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CASE STUDY 1
Case Study: Chapters 22 & 23
Case Study, Chapter 22, Neurological Assessment
Melissa Eggers, a 65-year-old retired cook, has a history of type 1 diabetes mellitus. She
presents to the clinic, where you practice nursing, because of sudden onset of dizziness. Ms.
Eggers is morbidly obese and uses a walker to ambulate. Vital signs are pulse 98 beats/min,
respirations 18 breaths/min, and blood pressure 170/90 mm Hg. Her dorsalis pedis pulse is weak
bilaterally; she has bilateral carotid bruits. Neurologically, she is intact.
Ms. Eggers dizziness can be contributed to several factors since she has multiple medical
conditions. As a type 1 diabetic, Ms. Eggers must maintain a stable blood sugar level.
Hypoglycemia or low blood sugar can result from a decrease in food intake or from taking too
much insulin. The brain cannot function properly due to lack of glucose and results in
lightheadedness or dizziness (Ignatavicius & Workmann, 2016). Conversely, when there is an
insufficient amount of insulin available for energy metabolism, hyperglycemia or high blood
sugar occurs which triggers dizziness due to dehydration. Bilateral carotid bruit implies that the
patient may have carotid artery disease. Carotid artery disease causes narrowing or blockage of
the carotid arteries which can decrease the amount of blood flow to the brain. This can cause
temporary symptoms such as dizziness, however a blockage greater than 60 percent carries a risk
of stroke and even death (Mayo Clinic, 2019). To obtain a detailed account of subjective data
about Ms. Eggers’s present condition, the following information should be solicited: date of
onset, precipitating factors and duration (Jensen, 2015).

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CASE STUDY 2
There are several factors that could put her at risk for stroke. Ms. Eggers is 65-years-old,
morbidly obese and has a history of type I diabetes which may be uncontrolled. She uses a
walker to ambulate therefore one could assume that she is physically inactive. High blood
pressure is a leading risk factor for stroke (American Heart Association, 2016) and her blood
pressure is 170/90 mm Hg, which is Stage II Hypertension. Bruits heard upon auscultation of
her bilateral carotid arteries is indicative of carotid stenosis and has been associated with an
increased risk of stroke” (Jensen, 2015, p. 471) . Lastly, palpation of Ms. Eggers’ lower
extremities revealed diminished bilateral dorsalis pedal pulses. This implies that she has poor
tissue perfusion and could potentially be a sign of peripheral vascular disease. Many of these
common medical conditions can increase her chance of having a stroke.
A variety of educational resources would be appropriate to help Ms. Eggers make healthy
lifestyle changes and control health conditions that would increase her risk for stroke. This
material should include recognition of the signs and symptoms of stroke, identifying and
modifying risk factors and stroke prevention. Although she has a history of type I diabetes,
emphasis should be placed on keeping her blood sugar under control. Ms. Eggers should be
instructed to change her diet, exercise regularly, take her hypertension and diabetes medication
as prescribed and have a complete eye exam performed yearly to identify early signs of
retinopathy. Self-care of her teeth, protecting her skin and checking her feet should also be
discussed. She should also be educated on the complications that accompany uncontrolled
diabetes. Since Ms. Eggers is a retired cook, she could benefit from a consultation with a
nutritionist. This collaborative approach can help her plan meals that are low in fat, salt, sugar
and cholesterol. Finally, referral to a diabetes support group would be essential in providing her
with advice for living with diabetes.

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CASE STUDY 1 Case Study: Chapters 22 & 23 Case Study, Chapter 22, Neurological Assessment Melissa Eggers, a 65-year-old retired cook, has a history of type 1 diabetes mellitus. She presents to the clinic, where you practice nursing, because of sudden onset of dizziness. Ms. Eggers is morbidly obese and uses a walker to ambulate. Vital signs are pulse 98 beats/min, respirations 18 breaths/min, and blood pressure 170/90 mm Hg. Her dorsalis pedis pulse is weak bilaterally; she has bilateral carotid bruits. Neurologically, she is intact. Ms. Eggers’ dizziness can be contributed to several factors since she has multiple medical conditions. As a type 1 diabetic, Ms. Eggers must maintain a stable blood sugar level. Hypoglycemia or low blood sugar can result from a decrease in food intake or from taking too much insulin. The brain cannot function properly due to lack of glucose and results in lightheadedness or dizziness (Ignatavicius & Workmann, 2016). Conversely, when there is an insufficient amount of insulin available for energy metabolism, hyperglycemia or high blood sugar occurs which triggers dizziness due to dehydration. Bilateral carotid bruit implies that the patient may have carotid artery disease. Carotid artery disease causes narrowing or blockage of the carotid arteries which can decrease the amount of blood flow to the brain. This can cause temporary symptoms such as dizziness, however a blockage greater than 60 percent carries a risk of stroke and even death (M ...
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