Brian Nolan is an 80-year-old man who has been admitted to the stroke unit overnight after having a left sided cerebral
vascular accident (CVA). He was found by relatives on the floor of his home, where he had been lying for an estimated
6 hours prior to being found. A CT scan showed the stroke to be ischaemic in nature and to have had infarcted a
significant area of the brain.
Brian has a background of COPD which he developed from a lifelong smoking habit. He had continued to smoke a pack
a day leading up to the CVA.
From handover you are told that Brian has been grumpy and annoyed all night. He arrived quite late and has not been
seen by any allied health team members yet. He was briefly reviewed by the junior doctor who prescribed 1g of
Paracetamol 6 hourly for pain and nothing else.
When you meet Brian, he is laying almost completely flat and has a pronounced right sided (his dominant side)
hemiplegia with no movement on that side of his body. He lets you know he is uncomfortable and wants to use the toilet,
but he is slurring his words. You notice a gurgling sound in his throat each time he breathes, and he has some saliva
coming from the right side of his mouth. The kitchen staff have left his breakfast of porridge and orange juice on the
table at the end of the bed and he has not touched it.
On closer examination you notice that Brian’s right calf is slightly larger than the left and he indicates pain when you
His last set of observations showed BP of 124/68mm/Hg, pulse of 78 beats per minute, Sp02 of 95% and a respiratory
rate of 18 breaths per minute. His temperature is 38.2 degrees C
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