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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).

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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