Question

Case Study:

Introduction: Presenting condition and symptoms Lydia Harrison is a 23-year-old medical receptionist. She is prone to colds and influenza, having been diagnosed with low immunity, so she receives the combined influenza vaccine annually to protect her from severe influenza strains. She encounters many people at work on a daily basis and finds that she catches a cold quite frequently during the winter months. She recently recovered from a minor bacterial bronchial infection and after taking antibiotics for a week, returned to work feeling well. After a few days, however, she began feeling weakness in her muscles believing that she might not have fully recovered from her lung infection, and was sent home from work. As evening approached, she experienced a slight amount of clumsiness and noticeable tingling in her hands and feet. Believing she might be developing a fever, she took two paracetamol tablets and retired to bed early. On waking in the morning, she was shocked to find paralysis in both her legs and difficulty breathing. Her mother rushed her to hospital emergency. After Mrs Harrison described her daughter’s symptom progression, emergency staff classified Lydia’s condition as an acute illness.

. 1. An acute illness can occur:

a. quite slowly and have short-lasting consequences.

b. during the colder months of the year

.c. quite suddenly and have long-lasting consequences.

d. usually in people over the age of 50 years.

2. For many clients suffering an acute illness, their first encounter with healthcare will be:

a. in the home

b. in an intensive care unit (ICU)

c. in a high-dependency unit (HDU)

d. in the emergency room

Phase 1 Lydia’s mother was highly distressed by the situation, and was both anxious and worried about her daughter’s health and future wellbeing. Emergency nursing staff provided Mrs Harrison with refreshment, and spent time talking to her in order to calm her fears. They explained that testing would need to be done to identify the problem, and that treatment would progress from there. They also allowed her to spend time with her daughter while various tests were conducted. Medical staff in the emergency unit conducted a physical assessment of Lydia and obtained a medical history from her mother. Based on Lydia’s symptoms of paralysis, they examined her reflexes via the ‘knee jerk’ reflex and found it to be missing. This indicated that the problem was related to the nervous system, and thus they ordered a series of tests related to nerve function. In the meantime, Lydia was moved to the ICU.

1. To help family members during this time of high stress, the most important thing nursing staff can do is:

a. keep the lines of communication open.

b. refer them to a counsellor.

c. keep them away from the stressful environment.

d. provide relaxing sedative medications.

2. Intensive care units (ICUs) care for:

a. clients who have suffered stroke.

b. highly infectious clients with communicable diseases.

c. severely unwell or injured clients who have various illnesses

. d. clients who have had complicated surgery.

In ICU Lydia was placed on a ventilator because medical staff were concerned that any paralysis in nervous system function might affect autonomic body functions such as breathing and heart rate. In the meantime, a spinal tap (a sampling of cerebrospinal fluid to test for high levels of protein), electrocardiogram (to test for impaired heart function), electromyography (to test for impaired electrical activity in skeletal muscles) and nerve conduction velocity test (to test whether electrical activity along the nerves is slow or blocked) were conducted. The tests showed increased levels of protein in the cerebrospinal fluid without increases in white blood cells, impaired function of the nerves to stimulation and severely slowed electrical activity along the nerves, but no impaired heart function was indicated. The results indicated that Lydia had Guillain-Barré syndrome (GBS), a rare acute inflammatory polyneuropathy, and that this was responsible for her paralysis.

1. Guillain-Barré syndrome (GBS) is characterised by

: a. nausea, vomiting and severe backache

. b. compromised vision and hearing.

c. influenza-like symptoms leading to bowel incontinence.

d. rapid and progressive neuromuscular paralysis.

2. Guillain-Barré syndrome is caused by:

a. a bacterial or viral infection.

b. there is no known cause of GBS.

c. a congenital defect.

d. a genetic mutation.

Lydia was moved to the general ward where medical staff discussed treatment options with Lydia and her mother, and informed them that there is essentially no treatment for GBS; rather, treatment is supportive. Lydia decided to undergo several sessions of plasma exchange (plasmapheresis) therapy, whereby some of her blood was pumped into a machine, the protein antibodies were removed and then the antibody-free blood was reintroduced back into her body. Mrs Harrison wanted to know whether her daughter could expect a full recovery and was informed that, because of the pathophyy could be expected. During Lydia’s stay in hospital, and because her outcomes were predictable, a clinical pathway was devised to provide a daily care plan for Lydia and provide guidelines on assessment, treatment, nutrition, education, referrals to be made and discharge planning. This gave nursing staff a guide as to what to expect from Lydia’s condition on any given day.

1. The pathophysiology of Guillain-Barré syndrome is associated with:

a. demyelination of peripheral nerves

. b. meningococcal infection in the spinal cord.

c. cerebrospinal fluid leakage in the brain.

d. muscular atrophy and flaccidity.

2. The main aim of clinical pathways is to:

a. monitor disease severity in clients

. b. encourage standardisation of care for all clients.

c. monitor and oversee the nursing role.

d. provide a job description for nursing staff.

Answer 1

1. An acute illness can occur:

c. Quite suddenly and have long-lasting consequences.

2. For many clients suffering an acute illness, their first encounter with healthcare will be:

d. in the emergency room

1. To help family members during this time of high stress, the most important thing nursing staff can do is:

a. keep the lines of communication open.

2. Intensive care units (ICUs) care for:

c. severely unwell or injured clients who have various illnesses.

1. Guillain-Barré syndrome (GBS) is characterised by:

d. rapid and progressive neuromuscular paralysis.

2. Guillain-Barré syndrome is caused by:

b. there is no known cause of GBS.

1. The pathophysiology of Guillain-Barré syndrome is associated with:

a. demyelination of peripheral nerves

2. The main aim of clinical pathways is to:

b. encourage standardisation of care for all clients.