CVA case

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CVA case
2
Doctor information

• John is a 77-years old hypertensive smoker who
  had a moderately severe right hemiplegia a year
  ago. He lives with his 73-year old wife Mary who
  has a history of depression. John is a large 6
  foot tall man with a BMI of 30. He Is able to
  walk a little with the aid of a tripod stick. He
  has markedly reduced power in both his right arm
  and leg. John is mentally competent, but is an ex
  boxer and has a quick temper. He likes a drink.
• Mary is much more frail and is very subservient.
  She was seen several years ago with a black eye
  and confessed her husband hit her.
• Their daughter Maureen who is teacher lives in
  Cornwall, but is visiting and made an appointment
  to see you in her fathers name

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Patient information

• You are Maureen, a teacher and the daughter of
  John and Mary. You live in Cornwall, but are
  visiting your parents and have made an
  appointment to see the doctor under your fathers
  name.
• You are concerned because mum is struggling to
  cope. Dad is aggressive and complains a lot. He
  had physio initially and was offered some other
  help but declined. You think mum is at the end of
  her tether and has become tearful and frustrated
  by the situation. You would like someone to help.
  You know dad can be violent and mum seems
  frightened of him.
• The doctor should know the following about your
  parents John is a 77-years old hypertensive
  smoker who had a moderately severe right
  hemiplegia a year ago. He lives with his 73-year
  old wife Mary who has a history of depression.
  John is a large 6 foot tall man with a BMI of 30.
  He Is able to walk a little with the aid of a
  tripod stick. He has markedly reduced power in
  both his right arm and leg. John is mentally
  competent, but is an ex boxer and has a quick
  temper. He likes a drink. Mary is much more frail
  and is very subservient. She was seen several
  years ago with a black eye and confessed her
  husband hit her.

4
Issues raised?
5
Issues raised?

• Confidentiality versus a need to receive
  information, not antagonise a relative who is
  trying to help
• Physical abuse/domestic violence is a worry here,
  (but note recent concerns that occasionally
  elderly relatives may be defrauded)
• Conflicting duties of care todad, mum, daughter

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What can the GP do?

• GP visit to assess the situation themselves
• Involve social services to provide support and
  investigate any concerns
• May need referral/re-referral to OT, physio,
  district nurse, day centre, respite care, Stroke
  Association etc
• Consider the presence of depression/ dementia/
  other diseases in John and Mary
• Try and be pro-active rather than reactive