Question:
Case Study
Tamara Binge is a 53-year-old female. Traditionally, her people come from the Bundjalung area, but she moved with her family when she was 16, to remote Far North Queensland. She now is a respected member of the Aurukun community, northwest of Cairns.
Tamara is an Aboriginal Health Worker in the Chivaree Aged Care Centre. She has been working there since she gained her qualification in 2012. Prior to this, Tamara had been working in reception in the council chambers. She is married to Barry Tomoroy and together, they have 6 children, aged 15-30. All of her children are in excellent health, and recently, she became a grandmother for the fourth time.
Tamara has a family history of cardiovascular disease (maternal grandmother), kidney disease (father) and diabetes (father). Her mother passed away after a short illness in 2018, and they were never sure why, but suspected kidney disease. Tamara has a history (2 years) of hypertension, that is well controlled with Captopril 25mg BD and Hydrochlorothiazide 25mg daily. She had a past history of smoking, but ceased when she became hypertensive. Tamara has regular check-ups at the local health centre when the Rural Flying Doctor Service (RFDS) are in town, to ensure she manages her hypertension proactively.
Tamara is also very proactive with her overall health. She walks for 3-4km every morning, and ensures she eats a healthy well-balanced diet, although, as the wet season means the town gets cut off, this can be difficult to maintain. She tries to ensure she eats her 5 vegetables and 2 serves of fruit per day, but frequently, the general store have difficulty keeping these products in stock, so there is a lot of packaged foods.
Recently Tamara thought she had a flu, and it took her quite a while to get over this. She still does not feel quite right. She has been very tired, she has oedema in her lower limbs, and she has itching of her skin. She notices that she has to urinate more often than normal during the night. She also feels a loss of appetite and nausea periodically throughout the day.
Tamara has come to you in the Primary Health Care Centre. You are her registered nurse, and you provide the main health services within the community and the outstations surrounding. You have an advanced skill set, including venepuncture, and ultrasound qualifications. You also have advanced life support training, and have contact with the RFDS doctors to order further tests as you need to support your community.
In your case study, address the following areas.
Please use the following main headings:
Short Introductionto the situation
You should assume the reader/marker is well versed in the scenario, so there is no need of an extensive recap
Provide a short thesis statement or road map for the case study. What will you be addressing?
Provisional Diagnosis
From the case study, what is your provisional diagnosis and rational for this, based on Tamaras presentation?
Link back to the case study to support your claims
Further tests, assessments and examinations
What further tests, assessments and examinations would you need to undertake to confirm your suspicions? Include (you may wish to use a table for this):
What would you expect these tests to show normally?
What would be abnormal and would confirm your diagnosis?
Treatment plan
What treatment plan would you recommend for your patient, given Tamaras connection to the community, and distance from a tertiary health care facility?
Consider geographical/location logistics, and her links to country and family
Patient education
What patient education would you need to undertake as part of this process, and what lifestyle recommendations would you make for Tamara?
Think about Tamaras links to healthcare and how this will influence your advice
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