M8 Case Study

Module 8 Case Study

Overview

Case studies are designed to increase your knowledge and analysis of weekly topics and also to expand your knowledge on the content presented as you apply it to a real life patient scenario. Utilize this case study as an entry into applying pathophysiology content to the clinical setting. After completing this assignment you will have a thorough understanding of the topic and the application of material you are learning this semester.

Learning Objective(s)

8-1 Explain how alterations of normal cardiovascular function causes disease or illness (CLO 1)
8-2 Identify the structure of normal cardiovascular and lymphatic function (CLO 1)
8-3 Explain how management of obesity and nutrition disorders positively impact health (CLO 3)
8-4 Distinguish the impact of obesity on adverse health conditions (CLO 4)
8-5 Recommend appropriate solution, adverse effects, and/or treatment for abnormal alterations (CLO 5)

Case Study:

You will submit your case study completed in the sections identified below:

1. Definition of diagnosis you suspect in this patient

2. Epidemiology

3. Etiology/Classification

4. Risk Factors

5. Pathophysiology

6. Clinical Presentation (including History and Physical Exam pertinent findings)

7. Diagnosis (including criteria, laboratory findings, imaging) *What diagnosis does this patient have? Diagnosis is established here.

8. Management of the disease

9. Prevention of recurrence

10. Complications and Prognosis

Bonus- Differential Diagnoses. If you accurately list the pertinent differential diagnoses for this patient, you will be awarded bonus points per the rubric.

Note: Use 3 or more references. List your content in sections denoting the headings 1-10 and in the order listed above. Bonus differential diagnoses can be included at the end of your submitted case study.

CHIEF COMPLAINT: Increasing shortness of breath.

HISTORY OF PRESENT ILLNESS

67-year-old White male who presented to the ED with the chief complaint of increasing shortness of breath. He is only able to walk 5 to 10 feet before becoming short of breath. He has been sleeping in a recliner for the past 3 weeks and has been waking up 5 to 6 times every night with shortness of breath. He denied chest pain and dyspnea at rest but had a cough at night when lying on his back. The patient also gives history of consuming an increased amount of high-sodium processed meats similar to the Atkins diet in the previous several weeks.

PAST MEDICAL HISTORY: Coronary artery disease (CAD), hypertension (HTN), hyperlipidemia, peripheral vascular disease (PVD), morbid obesity, and diabetes mellitus (DM).

PAST SURGICAL HISTORY: Coronary artery bypass graft (CABG), iliac stenting, and transurethral resection of prostate.

CURRENT HOSPITAL MEDICATIONS

Aspirin 81 mg PO daily

Atorvastatin 80 mg PO daily.

Norvasc 5mg PO daily.

Glipizide 10mg PO daily.

ALLERGIES: No known medication or food allergies.

SOCIAL HISTORY: Married. The patient’s wife continues to work part time. His two sons and one daughter live nearby.

BEHAVIORAL: Current 70 pack/years tobacco use. “Occasional” alcohol intake.

REVIEW OF SYSTEMS

Head: Denies any trauma, headache, or history of seizures.

Eyes: No visual field changes or blurred vision.

Chest: Positive for dyspnea on exertion (DOE), orthopnea, paroxysmal nocturnal dyspnea (PND).

Heart: Denies any chest pain or chest pressure. Denies dyspnea at rest.

Circulation: Denies numbness to upper and lower extremities.

Abdomen: Denies abdominal pain, nausea, and vomiting.

Neurological: Denies weakness, numbness, slurred speech.

General/Constitutional: In usual state of health prior to a few weeks ago when he noticed increasing shortness of breath and inability to sleep flat.

PHYSICAL EXAMINATION

Vital signs: Temperature 97.1 F oral (36.2 C), pulse 54/minute, respiration 24/minute, BP 154/70, weight 331.4 lb (150.3 kg), height 72 inches (182.9 cm), and body mass index (BMI) of 44.

General: Overweight and in no mild distress.

Skin: Warm, dry, and both lower extremities cool.

Head, eyes, ears, nose, throat: Pupils 2 mm and equal.

Chest: Bilateral breath sounds were noted on auscultation of the lungs with crackles in the right lower lobe.

Heart: Regular, S1S2, no murmurs, clicks, or rubs. Jugular venous pressure (JVP) was elevated at the middle of the ear at 45 degrees

Abdomen: Large, soft, bowel sounds active all 4 quadrants.

Extremities: Upper extremities warm with 2+ bilateral radial pulses, 1+ pitting edema up to mid-shin bilaterally, 2+ distal pulses, and erythema secondary to venous stasis

Musculoskeletal strength: bilateral upper extremities 5/5, bilateral lower extremities 5/5.

Musculoskeletal tone: Normal in bilateral upper and lower extremities.

Neurological: Alert, oriented 3, follows command to bilaterally, visual fields intact, extraocular movements intact.

DIAGNOSTICS

Laboratory Findings:

CBC: WBC 10K, Hgb 12, HCT 35, PLT 231

BMP: Sodium 135, K 4, BUN 32 mg/dL, creatinine of 1.2 mg/dL

B-natriuretic peptide (BNP-469 pg/mL), A1C of 7.3, and negative troponins.

Chest X-ray: pulmonary congestion

ECG: showed sinus bradycardia with a heart rate of 54.

Echocardiogram: mild bi-atrial enlargement, left ventricular ejection fraction (LVEF) of 59%, grade II diastolic dysfunction, and mild pulmonary HTN.

Based on the main diagnosis of this patient you, the nurse practitioner identify, you will submit your case study completed in the sections identified below:

1. Definition of diagnosis you suspect in this patient

2. Epidemiology

3. Etiology/Classification

4. Risk Factors of the diagnosis – emphasize with an asterisk (*) the risk factors this patient exhibits

5. Pathophysiology

6. Clinical Presentation (including History and Physical Exam pertinent findings of the typical presentation of this diagnosis)

7. Diagnosis (including criteria, laboratory findings, imaging)

8. Management of the disease

9. Prevention of recurrence

10. Complications and Prognosis

Bonus- Differential Diagnoses. If you accurately list the pertinent differential diagnoses for this patient, you will be awarded bonus points per the rubric.

Rubric

Case Study Rubric Week 8

Case Study Rubric Week 8
Criteria	Ratings	Pts
This criterion is linked to a Learning OutcomeEpidemiology, Etiology/Classification & Risk Factors	16 ptsExcellentComplete inclusion of epidemiology, etiology/classification data, and pertient risk factors12.44 ptsGoodIncomplete inclusion of epidemiology, etiology/classification data, and pertient risk factors. Missing 1-4 data points. 8.89 ptsFairIncomplete inclusion of epidemiology, etiology/classification data, and pertient risk factors. Missing 5 or more data points.0 ptsNo MarksNo inclusion of content for this topic	16 pts
This criterion is linked to a Learning OutcomePathophysiolgy	21 ptsExcellentComplete inclusion of pathophysiology content16.5 ptsVery GoodIncomplete inclusion of pathophysiology content. Missing 1-2 data points. 10.5 ptsGoodIncomplete inclusion of pathophysiology content. Missing 3-4 data points.6 ptsFairIncomplete inclusion of pathophysiology content. Missing 5 or more data points.0 ptsNo MarksNo inclusion of content for this topic	21 pts
This criterion is linked to a Learning OutcomeClinical Presentation & DiagnosisClinical Presentation (including History and Physical Exam pertinent findings), Diagnosis (including criteria, laboratory findings, imaging)	19 ptsExcellentComplete inclusion of clinical presentation & diagnosis criteria. Missing no more than 1 data points.15.83 ptsGoodIncomplete inclusion of clinical presentation & diagnosis criteria. Missing 2-4 data points. 11.08 ptsFairIncomplete inclusion of clinical presentation & diagnosis criteria. Missing 5 or more data points.0 ptsNo MarksNo inclusion of content for this topic.	19 pts
This criterion is linked to a Learning OutcomeManagement of the Disease, Prevention of Recurrence & Complications and Prognosis	16 ptsExcellentComplete inclusion of management of the disease, prevention of recurrence & complications and prognosis data points. Missing no more than 1 data points.12.44 ptsGoodIncomplete inclusion of management of the disease, prevention of recurrence & complications and prognosis data points. Missing 2-4 data points. 8.89 ptsFairIncomplete inclusion of management of the disease, prevention of recurrence & complications and prognosis data points. Missing 5 or more data points.0 ptsNo MarksNo inclusion of content for this topic.	16 pts
This criterion is linked to a Learning OutcomeBonus: Differential Diagnosis	0 ptsFull MarksAccurately list the 3-4 most pertinent differential diagnoses for this patient in order to receive points.0 ptsNo MarksNo partial points will be awarded.	0 pts
This criterion is linked to a Learning OutcomeReferences3 or more references listed in APA format.	4 to >0.8 ptsExcellent3 references. Correctly cited. Appropriate quality resources.0.8 to >0 ptsNo Marks	4 pts

Total Points: 76

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case study 2