Case Studies II

Case studies to develop interprofessional skills

Scenario 4
Alice is an 85 year-old woman, who lives near Roscommon, Michigan. She has lived alone on 50 acres of land ever since her husband Lawrence, a dairy farmer, passed away due to liver failure three years ago. Alice and her husband had ten children—one daughter lives in Houghton Lake, a son lives in West Branch (each 30 minutes away from Alice), and two of her kids live elsewhere in Michigan and five of them live out-of-state. Alice’s youngest child, a son, passed away in an accident when he was six years old. Lately, Alice has been showing signs of dementia and Alzheimer’s—she calls her children several times per day, and forgets some of her friends’ names. Roughly once a week, one of the ladies at the church Alice attends stops by to see how she is doing.

One day, when her friend was over, Alice started feeling numb on one side of her body. The friend immediately called 911, fearing that Alice was having a stroke. The ambulance came, and brought Alice to the hospital—she had indeed suffered from a stroke. However, the quick response of her friend and the ambulance minimized many of the potential effects of the stroke. The effects of the stroke include partial paralysis of Alice’s throat muscles, and weakness in the left side of her body. This weakness will affect Alice’s ability to perform several everyday tasks, including walking, getting dressed, cooking, and driving.

While in the hospital, the attending health professionals told Alice that she had osteoporosis. They also conducted a hearing and vision test, and noticed that both were beginning to deteriorate.

As soon as they were informed that their mother had been admitted to the hospital for a stroke, the two children that live nearby came to the hospital. One from out of state flew in the next day, and the others sent gifts and flowers. Alice did not recognize some of the names on the gifts, and did not recognize the child that lives out of state. Later that day, she said to a passing medical assistant, “Where’s Larry? Can you tell him I want to go home? I don’t feel so well, and I’m not sure what’s going on. I just want to be in my bed.”

Questions to Consider

      1. How will Alice’s osteoporosis and Alzheimer’s affect her post-stroke rehabilitation?
      2. Can Alice return home? If yes, what services will she need?
      3. Will Alice remember that she had a stroke?
    4. Who will play the biggest role in Alice’s rehabilitation? What approach will be best, to meet the needs of both Alice and the family?

Scenario 5
George is a 52 year-old male, who has lived in Saginaw, Michigan his entire life. He is a shift manager at the local automobile plant—having worked for the same company for 30 years. George has two sons, Eric, who works in Lansing; the other, Josh, is in the Peace Corps, serving in Africa. George and his wife divorced nearly a year ago, after 25 years of marriage. Six months ago, George received notice that the plant was going to close. 90 days later, the plant closed for good, and George lost his job, along with 500 of his colleagues.

Josh was back from Africa, visiting his father, when they engaged in a verbal argument about politics. When Josh walked away, from the living room in to the kitchen, he heard his father trying to yell, but he stammered and could not get his words out quite right. When George tried walking toward the kitchen, he started to stumble. Josh immediately called an ambulance, and George was rushed to the hospital. George had suffered a heart attack. At the hospital, the health team discovered that he had hypertension. While he was in the hospital, George told the attending nurse, “I want to get out of here. I don’t care if it kills me, just let me out. And by the way, where are my cigarettes?”

The team sat down and talked to Josh, and one of George’s former coworkers, and long-time friend (who showed up, after Josh called him). Josh told the team, “I just feel so bad. You know, I’ve been telling him for a long time that he needs to watch what he eats, and how much beer he drinks, but he just won’t listen. He’s as stubborn as a mule. I’d hate to think that our argument caused this.” George’s friend chimed in, “I’ve known George for a long time—he was never one to be health-conscious. His lifestyle will kill him, and the way he has been acting lately, maybe that’s just what he wants. I just don’t know what to do about it. Before she decided that she had had enough, I used to tell his old lady that she should talk to him about his lifestyle. I suppose she didn’t know what to do, either.”

Questions to Consider

      1. As a team, how would you empower George’s son and friend to get through to George, regarding his lifestyle choices?
      2. Which health issue does George need to address first?
      3. What will happen when Josh returns to Africa?
      4. Could George’s ex-wife play a role in his recovery?
    5. What can be done to avoid further health complications?

Scenario 6
Nadia is a 20 year-old college student from Dearborn, Michigan. Rather than live on campus, she chose to live at home with her mother, father, and younger brother. Her father owns and manages a restaurant in Dearborn, and her mother is an acute care nurse at a local hospital. Her older brother is attending medical school at a nearby university. Nadia’s hobbies include running, playing in the neighborhood softball league, and volunteering at community development agencies in Detroit. She prides herself on maintaining a healthy lifestyle. She was diagnosed with epilepsy as a child, and she claims to be taking her medication regularly.

One day, while working as a server at the family restaurant, Nadia suffered a seizure during a lunch shift. She fell and hit her head on a table, causing a concussion. While at the hospital, Nadia indicated that she has hit her head several times before, while having a seizure, including one incident roughly six months ago. She said that in recent months, she has been suffering from severe headaches from time-to-time, and thinks that they may be concussion-related.

When asked about Nadia’s medical history (as well as her family’s medical history), her parents told the medical staff that one of her aunts was epileptic. At one point, Nadia’s mother blurted out, “I keep telling her, ‘Nadia, you need to take your medication every day,’ and she never listens! This is the second time this year that we’ve been in the hospital for the exact same thing! She’s a good girl—very smart and talented, and we couldn’t be more proud of her. But I just don’t know what she’s thinking!”

Questions to Consider

      1. Do you believe that Nadia is taking her medication? If yes…why would her parents accuse her of not taking her medication? It is clear that the medication is not working—what would you recommend for Nadia’s continued care? If no…why might she not be taking her medication? What alternatives are available for Nadia’s continued care?
      2. Would you recommend any additional testing or treatment for Nadia?
      3. What ongoing care should the team provide to Nadia?
    4. What advice would you give to the family, to support Nadia’s care?