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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?
2. Bertie Botts temperature is 37.8 °C. Why do you think it is important as a nurse to watch out for fever?
3. Considering Mr Botts is kept nil by mouth, what care would you take in terms of medication administration?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!~~
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: 10581377.1. What risk factors do you think contributed to Bertie Botts diagnosis of Stroke?
The risk factors that might have contributed to Bertie Botts diagnosis of stroke are : that he is diabetic, overweight, suffers with hypertension as on medications for his blood pressure,
2. Bertie Botts temperature is 37.8 °C. Why do you think it is important as a nurse to watch out for fever?
It is important for the nurse to watch out for fever as that is a sign of infection.
3. Considering Mr Botts is kept nil by mouth, what care would you take in terms of medication administration?
As Bertie’s medication are all tablets, and is nil by mouth currently, his BP needs to be closely monitored as well as his blood sugars due to not being able to take them. Other possibility is if his medication can be changed to a liquid form instead but that would need to be discussed with the Doctors and pharmacists as some medications may not come in liquid form.1. What risk factors do you think contributed to Bertie Botts diagnosis of Stroke?
Bertie has Type 2 diabeters which is controlled by medications, and is overweight. He is also hypertensive, although this is not stated in his history, he is prescribed medication to lower his blood pressure. All of the above are risk factors.
2. Bertie Botts temperature is 37.8 °C. Why do you think it is important as a nurse to watch out for fever?
Bertie has been thrombolysed, and this could indicate complications with the treatment, or a possible infection.
3. Considering Mr Botts is kept nil by mouth, what care would you take in terms of medication administration?
As Bertie has been thrombolysied, he would not be eligible for a nasogastric tube (NG) for 24 hours after treatment, and as he is NMB oral medication will be unable to be administered. It would be a concern as Bertie is diabetic and blood sugars will undoubtedly be affected, and temperature is raised so he could possible receive and IV paracetamol drip once prescribed. I would monitor the urine output after the saline drip in given and consider a catheter for retention if patient has not urine output once dehydration is rectified.1. Bertie Botts is 57 so his age is a risk factor for a stroke, although a stroke can happen at any age as you get older arteries naturally become narrower and harder and more likely to develop astherosclerosis. Diabetes can also increase risk of a stroke. Although active he is slightly overweight which can increase your risk. Bertie Botts also has high blood pressure which is a risk factor.
2. As Bertie Botts’ temperature is 37.8 the nurse would need to watch out for signs of infection. Also studies have found that a rise in temperature 4-12 hours after Ischemic stroke onset is associated with increased stroke severity. Fever occurring after a stroke is associated with poor outcomes.
3. Bertie Botts is nill by mouth and has been given Activase, by intravenous infusion and has also been prescribed intravenous fluids. He takes Candersartan 8mg, Lansoprazole 30mg, Metformin 400mg twice daily and paracetomol as needed. He could possibly receive IV paracetomol in a drip once prescribed but as he is nil by mouth he would be unable to take his other medication. Therefore the nurse looking after him would need to pay close attention to his blood pressure and his blood sugar levels.1. Bertie is 57 so his age is a risk factor, he is a diabetic and overweight, he is also on blood pressure medication which indicates he suffers from hypertension
2. A fever can be an indicator of an infection, this needs to be monitored closely and he should be given IV paracetamol when necessary to lower his temperature
3. On admission his medications are all tablets so these would need to be changed to be given intravenously. His blood pressure and blood sugar need to be monitored closely as he is not eating or drinking which can make his blood sugar levels drop. IV paracetamol might also be considered as his temperature is increasing, this also needs to be monitored closely1. What risk factors do you think contributed to Bertie Botts diagnosis of Stroke?
The fact that Bertie is going through a stressful period is his life with looking after is children and been a full time teacher is a risk worth considering. Also he’s diabetic which is a risk factor.
2. Bertie Botts temperature is 37.8 °C. Why do you think it is important as a nurse to watch out for fever? It is important for the nurse to watch out for fever because its an indicator for infection.
3. Considering Mr Botts is kept nil by mouth, what care would you take in terms of medication administration? If there’s any medication prescribed for Bertie and he’s NBM this have to be prescribed as intravenous1. What risk factors do you think contributed to Bertie Botts diagnosis of Stroke? Most obvious is the patient’s BMI and diabtetic link, his ethnicity is a factor to consider, as strokes are more prevalent in african-descended males, dditionally I would think his age is also a factor too.
2. Bertie Botts temperature is 37.8 °C. Why do you think it is important as a nurse to watch out for fever? The fever could be an indication of sepsis infection or a side effect of the Alteplase medication. Fevers are commonly associated with patient mortality rates in post-stroke individuals, IV Paracetamol should be administered and repeated in frequency as per guidelines, regular observations should be maintained for detioriation or progession.
3. Considering Mr Botts is kept nil by mouth, what care would you take in terms of medication administration? The route of administration would have to be IV for his medication, all of his medication is available in IV form, bolus or in an infusion. I would ensure that all of his medication is prescribed for an IV route and at the appropriate frequency.
As others have contributed-
Bertie is 57, he has type 2 diabetes, hes overweight and and medication indicates high blood pressure, these are all risk factors for stroke.
A fever after a stroke may be common but will require monitoring as it can be invicative of infection and cause complication of recovery.
As he is nil by mouth medication would need to be considered, IV route possibility with paracetamol added for his temperature. Bertie would need monitoring regularly particualy his blood sugars, blood pressure and signs of infection.I think Lauren has raised some important factors in regards to the patient being ‘thrombolysied, he would not be eligible for a nasogastric tube (NG) for 24 hours after treatment,’
Not everyone who has an ischaemic stroke is suitable for thrombolysis. At present, around 12% of people who are admitted to the hospital with a stroke are eligible to receive it. If you are not suitable, it may be because:
You do not know or cannot tell doctors when your symptoms began.
You do not reach the hospital in time.
You have had another stroke or head injury within the past three months.this information is from Stroke.org and raises a red flag for me also. we are told his wife ‘heard him fall’ so we can assume he’s within the 4-6hr window for thrombolysis. We are not told if he had a head injury. Would that have shown up on CT or has that just not been considered, it isn’t wholly clear
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https://www.stroke.org.uk/what-is-stroke/diagnosis-to-discharge/treatment1. Bertie is on blood pressure medication, indicating he could suffer from hypertension. Moreover, he is overweight and diabetic, so his condition could lead to stroke.
2. Fever is a sign of infection so the nurse needs to give paracetamol to lower his temperature and keep a close watch on his body temperature.
3. Considering Mr Botts is kept nil by mouth, his medications should be changed from tablets to Intravenous. As he is not eating or drinking, his sugar level will be affected so the nurse needs to check his sugar level and blood pressure regularly.1. Bertie has type 2 diabetes and high blood pressure, he has high BMI which are all symptoms that lead to a stroke. His homelife seems to be stressful which could also play a part in his stroke.
2. Bertie will need to be monitored and have his observations. One of the reasons is his high temperature which could indicate an infection. Paracetamol is given to lower his body temperature.
3. Perhaps change Bertie medication to fluid or intravenously and maybe be put on the drip to get fluid into Bertie as he has not been urinating nor eating or drinking. Dehydration can higher the blood pressure.1. What risk factors do you think contributed to Bertie Botts diagnosis of Stroke?
Risk factors that may have led to Mr Botts stroke include his age, the fact he is overweight and his medication of candesartan leads you to believe he suffers from high blood pressure (hypertension).
2. Bertie Botts temperature is 37.8 °C. Why do you think it is important as a nurse to watch out for fever?
Mr Botts temperature is 37°C it is important this is monitored as this may indicate signs of infection.
3. Considering Mr Botts is kept nil by mouth, what care would you take in terms of medication administration?
I would enquire as to whether the medication could be given intravenously or if there were any alternative medications that could be used if this was not possible.1. What risk factors do you think contributed to Bertie Botts diagnosis of Stroke?
Mr Botts has a high BMI, hypertension and is diabetic. His age and ethnicity could also be contributing factors.2. Bertie Botts temperature is 37.8 °C. Why do you think it is important as a nurse to watch out for fever?
A high temperature could be a sign of infection.3. Considering Mr Botts is kept nil by mouth, what care would you take in terms of medication administration?
Any oral medications would need to be replaced by medication given via a different route.1. What risk factors do you think contributed to Bertie Botts diagnosis of Stroke?
These factors could include Mr Botts ethnicity (Asia/Black known to have a higher prevalence of stroke), age 57, being overweight (can lead to fat deposit on the arteries causing the narrowing of the vessels thus, blood clotting which could travel to the brain and block blood flow), being a diabetic with hypertension.2. Bertie Botts temperature is 37.8 °C. Why do you think it is important as a nurse to watch out for fever?
This is important as high temperature are often sign of infection also, high temperature could cause the vessels to dilate thus, increasing blood flow and blood pressure…this could lead to a heart attack since Mr Botts already has hypertension thus, monitoring and keeping it under control is crucial.3. Considering Mr Botts is kept nil by mouth, what care would you take in terms of medication administration?
Any oral medication will not be administer, I will contact the medical team to prescribe other alternative to suit possible route IM, IV…1. Diabetes, high BP (on hypertension medication), stress of family and work commitments
2. As a sign of infection or sepsis indicator
3. Making sure his medication is not oral also as he won’t be able to drink water. Its important he is monitored as well because the drugs may have a different affect with/without food. He shouldn’t be given any NSAIDs which could cause stomach ulcer.I agree with the above comments.
1. What risk factors do you think contributed to Bertie Botts diagnosis of Stroke?
Bertie is 57, which can be a risk factor. He is also overweight, has hypertension and diabetes.2. Bertie Botts temperature is 37.8 °C. Why do you think it is important as a nurse to watch out for fever?
fever can indicate infection, so it needs to be monitored. Moreover, in severe stroke, massive tissue necrosis can elevate body temperature. Another cause of noninfectious fever can be the presence of blood in the brain.3. Considering Mr Botts is kept nil by mouth, what care would you take in terms of medication administration?
oral medications cannot be taken, so they have to be administered intravenously. Because he is diabetic and he is not eating or drinking, his blood sugar levels need to be monitored closely.The risk factor that contribute to Bertie 57, (overweight, hypertensive and diabetic). His BMI(body max index) could contribute to risk of stroke though not mentioned in PMx according to BNF candesartan of treatment for hypertension, which also is a risk factor.
Other stressful situation is the burden of children still in full time education. As temperature is 37.8(degree centigrade), it could be symptom of infection as evidence has shown.(Grau et al, 1999).
Mr Botts is nil by mouth, concern will be that he is unable to take his antihypertensive medication and his metformin. I will keep closely eye on his blood sugar/blood pressure. I will inquire from medical team if there is a deferent route for antihypertensive medication. Sugar will be reviewed at regular intervals with the view to change IVI to Hartman, if he becomes hypoglycaemic. My big concern is the lack of urine output(although current news of 6 is not part of it). It is e red flag for sepsis with low grade fever and heart rate increase. I will be wary of putting low grade fever down to stroke alone as noted. As the cause is also noted to be from infection through evidence, I will ask my Botts for his consent to catharize and start a strict fluid checks and balances.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.
1. What risk factors do you think contributed to Bertie Botts diagnosis of Stroke?
Bertie Botts has type 2 diabetes. He is overweight and he has hypertension. Also, his ethnicity is a contributing factor.
2. Bertie Botts temperature is 37.8 °C. Why do you think it is important as a nurse to watch out for fever?
It is important for the nurse to watch out for fever because it is often a sign of infection.
3. Considering Mr Botts is kept nil by mouth, what care would you take in terms of medication administration?
The medicines can not be taken orally. The medicines have to be administered intravenously.Some really interesting posts. I agree with all the comments . I think it is important to take his lifestyle into consideration.
1.what risk factors do you think contributed to Bartie Botts diagnosis of stroke.
Bartie Botts is over weight and has had hypertension that could have contributed to him having a stroke.
2. Bartie Botts temperature is 37.8. Why do you think it is important as a nurse to watch out for fever.
Bartie Botts temperature can be a sign of an infection in his body. This should be monitored closely so early diagnosis of any illness can be detected and cured.considering Mr Botts is kept nil by mouth, what care would you take in terms of medication.
I think his medication should be administered intravenously
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