaide family home. Her two
children and grandchildren live interstate and have not visited
since January 2020 due to border closures related to COVID-19. She
is socially active with friends, plays cards twice a week, choir
practice twice a week and attends church on Sundays. Several weeks
ago, Wilma was having lunch with her friends and found it difficult
to form her words, her friends were unable to understand what she
was saying and shortly after this she collapsed in her chair,
unable to respond to verbal stimuli. An ambulance was called, and
Wilma was taken to the hospital.
• On arrival to the hospital, Wilma’s observations: P 134, RR
26, BP 165/95, T 37.6, SpO2 92% on room air, GCS of 12.
• A CT scan provided a diagnosis of CVA.
• Wilma’s past medical history includes: Salpingo-oopherectomy
and Hysterectomy – 23 years ago; NIDDM - 15 years; AF; GORD; Smoker
– 10/day; Hypertension; Hypercholesterolaemia; MI Wilma was
admitted to the neurological ward with the following assessment
information: GCS of 13, left sided hemiplaegia, expressive
dysphasia, dysphagia and blurred vision. A review by the speech
pathologist and physiotherapist was arranged. Ten days later Wilma
was transferred to a rehabilitation hospital with residual
dysphasia, left sided hemiplegia.
Ongoing medications include:
Apixaban 5 mg PO daily
Ezetimibe 10 mg PO daily
Digoxin 125 mcg PO daily
Perindopril 2 mg PO daily
Simvastatin 40 mg PO daily
Amlodipine 10 mg PO daily
1. Identify the most likely aetiology of Wilma’s CVA • Explain
how and why this can lead to a CVA from a pathophysiological
perspective. • Include the pathophysiology of Wilma’s CVA. • In
other words, discuss the pathogenesis of the most likely cause and
how it can lead to CVA in relation to Wilma’s case. 20%
2. Identify two (2) other risk factors that Wilma has that may
contribute to a CVA • For each of these risk factors explain how
& why they increase the risk of a CVA.
3. Select two (2) signs and/or symptoms that Wilma has as a
result of his CVA • For each sign/symptom explain how and why it
occurs, from a pathophysiological perspective. 35%
4. Select three (3) of Wilma’s medications and explain why each
of these are ordered. • Include the pharmacodynamics and
pharmacokinetics of each medication, relevant adverse effects,
contraindications, and nursing considerations.
5. All Wilma’s medications are administered orally. Explain what
the first pass is and the implications this has for a drug’s
bioavailability.
independently alone, in her North Adelaide family home. Her two
children and grandchildren live interstate and have not visited
since January 2020 due to border closures related to COVID-19. She
is socially active with friends, plays cards twice a week, choir
practice twice a week and attends church on Sundays. Several weeks
ago, Wilma was having lunch with her friends and found it difficult
to form her words, her friends were unable to understand what she
was saying and shortly after this she collapsed in her chair,
unable to respond to verbal stimuli. An ambulance was called, and
Wilma was taken to the hospital.
• On arrival to the hospital, Wilma’s observations: P 134, RR
26, BP 165/95, T 37.6, SpO2 92% on room air, GCS of 12.
• A CT scan provided a diagnosis of CVA.
• Wilma’s past medical history includes: Salpingo-oopherectomy
and Hysterectomy – 23 years ago; NIDDM - 15 years; AF; GORD; Smoker
– 10/day; Hypertension; Hypercholesterolaemia; MI Wilma was
admitted to the neurological ward with the following assessment
information: GCS of 13, left sided hemiplaegia, expressive
dysphasia, dysphagia and blurred vision. A review by the speech
pathologist and physiotherapist was arranged. Ten days later Wilma
was transferred to a rehabilitation hospital with residual
dysphasia, left sided hemiplegia.
Ongoing medications include:
Apixaban 5 mg PO daily
Ezetimibe 10 mg PO daily
Digoxin 125 mcg PO daily
Perindopril 2 mg PO daily
Simvastatin 40 mg PO daily
Amlodipine 10 mg PO daily
1. Identify the most likely aetiology of Wilma’s CVA • Explain
how and why this can lead to a CVA from a pathophysiological
perspective. • Include the pathophysiology of Wilma’s CVA. • In
other words, discuss the pathogenesis of the most likely cause and
how it can lead to CVA in relation to Wilma’s case. 20%
2. Identify two (2) other risk factors that Wilma has that may
contribute to a CVA • For each of these risk factors explain how
& why they increase the risk of a CVA.
3. Select two (2) signs and/or symptoms that Wilma has as a
result of his CVA • For each sign/symptom explain how and why it
occurs, from a pathophysiological perspective. 35%
4. Select three (3) of Wilma’s medications and explain why each
of these are ordered. • Include the pharmacodynamics and
pharmacokinetics of each medication, relevant adverse effects,
contraindications, and nursing considerations.
5. All Wilma’s medications are administered orally. Explain what
the first pass is and the implications this has for a drug’s
bioavailability.