Nursing management of patients case study


Nursing care management of patients is one of the most critical areas that nurses should equip themselves with the necessary skills and prowess. Notably, patient health is one of the most essential aspects that nurses should ensure they look into. In some extreme cases, a number of patients have sometimes displayed extra-ordinary symptoms of certain diseases (Gustavsson, 2014). From the case of Mrs. Cook, it is evident that she has a number of health issues that need to be looked into in order to help stabilize her health. Patient medical, social and health history are some of the most critical aspects that should be considered whenever they experience any health issues. For instance, having suffered from Type II Diabetes Mellitus two years back, the current situation that Mrs. Cook is experiencing will be highly dependent on the drugs that she had used then and other medical aspects such as the oral contraceptive pill (OCP). This paper seeks to discuss a number of issues related to Mrs. Cook’s health.

What sort of stroke has Mrs Cook had?

The kind of stroke the Mrs. Cook suffered is the left sided stroke. The ability to speak is often controlled by the left sides of the brain. Therefore, losing her ability to speak implied that Mrs. Cook suffered cerebrovascular accident or CVA) that usually cause adverse effects on the left side of the human brain. It is evident that Mrs. Cook was able to carry out all other activities since other body activities such as movement and sensation is often controlled by the other sides of the human brain. The implication of Mrs. Cooks problems are understandable since in case the stroke caused problems on the the left side of her brain, she could not understand even what other people had to tell her. Most problems that people experience during and after stroke are often related to the side of the brain affected.

                                  Mrs Cook’s medication in relation to her condition

Before making a decision on the types of medication to give to Mrs. Cook, it is quite important to ensure that her past health records are analyzed in order to understand the type of medication that she has taken in the past. In addition, understanding Mrs. Cook’s past medical records will go a long way in determining the type of medication to withhold in order to avoid any medical complications. Dopamine agonists, amphetamines, piracetam (Nootropil), and most currently donepezil (Aricept), have all been utilized in the management of aphasia in either the acute stages or chronic phases. The main justification that has been leveled for the use of such drugs in the medication of aphasia has for a long time been based on the fact that researchers have found two types of major evidence on the disease. Some of the drugs, for instance, dextroamphetamine (Dexedrine), have been used to improve the attention span and improve the patient’s learning skills and memory. Notably, learning is a very essential technique that can be used for acquisition of better motor as well as cognitive skills, and, therefore, for useful recovery from Mrs. Cooks sickness related to aphasia.

Besides, various laboratory and clinical data results imply that the aspect of drug treatment might sometimes be used to partially restore the patient’s normal metabolic functions that take place in the ischemic zone that often surrounds the human brain lesion. Moreover, the treatment might also have a neuroprotective effect that follows an acute damage to the left side of the human brain. An example of such medication involves the use of nootropic agent piracetam. Past health records and Mrs. Cooks subscription to the OCP can also lead to withholding some medications that might react with her hormones negatively (Trialists’Collaboration, 2013).

Is Mrs Cook at risk of developing Increased Intracranial Pressure (IICP)?

Despite her health status not being stable, Mrs. Cook is not at a higher risk of developing Increased Intracranial Pressure (IICP). This is because IICP mainly affects very ill patients who have a number of neurologic disorders. In the case of Mrs. Cook, she does not have any severe neurologic disorders except the fact that she suffered a left side stroke. The only risk that Mrs. Cook might be at could be developing Intracranial hypertension (ICP) but not IICP. As a result of her overweight situation and past history with type II diabetes Mellitus, Mrs. Cook is not a higher risk of developing IICP. Usually, IICP affects people who suffer from traumatically induced brain problems. However, Mrs. Cook’s situation cannot be described as traumatically induced. In addition, IICP often results from an injury to the brain that is related to bleeding. In the case of Mrs. Cook, it was found out that she did not suffer any bleeding problems and her condition was not caused by an injury to her brain. Moreover, IICP is often associated with people who suffer from hypertension and people whose blood pressure is relatively high at all times. For Mrs. Cook, there is no history of hypertension in her health records hence putting her out of the risk of developing IICP. However, there is need to ensure that her condition is stabilized so as to avoid any situation that might make her develop IICP in the future.

What are the signs and symptoms of IICP and what nursing assessments
would you conduct to identify this?

The signs and symptoms of ICCP are varied depending on the health status of the patient and the nature of stage that the patient’s medical procedures are. The symptoms also vary depending on whether the patient is an adult or a child. Some of the signs include headache, vomiting, nausea, increased blood pressure, confusion about time, decreased mental abilities, double vision, and eye pupils that do not respond to light changes. Other symptoms include drowsiness, visibly separated sutures, and bulging fontanelle (Nagi & Kaur, 2014). The headache is usually as a result of increased pressure in the brain that causes the blood vessels in the brain to strain in transporting the blood throughout the head. Increased blood pressure is often caused by the high pressure that the blood flows in the brain hence making it difficult for the patients to completely fail to comprehend the external environment. In addition, double vision usually occurs as a result of increased blood flow to the eyes hence making the people suffering from IICP fail to clearly view the surrounding aspects. General body weakness is also evident in patients suffering from the disorder since the brain fails to control all the body activities (Vataja et al, 2014).

In order to carry out assessments on the disease, health care providers should ensure that they make the diagnosis right at the patient’s bedside that is often in an emergency section or a hospital. It is possible for primary care givers to spot early symptoms associated with increased intracranial pressure that include headache, seizures, and any other nervous system issues. Nurses can use MRI or CT scan carried out in the head to help in determining the main symptoms of increased intracranial pressure that are internally located in the patient’s brain. In addition, increased intracranial pressure might also be measured when a nurse carries out a spinal tap also known as lumbar puncture on the patient. This can always be measured directly through the use of a device that is usually drilled through the patient’s skull or a specific tube known as catheter that is often inserted through a hollow area in the patient’s brain known as the ventricle (Sharma & Mattoo, 2015).

Areas of concern throughout Mrs Cook’s case study

There are several aspects of concern that need to be looked at before making any medical treatments for Mrs. Cook. The physical, mental, social, emotional, and behavioral aspects on Mrs. Cook’s health are very essential in ensuring that she gets the best medical attention for her condition. Notably, she has a history on such factors as activity and sickness that needs to be addressed based on the facts that would be discussed in this section.

Physical concerns

One of the major physical issues that have been attributed to Mrs. Cook includes her mild overweight situation. As a result of this, she could experience a number of problems if she fails to carry out regular exercise activities. In addition, Mrs. Cook needs to ensure that she maintains a healthy physical body so as to reduce any chances of her falling ill as a result of excess body fats. Due to her weight, it is evident that Mrs. Cook might develop conditions related to high blood pressure that might lead to the risk of developing IICP in the future. However, being a teacher, it is clear that Mrs. Cook takes part in school games such as netball that help her keep her body fitness checked. In order to control her weight, she should ensure that she plays netball more often and not just twice a week. Since being overweight can be associated to diseases such as Diabetes Mellitus type II that she once suffered, she should aim at ensuring her weight is reduced to ensure that her health is not at stake (Kim et al, 2011).

Mental concerns

Thought the only mental activity that Mrs. Cook is involved actively with includes teaching maths in class, there is a possibility that Mrs. Cook overworks herself while in school. Notably, it is of essence to note that teaching mathematics in a middle school is not that easy as it might be quite involving. As a result of this, it is admissible that some of the health problems that Mrs. Cook might have experienced could be as a result of overworking her brain and talking too much while in class and during the school committee meetings that she is part of. In the case of her situation, it is important to ensure that the nurses check her for any mental changes that she might experience at the moment (Kanekar, Zacharia, & Roller, 2012).

Social concerns

Based on how Mrs. Cook relates with her family and friends, it is notable that she has a good relationship with her husband and sons since we are not told of any history of quarrels or misunderstanding. As a result, the support she would get from her family would be essential in ensuring that she heals faster. Her family would also act as care givers in case she falls sick while at home hence help her with household activities.

Emotional concerns

By feeling loved by her husband and sons, Mrs. Cook would be better placed to heal faster since the care and support would make her feel better thereby creating an atmosphere that is effective for her health condition. In addition, the nurses should ensure that they carry out management practices that help take care of her emotions (Jauch et al, 2013).

The likely discharge planning, education and allied health input

In order to help Mrs. Cook heal faster, it is important to ensure that she is well taken care of and educated on the kind of meals that she should take. Due to her weight, Mrs. Cook should be educated on eating more fruits and having more time at home exercising that straining herself at work. Besides, she should be treated in a way that will help her cope with her situation once discharged.

The lifestyle choices that are recommended for someone suffering from CVA as Mrs. Cook should involve active and suitable lifestyle around people who someone cares for and a stress-free life.


In conclusion, it is important to note that nursing care management is quite important in ensuring that patients get better. Through the various aspects that have been included in the essay, it is important to note that brain disorders such as left sided stroke can lead to a number of health issues to a patient. It is therefore, important to understand the patient’s past health status and history in order to help them in going through tough medical situations. The patient’s physical, mental, emotional and mental aspects should also be viewed in order to ensure that the diagnosis and treatment processes are carried out as required. In addition, it is important to ensure that medical tests are carried out at all times to keep the patient on check.


Gustavsson, B. (2014). Management of Increased Intracranial Pressure. InAcute Pediatric Neurology (pp. 211-227). Springer London.

Jauch, E. C., Saver, J. L., Adams Jr, H. P., Bruno, A., Connors, J. J., Demaerschalk, B. M., … & Yonas, H. (2013). on behalf of the American Heart Association Stroke Council, Council on Cardiovascular Nursing, Council on Peripheral Vascular Disease, and Council on Clinical Cardiology. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke44(3), 870-947.

Kanekar, S. G., Zacharia, T., & Roller, R. (2012). Imaging of stroke: Part 2, Pathophysiology at the molecular and cellular levels and corresponding imaging changes. American Journal of Roentgenology198(1), 63-74.

Kim, H. J., Song, J. M., Kwon, S. U., Kim, B. J., Kang, D. H., Song, J. K., … & Kang, D. W. (2011). Right–left propensity and lesion patterns between cardiogenic and aortogenic cerebral embolisms. Stroke42(8), 2323-2325.

Nagi, M., & Kaur, S. (2014). Nursing Management of a Patient with Increased Intracranial Pressure: A Review. Research & Reviews: A Journal of Neuroscience4(2), 19-23.

Sharma, R., & Mattoo, P. (2015). Colour Doppler Study of Extracranial Carotid Arteries in             Stroke. Hypertension3(4), 2.

Trialists’Collaboration, S. U. (2013). Organised inpatient (stroke unit) care for stroke. Cochrane Database Syst Rev9.

Vataja, R., Leppävuori, A., Pohjasvaara, T., Mäntylä, R., Aronen, H. J., Salonen, O., … & Erkinjuntti, T. (2014). Poststroke depression and lesion location revisited. The Journal of neuropsychiatry and clinical neurosciences.

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