Collaborative Discussion Questions for Bertie Botts
Answer the below questions as individuals for the case of Bertie Botts and discuss each other’s responses as a cohort by replying to your colleagues answers also:
1. What risk factors do you think contributed to Bertie Botts diagnosis of Stroke?
Though he appears pretty active, I would be concerned that raised BMI could contribute to risk of stroke. Though not mentioned in his PMx, according to BNF Candestartan is treatment for Hypertension which is also a risk factor, additionally, having children in full time education can be stressful.
2. Bertie Botts temperature is 37.8 °C. Why do you think it is important as a nurse to watch out for fever?
Though apparently fairly common to have fever (40-60%) post stroke, nursing staff need to be mindful it could be a symptom of infection as evidence has shown that it is likely to be caused by infection (Grau et al, 1999)
3. Considering Mr Botts is kept nil by mouth, what care would you take in terms of medication administration?
Mr. Botts being kept nil by mouth has two detrimental effects that I can see, he is unable to take his Antihypertensive medication and also his Metformin. I would be concerned over both and would keep close eye on his blood sugars as well as his blood pressure. I would ask medical team if there is a different route for antihypertensive and review sugars regularly with a view to potentially change IVI to Hartmanns if he becomes hypoglycaemic.
My biggest concern with Mr. Botts is his lack of urinary output!! He is currently NEWS of 6
Though urinary output is not noted as part of NEWS it is a red flag for sepsis and with low grade fever and increased heart rate I would be wary of putting his low grade fever down to the stroke alone as noted above, infection has been shown to be the cause according to evidence. I would seek Mr.Botts consent to catheterise and start a strict fluid balance!
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Grau AJ, Buggle F, Schnitzler P, Spiel M, Lichy C, Hacke W. Fever and infection early after ischemic stroke. J Neurol Sci. 1999 Dec 15;171(2):115-20. doi: 10.1016/s0022-510x(99)00261-0. PMID: 10581377.
