Case study 4 <\/p>\n
Patient Profile<\/p>\n
Mr. Benjamin is a 70 year old male who has scheduled an appointment with HCP. He<\/p>\n
explains to the nurse, \u00e2\u20ac\u0153I came in because over the last few months I have noticed that<\/p>\n
every time I go to the bathroom I have to really strain to go. Even though I feel like my<\/p>\n
bladder is full, only a little comes out. The next thing I know I am back in the bathroom<\/p>\n
trying like heck to go again. It is like it\u00e2\u20ac\u2122s clogged up there or something.\u00e2\u20ac\u009d The nurse<\/p>\n
gives Mr. Benjamin a copy of the American Urological Association BPH Symptom Index<\/p>\n
Questionnaire to complete while he waits for HCP to see him. The nurse explains that<\/p>\n
based on the problems that he has described, this questionnaire will provide the HCP<\/p>\n
with additional information to help determine what may be causing his symptoms.<\/p>\n
Case Study<\/p>\n
Mr. Benjamin\u00e2\u20ac\u2122s HCP reviews the completed BPH Symptom Index Questionnaire. Mt.<\/p>\n
Benjamin\u00e2\u20ac\u2122s score is 12 out of 35. Physical exam reveals that Mr. Benjamin has an<\/p>\n
enlarged prostate. The HCP would like him to have a few tests to help make a definitive<\/p>\n
diagnosis. The HCP prescribes a urinalysis and culture and sensitivity (U\/A C&S),<\/p>\n
complete blood count count (CBC), serum blood urea nitrogen (BUN) and creatinine<\/p>\n
(create) levels, and a prostate-specific antigen (PSA). Mr. Benjamin is also scheduled to<\/p>\n
have a cystography and bladder ultrasound.<\/p>\n
Questions<\/p>\n
1. Briefly explain the function of the prostate.<\/p>\n
2. Discuss benign prostatic hyperplasia (BPH). What anatomical changes in the<\/p>\n
prostate result in BPH, and what are the manifestations that result from the<\/p>\n
pathophysiologic changes caused by BPH.<\/p>\n
3. The following diagnostic tests were prescribed by his HCP: U\/A C&S, CBC, BUN<\/p>\n
and creatinine, PSA, cystography and bladder ultrasound. Provide a brief rationale<\/p>\n
for each test.<\/p>\n
4. Discuss three diagnostic tests not prescribed in this case that could also be used to<\/p>\n
help rule out differential diagnoses and use a definitive diagnosis of BPH.<\/p>\n
5. The nurse asked Mr. Benjamin to complete the American Urological Association<\/p>\n
BPH Symptom Index Questionnaire. What are the seven questions asked on this<\/p>\n
assessment tool and describe what the client\u00e2\u20ac\u2122s score indicates.<\/p>\n
6. Benjamin\u00e2\u20ac\u2122s HCP tells Mr. Benjamin, I am glad you came in to see me to evaluate<\/p>\n
your symptoms. BPH is a very common problem and treatment can help prevent<\/p>\n
complications. What are the potential complications of BPH?<\/p>\n
7. Discuss finasteride as a preferred pharmacologic treatment option for the client with<\/p>\n
BPH. How does this medication work what are the limitations of its use,, and what<\/p>\n
potential adverse effects should the client e educated about prior to initiating<\/p>\n
therapy? Can you identify two other medications that may be prescribed to treat<\/p>\n
BPH?<\/p>\n
8. Benjamin asks his HCP, \u00e2\u20ac\u0153Are there any herbal or natural remedies for this problem?<\/p>\n
I am not a fan of taking pills. For 70 years, I have managed to avoid having to take<\/p>\n
pills every day and don\u00e2\u20ac\u2122t like having to start now.\u00e2\u20ac\u009d What two alternative therapies<\/p>\n
might the HCP suggest?<\/p>\n
9. Benjamin\u00e2\u20ac\u2122s symptoms continue despite treatment and he has had recurrent urinary<\/p>\n
tract infections. He is scheduled to have a turp. What is accomplished by this<\/p>\n
procedure? Does this require the client\u00e2\u20ac\u2122s informed consent?<\/p>\n
\u00ef\u201a\u00b7 Following his TURP, Mr. Benjamin is admitted to a surgical nursing unit. He has a<\/p>\n
three-way urinary catheter inserted for continuous bladder irrigation. What clinical<\/p>\n
manifestations should the nurse monitor that indicate postoperative complications?<\/p>\n
\u00ef\u201a\u00b7 Describe continuous bladder irrigation and its purpose. What will the nurse<\/p>\n
document to help the surgeon determine when this intervention can be<\/p>\n
discontinued?<\/p>\n
\u00ef\u201a\u00b7 Postoperatively, Mr. Benjamin has on sequential compression devices (SCDs).<\/p>\n
Provide the rationale for why SCDs have been prescribed.<\/p>\n
\u00ef\u201a\u00b7 Identify 3 priority nursing diagnoses that are appropriate to consider while caring for<\/p>\n
Mr. Benjamin following TURP.<\/p>\n
\u00ef\u201a\u00b7 Benjamin expresses concern to his nurse stating \u00e2\u20ac\u0153I heard that after this procedure,<\/p>\n
sometimes things don\u00e2\u20ac\u2122t always work right down there.\u00e2\u20ac\u009d Provide Mr. Benjamin with an<\/p>\n
explanation of the potential erectile dysfunction he may experience.<\/p>\n
<\/p>\n
Clinical Case Study # 3<\/p>\n
Derek<\/p>\n
Patient Profile:<\/p>\n
Derek is a 22-year-old male found by his roommate to be conscious but very lethargic<\/p>\n
and not responding to questions. Derek was transported to the emergency department<\/p>\n
(ED) by emergency medial personnel who began administering oxygen via a non-<\/p>\n
rebreather mask enroute to the hospital. Upon arrival in the ED, Derek is conscious but<\/p>\n
unresponsive. Derek\u00e2\u20ac\u2122s roommate accompanied him to the ED The roommate states, \u00e2\u20ac\u0153I<\/p>\n
went into the TV room in the frat house this afternoon and Derek was lying on the sofa. I<\/p>\n
started talking to him. He just looked at me with a blank stare, and would not answer<\/p>\n
me. He was just lying there almost stiff looking. What in the world is wrong with him?<\/p>\n
Study<\/p>\n
Derek\u00e2\u20ac\u2122s vital signs are blood pressure 132\/56, heart rate 130, respiratory rate 20, and<\/p>\n
rectal temperature of 104.1. F (40 C). His oxygen saturation is 97% on oxygen. A 12-<\/p>\n
lead electrocardiogram (ECG, EKG) shows sinus tachycardia. Physical assessment<\/p>\n
findings include severe neck and joint stiffness and a petechial rash on his chest.<\/p>\n
Diagnostic tests prescribed include a computed tomography (CT) scan of Derek\u00e2\u20ac\u2122s head<\/p>\n
and then a lumbar puncture (LP). A complete blood count (CBC), urinalysis (U\/A), urine<\/p>\n
culture and sensitivity ( U\/A C&S), basic metabolic panel (BMP), blood cultures x 2 sites<\/p>\n
(BC x 2), and a serum drug screen have been prescribed. Suspecting that Derek may<\/p>\n
have meningitis, the health care provider (HCP) prescribed ceftriaxone sodium 2 grams<\/p>\n
intravenous (IV) every 12 hours, with the first dose to be given after obtaining the blood<\/p>\n
cultures and doing the LP. Derek is admitted and assigned to a respiratory isolation<\/p>\n
room. IV fluids of normal saline are prescribed. Derek\u00e2\u20ac\u2122s white blood cells (WBC) are<\/p>\n
15,300 cells\/mm3. The CT scan was negative for a cranial mass or bleeding. The<\/p>\n
cerebral spinal fluid (CSF) obtained during the LP appears cloudy. CSF analysis<\/p>\n
findings reveal a decreased glucose level, elevated protein level and an elevated WBC<\/p>\n
count. The urinalysis, urine culture, blood cultures, and BMP are within normal limits.<\/p>\n
Derek\u00e2\u20ac\u2122s drug screen is negative.<\/p>\n
Questions<\/p>\n
1. discuss the causes of meningitis and describe the pathophysiologic changes in the<\/p>\n
brain that result from this infection.<\/p>\n
2. Describe the clinical manifestations of bacterial and viral meningitis.<\/p>\n
3. The nurse assesses Derek for the Kernig\u00e2\u20ac\u2122s sign and Brudzinski\u00e2\u20ac\u2122s sign Describe how<\/p>\n
each sign is assessed and what a positive result indicates.<\/p>\n
Briefly discuss the incidence of bacterial meningitis. Which individuals are more often<\/p>\n
affected in terms of age and gender, and is there an increase in cases depending on the<\/p>\n
time of the year?<\/p>\n
4. Briefly discuss the incidence of bacterial meningitis. Which individuals are more<\/p>\n
often affected in terms of age and gender, and is there an increase in cases<\/p>\n
depending on the time of the year?<\/p>\n
5. Derek is admitted to a respiratory isolation room. When can he be transferred to a<\/p>\n
regular hospital room?<\/p>\n
6. The nurse applies pads to the bedside rails and makes sure that there is suction<\/p>\n
equipment, an airway, oxygen and a padded tongue blade by Derek\u00e2\u20ac\u2122s bedside.<\/p>\n
Explain why the nurse has taken these precautions and any concerns you have<\/p>\n
about the precautions the nurse has implemented.<\/p>\n
7. Explain why the HCP has prescribed a head CT scan and why the CT scan should<\/p>\n
be done prior to the lumbar puncture.<\/p>\n
8. Briefly discuss why the HCP has requested that Derek have a lumbar puncture.<\/p>\n
What are the nurse\u00e2\u20ac\u2122s responsibilities in assisting the HCP during the lumbar<\/p>\n
puncture procedure?<\/p>\n
9. What is the rationale for doing a serum drug screen as part of Derek\u00e2\u20ac\u2122s diagnostic<\/p>\n
workup?<\/p>\n
10. Derek\u00e2\u20ac\u2122s roommate explained Derek just looked at me with a blank stare and would<\/p>\n
not answer me. \u00e2\u20ac\u0153Offer a brief explanation for why Derek did not answer his<\/p>\n
roommate.<\/p>\n
11. A gram stain of the CSF reveals Neisseria Meningitiis. Derek has bacterial<\/p>\n
meningitis (meningococcal meningitis). The HCP has already prescribed ceftriaxone<\/p>\n
sodium following the blood cultures and lumbar puncture. Additional medications<\/p>\n
prescribed are dexamethasone, acetaminophen, and morphine sulfate. Briefly<\/p>\n
discuss the rationale for each of these prescribed medications.<\/p>\n
\u00ef\u201a\u00b7 Identify at least three nonpharmacologic nursing interventions that the nurse can<\/p>\n
implement to promote comfort the client with meningitis.<\/p>\n
\u00ef\u201a\u00b7 Identify three priority nursing diagnoses appropriate for inclusion in Derek\u00e2\u20ac\u2122s plan o<\/p>\n
care.<\/p>\n
\u00ef\u201a\u00b7 Considering Derek\u00e2\u20ac\u2122s living situation, discuss the precautions that should be taken.<\/p>\n
<\/p>\n
Case Study # 2<\/p>\n
Mrs. Duarte<\/p>\n
Patient Profile<\/p>\n
Mrs. Duarte is a 40 year old woman who has scheduled an appointment with her<\/p>\n
primary HCP to assess a lump that has developed on the left side of her neck.<\/p>\n
Case Study<\/p>\n
Mrs. Duarte explains to her HCP that she has noticed a swollen area on the left side of<\/p>\n
her neck that has been increasing in size. She states, \u00e2\u20ac\u0153I am really afraid I have cancer. I<\/p>\n
eat plenty but seem to be losing weiht. II have lost 10 pounds in less than 2 months. I<\/p>\n
have been very agitated and irritable. Perhaps I am nervous about the possibility that<\/p>\n
this lump is cancer.\u00e2\u20ac\u009d Her vital signs are blood pressure 142\/64, pulse 128, respiratory<\/p>\n
rate 24, and temperature 98.8F (37C). The HCP palpates a smooth soft, enlarged left<\/p>\n
lobe of the thyroid gland. The HCP places the bell of the stethoscope over the swollen<\/p>\n
area and auscultates a bruit. Further discussion reveals that Mrs. Duarte has been<\/p>\n
havin difficulty sleeping, thinning hair and loose bowel movements. Concerned that Mrs.<\/p>\n
Duarte has a thyroid disorder, the HCP prescribes serium laboratory testing to assess<\/p>\n
the client\u00e2\u20ac\u2122s levels of thyroid stimulating hormone (TSH) and free tetraiodothyronine<\/p>\n
(thyroxine or T4 ) and schedules the client for a radioactive iodine uptake test.<\/p>\n
Questions<\/p>\n
1.Describe the anatomy of the thyroid and, its hormone production, and briefly discuss<\/p>\n
its function.<\/p>\n
2. Does the HCP suspect that Mrs. Duarte has hypothyroidism or hyperthyroidism?<\/p>\n
Identify the clinical manifestations that support your answer.<\/p>\n
3.Identify 3 nursing diagnoses appropriate for Mrs. Duarte.<\/p>\n
4. Referring to the diagnoses identified in question #3, what is the priority nursing<\/p>\n
diagnosis for Mrs. Duarte? Write two goals for the client related to diagnosis, and<\/p>\n
generate at least three nursing interventions to include in her plan of care.<\/p>\n
5. The HCP heard a bruit over Mrs. Duarte\u00e2\u20ac\u2122s thyroid gland. Is this a normal or abormal<\/p>\n
finding? Explain what a bruit is and what it indicates.<\/p>\n
6. Mrs. Duarte is noted to have mild periorbital edema. What causes this edema? What<\/p>\n
are the potential complications that can arise? What suggestions can the nurse offer<\/p>\n
for minimzing the potential complications and discomfort if the edema worsens?<\/p>\n
7. Briefly explain what the TSH and free T4 tests measure and provide the normal<\/p>\n
range for each. What TSH and free T4 tests measure and provide the normal range<\/p>\n
for each. What TSH and fee T4 test results will confirm the suspected thyroid<\/p>\n
disease identified in question # 2.<\/p>\n
8. Identify the chief component in the synthesis of T3 and T4, and discuss how<\/p>\n
most individuals obtain adequate amounts of this component to support the<\/p>\n
body\u00e2\u20ac\u2122s normal thyroid function.<\/p>\n
9. Explain to Mrs Duarte how the radioactive iodine (RAI) uptake test is conducted and<\/p>\n
how the results will help the HCP confirm Mrs. Duarte\u00e2\u20ac\u2122s diagnosis.<\/p>\n
10. Mrs. Duarte does not have cancer. Explain what is causing the \u00e2\u20ac\u0153lump\u00e2\u20ac\u009d in Mrs.<\/p>\n
Duarte\u00e2\u20ac\u2122s neck.<\/p>\n
11. The HCP suggests that Mrs. Duarte have RAI therapy. Briefly explain this therapy to<\/p>\n
Mrs. Duarte and the precautions she should take regarding contact with others in the<\/p>\n
days following RAI therapy.<\/p>\n
12. What potential adverse effect of the initial dose of RAI therapy is considered a<\/p>\n
medical emergency? Briefly discuss the clinical manifestations that should be<\/p>\n
monitored to detect this adverse effect.<\/p>\n
13. To insure that Mrs. Duarte is an appropriate candidate for RAI therapy, explain<\/p>\n
which laboratory test will be performed prior to beginning treatment.<\/p>\n
14. Mrs. Duarte develops hypothyroidism following her RAI therapy. Her HCP prescribes<\/p>\n
levothyroxine sodium. She asks the nurse \u00e2\u20ac\u0153What is this medication for, and how long<\/p>\n
will I need to take it? Provide the client with teaching regarding the rationale for the<\/p>\n
prescribed levothyroxine sodium and respond to Mrs. Duarte\u00e2\u20ac\u2122s question regarding<\/p>\n
the length of treatment.<\/p><\/p>\n","protected":false},"excerpt":{"rendered":"
Case study 4 Patient Profile Mr. Benjamin is a 70 year old male who has scheduled an appointment with HCP. He explains to the nurse, \u00e2\u20ac\u0153I 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 […]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":"","_joinchat":[]},"categories":[1],"tags":[],"_links":{"self":[{"href":"https:\/\/qualityassignments.net\/wp-json\/wp\/v2\/posts\/141921"}],"collection":[{"href":"https:\/\/qualityassignments.net\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/qualityassignments.net\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/qualityassignments.net\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/qualityassignments.net\/wp-json\/wp\/v2\/comments?post=141921"}],"version-history":[{"count":0,"href":"https:\/\/qualityassignments.net\/wp-json\/wp\/v2\/posts\/141921\/revisions"}],"wp:attachment":[{"href":"https:\/\/qualityassignments.net\/wp-json\/wp\/v2\/media?parent=141921"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/qualityassignments.net\/wp-json\/wp\/v2\/categories?post=141921"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/qualityassignments.net\/wp-json\/wp\/v2\/tags?post=141921"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}