Fluent Essays

Case study 4 Patient ProfileMr. Benjamin is a 70 year old male who has scheduled an appointment with HCP. Heexplains to the nurse, “I came in because over the last few months I have noticed thatevery time I go to the bathroom I have to really strain to go. Even though I feel like mybladder is full, only a little comes out. The next thing I know I am back in the bathroomtrying like heck to go again. It is like it’s clogged up there or something.” The nursegives Mr. Benjamin a copy of the American Urological Association BPH Symptom IndexQuestionnaire to complete while he waits for HCP to see him. The nurse explains thatbased on the problems that he has described, this questionnaire will provide the HCPwith additional information to help determine what may be causing his symptoms.Case StudyMr. Benjamin’s HCP reviews the completed BPH Symptom Index Questionnaire. Mt.Benjamin’s score is 12 out of 35. Physical exam reveals that Mr. Benjamin has anenlarged prostate. The HCP would like him to have a few tests to help make a definitivediagnosis. 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 tohave a cystography and bladder ultrasound.Questions1. Briefly explain the function of the prostate.2. Discuss benign prostatic hyperplasia (BPH). What anatomical changes in theprostate result in BPH, and what are the manifestations that result from thepathophysiologic changes caused by BPH.3. The following diagnostic tests were prescribed by his HCP: U/A C&S, CBC, BUNand creatinine, PSA, cystography and bladder ultrasound. Provide a brief rationalefor each test.4. Discuss three diagnostic tests not prescribed in this case that could also be used tohelp rule out differential diagnoses and use a definitive diagnosis of BPH.5. The nurse asked Mr. Benjamin to complete the American Urological AssociationBPH Symptom Index Questionnaire. What are the seven questions asked on thisassessment tool and describe what the client’s score indicates.6. Benjamin’s HCP tells Mr. Benjamin, I am glad you came in to see me to evaluateyour symptoms. BPH is a very common problem and treatment can help preventcomplications. What are the potential complications of BPH?7. Discuss finasteride as a preferred pharmacologic treatment option for the client withBPH. How does this medication work what are the limitations of its use,, and whatpotential adverse effects should the client e educated about prior to initiatingtherapy? Can you identify two other medications that may be prescribed to treatBPH?8. Benjamin asks his HCP, “Are 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 takepills every day and don’t like having to start now.” What two alternative therapiesmight the HCP suggest?9. Benjamin’s symptoms continue despite treatment and he has had recurrent urinarytract infections. He is scheduled to have a turp. What is accomplished by thisprocedure? Does this require the client’s informed consent? Following his TURP, Mr. Benjamin is admitted to a surgical nursing unit. He has athree-way urinary catheter inserted for continuous bladder irrigation. What clinicalmanifestations should the nurse monitor that indicate postoperative complications? Describe continuous bladder irrigation and its purpose. What will the nursedocument to help the surgeon determine when this intervention can bediscontinued? Postoperatively, Mr. Benjamin has on sequential compression devices (SCDs).Provide the rationale for why SCDs have been prescribed. Identify 3 priority nursing diagnoses that are appropriate to consider while caring forMr. Benjamin following TURP. Benjamin expresses concern to his nurse stating “I heard that after this procedure,sometimes things don’t always work right down there.” Provide Mr. Benjamin with anexplanation of the potential erectile dysfunction he may experience.Clinical Case Study # 3DerekPatient Profile:Derek is a 22-year-old male found by his roommate to be conscious but very lethargicand 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 butunresponsive. Derek’s roommate accompanied him to the ED The roommate states, “Iwent into the TV room in the frat house this afternoon and Derek was lying on the sofa. Istarted talking to him. He just looked at me with a blank stare, and would not answerme. He was just lying there almost stiff looking. What in the world is wrong with him?StudyDerek’s vital signs are blood pressure 132/56, heart rate 130, respiratory rate 20, andrectal temperature of 104.1. F (40 C). His oxygen saturation is 97\% on oxygen. A 12-lead electrocardiogram (ECG, EKG) shows sinus tachycardia. Physical assessmentfindings include severe neck and joint stiffness and a petechial rash on his chest.Diagnostic tests prescribed include a computed tomography (CT) scan of Derek’s headand then a lumbar puncture (LP). A complete blood count (CBC), urinalysis (U/A), urineculture 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 mayhave meningitis, the health care provider (HCP) prescribed ceftriaxone sodium 2 gramsintravenous (IV) every 12 hours, with the first dose to be given after obtaining the bloodcultures and doing the LP. Derek is admitted and assigned to a respiratory isolationroom. IV fluids of normal saline are prescribed. Derek’s white blood cells (WBC) are15,300 cells/mm3. The CT scan was negative for a cranial mass or bleeding. Thecerebral spinal fluid (CSF) obtained during the LP appears cloudy. CSF analysisfindings reveal a decreased glucose level, elevated protein level and an elevated WBCcount. The urinalysis, urine culture, blood cultures, and BMP are within normal limits.Derek’s drug screen is negative.Questions1. discuss the causes of meningitis and describe the pathophysiologic changes in thebrain that result from this infection.2. Describe the clinical manifestations of bacterial and viral meningitis.3. The nurse assesses Derek for the Kernig’s sign and Brudzinski’s sign Describe howeach sign is assessed and what a positive result indicates.Briefly discuss the incidence of bacterial meningitis. Which individuals are more oftenaffected in terms of age and gender, and is there an increase in cases depending on thetime of the year?4. Briefly discuss the incidence of bacterial meningitis. Which individuals are moreoften affected in terms of age and gender, and is there an increase in casesdepending on the time of the year?5. Derek is admitted to a respiratory isolation room. When can he be transferred to aregular hospital room?6. The nurse applies pads to the bedside rails and makes sure that there is suctionequipment, an airway, oxygen and a padded tongue blade by Derek’s bedside.Explain why the nurse has taken these precautions and any concerns you haveabout the precautions the nurse has implemented.7. Explain why the HCP has prescribed a head CT scan and why the CT scan shouldbe done prior to the lumbar puncture.8. Briefly discuss why the HCP has requested that Derek have a lumbar puncture.What are the nurse’s responsibilities in assisting the HCP during the lumbarpuncture procedure?9. What is the rationale for doing a serum drug screen as part of Derek’s diagnosticworkup?10. Derek’s roommate explained Derek just looked at me with a blank stare and wouldnot answer me. “Offer a brief explanation for why Derek did not answer hisroommate.11. A gram stain of the CSF reveals Neisseria Meningitiis. Derek has bacterialmeningitis (meningococcal meningitis). The HCP has already prescribed ceftriaxonesodium following the blood cultures and lumbar puncture. Additional medicationsprescribed are dexamethasone, acetaminophen, and morphine sulfate. Brieflydiscuss the rationale for each of these prescribed medications. Identify at least three nonpharmacologic nursing interventions that the nurse canimplement to promote comfort the client with meningitis. Identify three priority nursing diagnoses appropriate for inclusion in Derek’s plan ocare. Considering Derek’s living situation, discuss the precautions that should be taken.Case Study # 2Mrs. DuartePatient ProfileMrs. Duarte is a 40 year old woman who has scheduled an appointment with herprimary HCP to assess a lump that has developed on the left side of her neck.Case StudyMrs. Duarte explains to her HCP that she has noticed a swollen area on the left side ofher neck that has been increasing in size. She states, “I am really afraid I have cancer. Ieat plenty but seem to be losing weiht. II have lost 10 pounds in less than 2 months. Ihave been very agitated and irritable. Perhaps I am nervous about the possibility thatthis lump is cancer.” Her vital signs are blood pressure 142/64, pulse 128, respiratoryrate 24, and temperature 98.8F (37C). The HCP palpates a smooth soft, enlarged leftlobe of the thyroid gland. The HCP places the bell of the stethoscope over the swollenarea and auscultates a bruit. Further discussion reveals that Mrs. Duarte has beenhavin difficulty sleeping, thinning hair and loose bowel movements. Concerned that Mrs.Duarte has a thyroid disorder, the HCP prescribes serium laboratory testing to assessthe client’s levels of thyroid stimulating hormone (TSH) and free tetraiodothyronine(thyroxine or T4 ) and schedules the client for a radioactive iodine uptake test.Questions1.Describe the anatomy of the thyroid and, its hormone production, and briefly discussits function.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 nursingdiagnosis for Mrs. Duarte? Write two goals for the client related to diagnosis, andgenerate at least three nursing interventions to include in her plan of care.5. The HCP heard a bruit over Mrs. Duarte’s thyroid gland. Is this a normal or abormalfinding? Explain what a bruit is and what it indicates.6. Mrs. Duarte is noted to have mild periorbital edema. What causes this edema? Whatare the potential complications that can arise? What suggestions can the nurse offerfor minimzing the potential complications and discomfort if the edema worsens?7. Briefly explain what the TSH and free T4 tests measure and provide the normalrange for each. What TSH and free T4 tests measure and provide the normal rangefor each. What TSH and fee T4 test results will confirm the suspected thyroiddisease identified in question # 2.8. Identify the chief component in the synthesis of T3 and T4, and discuss howmost individuals obtain adequate amounts of this component to support thebody’s normal thyroid function.9. Explain to Mrs Duarte how the radioactive iodine (RAI) uptake test is conducted andhow the results will help the HCP confirm Mrs. Duarte’s diagnosis.10. Mrs. Duarte does not have cancer. Explain what is causing the “lump” in Mrs.Duarte’s neck.11. The HCP suggests that Mrs. Duarte have RAI therapy. Briefly explain this therapy toMrs. Duarte and the precautions she should take regarding contact with others in thedays following RAI therapy.12. What potential adverse effect of the initial dose of RAI therapy is considered amedical emergency? Briefly discuss the clinical manifestations that should bemonitored to detect this adverse effect.13. To insure that Mrs. Duarte is an appropriate candidate for RAI therapy, explainwhich laboratory test will be performed prior to beginning treatment.14. Mrs. Duarte develops hypothyroidism following her RAI therapy. Her HCP prescribeslevothyroxine sodium. She asks the nurse “What is this medication for, and how longwill I need to take it? Provide the client with teaching regarding the rationale for theprescribed levothyroxine sodium and respond to Mrs. Duarte’s question regardingthe length of treatment.