Case study 4
Mr. Benjamin is a 70 year old male who has scheduled an appointment with HCP. He
explains to the nurse, â€œI came in because over the last few months I have noticed that
every time I go to the bathroom I have to really strain to go. Even though I feel like my
bladder is full, only a little comes out. The next thing I know I am back in the bathroom
trying like heck to go again. It is like itâ€™s clogged up there or something.â€ The nurse
gives Mr. Benjamin a copy of the American Urological Association BPH Symptom Index
Questionnaire to complete while he waits for HCP to see him. The nurse explains that
based on the problems that he has described, this questionnaire will provide the HCP
with additional information to help determine what may be causing his symptoms.
Mr. Benjaminâ€™s HCP reviews the completed BPH Symptom Index Questionnaire. Mt.
Benjaminâ€™s score is 12 out of 35. Physical exam reveals that Mr. Benjamin has an
enlarged prostate. The HCP would like him to have a few tests to help make a definitive
diagnosis. The HCP prescribes a urinalysis and culture and sensitivity (U/A C&S),
complete blood count count (CBC), serum blood urea nitrogen (BUN) and creatinine
(create) levels, and a prostate-specific antigen (PSA). Mr. Benjamin is also scheduled to
have a cystography and bladder ultrasound.
1. Briefly explain the function of the prostate.
2. Discuss benign prostatic hyperplasia (BPH). What anatomical changes in the
prostate result in BPH, and what are the manifestations that result from the
pathophysiologic changes caused by BPH.
3. The following diagnostic tests were prescribed by his HCP: U/A C&S, CBC, BUN
and creatinine, PSA, cystography and bladder ultrasound. Provide a brief rationale
for each test.
4. Discuss three diagnostic tests not prescribed in this case that could also be used to
help rule out differential diagnoses and use a definitive diagnosis of BPH.
5. The nurse asked Mr. Benjamin to complete the American Urological Association
BPH Symptom Index Questionnaire. What are the seven questions asked on this
assessment tool and describe what the clientâ€™s score indicates.
6. Benjaminâ€™s HCP tells Mr. Benjamin, I am glad you came in to see me to evaluate
your symptoms. BPH is a very common problem and treatment can help prevent
complications. What are the potential complications of BPH?
7. Discuss finasteride as a preferred pharmacologic treatment option for the client with
BPH. How does this medication work what are the limitations of its use,, and what
potential adverse effects should the client e educated about prior to initiating
therapy? Can you identify two other medications that may be prescribed to treat
8. Benjamin asks his HCP, â€œAre there any herbal or natural remedies for this problem?
I am not a fan of taking pills. For 70 years, I have managed to avoid having to take
pills every day and donâ€™t like having to start now.â€ What two alternative therapies
might the HCP suggest?
9. Benjaminâ€™s symptoms continue despite treatment and he has had recurrent urinary
tract infections. He is scheduled to have a turp. What is accomplished by this
procedure? Does this require the clientâ€™s informed consent?
ï‚· Following his TURP, Mr. Benjamin is admitted to a surgical nursing unit. He has a
three-way urinary catheter inserted for continuous bladder irrigation. What clinical
manifestations should the nurse monitor that indicate postoperative complications?
ï‚· Describe continuous bladder irrigation and its purpose. What will the nurse
document to help the surgeon determine when this intervention can be
ï‚· Postoperatively, Mr. Benjamin has on sequential compression devices (SCDs).
Provide the rationale for why SCDs have been prescribed.
ï‚· Identify 3 priority nursing diagnoses that are appropriate to consider while caring for
Mr. Benjamin following TURP.
ï‚· Benjamin expresses concern to his nurse stating â€œI heard that after this procedure,
sometimes things donâ€™t always work right down there.â€ Provide Mr. Benjamin with an
explanation of the potential erectile dysfunction he may experience.
Clinical Case Study # 3
Derek is a 22-year-old male found by his roommate to be conscious but very lethargic
and not responding to questions. Derek was transported to the emergency department
(ED) by emergency medial personnel who began administering oxygen via a non-
rebreather mask enroute to the hospital. Upon arrival in the ED, Derek is conscious but
unresponsive. Derekâ€™s roommate accompanied him to the ED The roommate states, â€œI
went into the TV room in the frat house this afternoon and Derek was lying on the sofa. I
started talking to him. He just looked at me with a blank stare, and would not answer
me. He was just lying there almost stiff looking. What in the world is wrong with him?
Derekâ€™s vital signs are blood pressure 132/56, heart rate 130, respiratory rate 20, and
rectal temperature of 104.1. F (40 C). His oxygen saturation is 97% on oxygen. A 12-
lead electrocardiogram (ECG, EKG) shows sinus tachycardia. Physical assessment
findings include severe neck and joint stiffness and a petechial rash on his chest.
Diagnostic tests prescribed include a computed tomography (CT) scan of Derekâ€™s head
and then a lumbar puncture (LP). A complete blood count (CBC), urinalysis (U/A), urine
culture and sensitivity ( U/A C&S), basic metabolic panel (BMP), blood cultures x 2 sites
(BC x 2), and a serum drug screen have been prescribed. Suspecting that Derek may
have meningitis, the health care provider (HCP) prescribed ceftriaxone sodium 2 grams
intravenous (IV) every 12 hours, with the first dose to be given after obtaining the blood
cultures and doing the LP. Derek is admitted and assigned to a respiratory isolation
room. IV fluids of normal saline are prescribed. Derekâ€™s white blood cells (WBC) are
15,300 cells/mm3. The CT scan was negative for a cranial mass or bleeding. The
cerebral spinal fluid (CSF) obtained during the LP appears cloudy. CSF analysis
findings reveal a decreased glucose level, elevated protein level and an elevated WBC
count. The urinalysis, urine culture, blood cultures, and BMP are within normal limits.
Derekâ€™s drug screen is negative.
1. discuss the causes of meningitis and describe the pathophysiologic changes in the
brain that result from this infection.
2. Describe the clinical manifestations of bacterial and viral meningitis.
3. The nurse assesses Derek for the Kernigâ€™s sign and Brudzinskiâ€™s sign Describe how
each sign is assessed and what a positive result indicates.
Briefly discuss the incidence of bacterial meningitis. Which individuals are more often
affected in terms of age and gender, and is there an increase in cases depending on the
time of the year?
4. Briefly discuss the incidence of bacterial meningitis. Which individuals are more
often affected in terms of age and gender, and is there an increase in cases
depending on the time of the year?
5. Derek is admitted to a respiratory isolation room. When can he be transferred to a
regular hospital room?
6. The nurse applies pads to the bedside rails and makes sure that there is suction
equipment, an airway, oxygen and a padded tongue blade by Derekâ€™s bedside.
Explain why the nurse has taken these precautions and any concerns you have
about the precautions the nurse has implemented.
7. Explain why the HCP has prescribed a head CT scan and why the CT scan should
be done prior to the lumbar puncture.
8. Briefly discuss why the HCP has requested that Derek have a lumbar puncture.
What are the nurseâ€™s responsibilities in assisting the HCP during the lumbar
9. What is the rationale for doing a serum drug screen as part of Derekâ€™s diagnostic
10. Derekâ€™s roommate explained Derek just looked at me with a blank stare and would
not answer me. â€œOffer a brief explanation for why Derek did not answer his
11. A gram stain of the CSF reveals Neisseria Meningitiis. Derek has bacterial
meningitis (meningococcal meningitis). The HCP has already prescribed ceftriaxone
sodium following the blood cultures and lumbar puncture. Additional medications
prescribed are dexamethasone, acetaminophen, and morphine sulfate. Briefly
discuss the rationale for each of these prescribed medications.
ï‚· Identify at least three nonpharmacologic nursing interventions that the nurse can
implement to promote comfort the client with meningitis.
ï‚· Identify three priority nursing diagnoses appropriate for inclusion in Derekâ€™s plan o
ï‚· Considering Derekâ€™s living situation, discuss the precautions that should be taken.
Case Study # 2
Mrs. Duarte is a 40 year old woman who has scheduled an appointment with her
primary HCP to assess a lump that has developed on the left side of her neck.
Mrs. Duarte explains to her HCP that she has noticed a swollen area on the left side of
her neck that has been increasing in size. She states, â€œI am really afraid I have cancer. I
eat plenty but seem to be losing weiht. II have lost 10 pounds in less than 2 months. I
have been very agitated and irritable. Perhaps I am nervous about the possibility that
this lump is cancer.â€ Her vital signs are blood pressure 142/64, pulse 128, respiratory
rate 24, and temperature 98.8F (37C). The HCP palpates a smooth soft, enlarged left
lobe of the thyroid gland. The HCP places the bell of the stethoscope over the swollen
area and auscultates a bruit. Further discussion reveals that Mrs. Duarte has been
havin difficulty sleeping, thinning hair and loose bowel movements. Concerned that Mrs.
Duarte has a thyroid disorder, the HCP prescribes serium laboratory testing to assess
the clientâ€™s levels of thyroid stimulating hormone (TSH) and free tetraiodothyronine
(thyroxine or T4 ) and schedules the client for a radioactive iodine uptake test.
1.Describe the anatomy of the thyroid and, its hormone production, and briefly discuss
2. Does the HCP suspect that Mrs. Duarte has hypothyroidism or hyperthyroidism?
Identify the clinical manifestations that support your answer.
3.Identify 3 nursing diagnoses appropriate for Mrs. Duarte.
4. Referring to the diagnoses identified in question #3, what is the priority nursing
diagnosis for Mrs. Duarte? Write two goals for the client related to diagnosis, and
generate at least three nursing interventions to include in her plan of care.
5. The HCP heard a bruit over Mrs. Duarteâ€™s thyroid gland. Is this a normal or abormal
finding? Explain what a bruit is and what it indicates.
6. Mrs. Duarte is noted to have mild periorbital edema. What causes this edema? What
are the potential complications that can arise? What suggestions can the nurse offer
for minimzing the potential complications and discomfort if the edema worsens?
7. Briefly explain what the TSH and free T4 tests measure and provide the normal
range for each. What TSH and free T4 tests measure and provide the normal range
for each. What TSH and fee T4 test results will confirm the suspected thyroid
disease identified in question # 2.
8. Identify the chief component in the synthesis of T3 and T4, and discuss how
most individuals obtain adequate amounts of this component to support the
bodyâ€™s normal thyroid function.
9. Explain to Mrs Duarte how the radioactive iodine (RAI) uptake test is conducted and
how the results will help the HCP confirm Mrs. Duarteâ€™s diagnosis.
10. Mrs. Duarte does not have cancer. Explain what is causing the â€œlumpâ€ in Mrs.
11. The HCP suggests that Mrs. Duarte have RAI therapy. Briefly explain this therapy to
Mrs. Duarte and the precautions she should take regarding contact with others in the
days following RAI therapy.
12. What potential adverse effect of the initial dose of RAI therapy is considered a
medical emergency? Briefly discuss the clinical manifestations that should be
monitored to detect this adverse effect.
13. To insure that Mrs. Duarte is an appropriate candidate for RAI therapy, explain
which laboratory test will be performed prior to beginning treatment.
14. Mrs. Duarte develops hypothyroidism following her RAI therapy. Her HCP prescribes
levothyroxine sodium. She asks the nurse â€œWhat is this medication for, and how long
will I need to take it? Provide the client with teaching regarding the rationale for the
prescribed levothyroxine sodium and respond to Mrs. Duarteâ€™s question regarding
the length of treatment.