Case study

1. Read the case study below.
2. In your initial discussion post, answer the questions related to the case scenario and support your response with at least one evidence-based reference by Wed., 11:59 pm MT.
3. Provides a minimum of two responses weekly on separate days; e.g., replies to a post from a peer; AND faculty member’s question; OR two peers if no faculty question using appropriate resources, before Sun., 11:59 pm MT.

Case Scenario

A 76-year -old man is brought to the primary care office by his wife with concerns about his worsening memory. He is a retired lawyer who has recently been getting lost in the neighborhood where he has lived for 35 years. He was recently found wandering and has often been brought home by neighbors. When asked about this, he becomes angry and defensive and states that he was just trying to go to the store and get some bread.

His wife expressed concerns about his ability to make decisions as she came home two days ago to find that he allowed an unknown individual into the home to convince him to buy a home security system which they already have. He has also had trouble dressing himself and balancing his checkbook. At this point, she is considering hiring a day-time caregiver help him with dressing, meals and general supervision why she is at work.

Past Medical History: Gastroesophageal reflux (treated with diet); is negative for hypertension, hyperlipidemia, stroke or head injury or depression

Allergies: No known allergies

Medications: None

Family History

• Father deceased at age 78 of decline related to Alzheimer’s disease
• Mother deceased at age 80 of natural causes
• No siblings

Social History

• Denies smoking
• Denies alcohol or recreational drug use
• Retired lawyer
• Hobby: Golf at least twice a week

Review of Systems

• Constitutional: Denies fatigue or insomnia
• HEENT: Denies nasal congestion, rhinorrhea or sore throat.
• Chest: Denies dyspnea or coughing
• Heart: Denies chest pain, chest pressure or palpitations.
• Lymph: Denies lymph node swelling.
• Musculoskeletal: denies falls or loss of balance; denies joint point or swelling

General Physical Exam  

• Constitutional: Alert, angry but cooperative
• Vital Signs: BP-128/72, T-98.6 F, P-76, RR-20
• Wt. 178 lbs., Ht. 6’0″, BMI 24.1

HEENT

• Head normocephalic; Pupils equal and reactive to light bilaterally; EOM’s intact

Neck/Lymph Nodes

• No abnormalities noted

Lungs 

• Bilateral breath sounds clear throughout lung fields.

Heart 

• S1 and S2 regular rate and rhythm, no rubs or murmurs.

Integumentary System 

• Warm, dry and intact. Nail beds pink without clubbing.

Neurological

• Deep tendon reflexes (DTRs): 2/2; muscle tone and strength 5/5; no gait abnormalities; sensation intact bilaterally; no aphasia

Diagnostics

• Mini-Mental State Examination (MMSE): Baseline score 12 out of 30 (moderate dementia)
• MRI: hippocampal atrophy
• Based on the clinical presentation and diagnostic findings, the patient is diagnosed with Alzheimer’s type dementia.

Discussion Questions

1. Compare and contrast the pathophysiology between Alzheimer’s disease and frontotemporal dementia.
2. Identify the clinical findings from the case that supports a diagnosis of Alzheimer’s disease.
3. Explain one hypothesis that explains the development of Alzheimer’s disease
4. Discuss the patient’s likely stage of Alzheimer’s disease.

 

Please see instructions attached. 

Hi writer please see attach document for the  case study with instructions including rubric 

 

References no later than 5 years please. 

Concept: Delegation

 Case Study

You are working the night shift on a medical unit and have been assigned charge nurse responsibilities. You are working with four RNs, one LPN, and two UAPs. A client becomes pulseless and is not breathing, and the nurse assigned to the client’s care calls a code. The nurse is occupied at this client’s bedside for 1.5 hours until the resuscitation effort is completed, and the client is transferred to the intensive care unit. This nurse also has four other assigned clients. In addition to the nurse assigned to care for the client requiring resuscitation, two of the other nurses working on your unit are assisting in the code.

 

Review the case study and write an essay (suggested length of 2–3 pages, excluding title page and reference page) in which you do the following:

1. Discuss what tasks could you delegate to the UAPs?
2. The LPN working on the unit is a new graduate and has been employed for only 4 weeks. How would you collaborate with this nurse when delegating tasks for completion?
3. Discuss how you will maintain the safety of the other clients on your unit while three nurses are occupied with the client requiring resuscitation?

Explain how might effective delegation to other team members contribute to care of the clients on the unit? (Remember, this is not a question about the patient that is coded, but how you will handle the unit while you are short staffed).

 

40 yo Asia woman comes into the clinic complaining of red rash all down her back but more noted under her bra strap, noted 14 days ago, painful, and used Tylenol with no real relief. Ms. Kim has not been to the doctor for over 2 years, with no insurance in the past. She has a medical card now. Ms. Kim is married, Last menstrual period not sure, maybe 1 month ago, g2 para 2l living 1, no real medical problems, no medications other than women vitamins but can’t afford now, business slow at her restaurant. It is located on the south side of Chicago, and lots of renovations are causing her to lose business. She also stated she couldn’t see out of her peripheral vision. This is a new issue for her too. She stated she sometimes has a blurry vision with headaches. No glasses, no eye exam in years

 

1.List 3 Differential Diagnosis for Ms. Kim’s complaints

2. What system or systems should be addressed with this patient?

3. What other questions need to be asked? If any, what do gravida para and living mean in this case? explain in details

4. What would be the plan for this patient? Please include education, referral, recommendations

5 What guidelines were used to come to the final diagnosis? What is the diagnosis(es)?

 

 

 

A 62-year-old female  presents with severe right eye pain, tearing, photophobia, and blurry vision after being kicked in the eye by her 9-year-old niece 2 hours ago while she was helping her niece practice prior to her niece’s  soccer game.  She denies any flashing lights or floaters or mucous drainage from her right eye but she does complain of feeling “like something is in my right eye”. She denies any other pain or discomfort.

Past Medical History:

Hypertension

Type 2 DM

Past Surgical History

Bilateral Cataract surgery 2 years ago.

Cholecystectomy 10 years ago

Social History:Denies alcohol, tobacco, or illicit drug use.

Medications:Hydrochlorothiazide

Allergies:None

ROS:Negative except HPI

 

1.Discuss the specific health history questions you need to ask and why.

2. Discuss the specific physical exam techniques/procedures/imaging/laboratory tests you need to perform

    and why.

3. Identify 3 differential diagnoses supported by evidence-based practice.

4. What is your working definitive diagnosis/assessment and evidenced-based practice rationale?

5. What is your evidence-based treatment/management plan?

 

A 38 -year-old morbidly obese Caucasian woman inquires about bariatric surgery, a treatment option for patients with a body-mass index of 40 or more (or 35 or more when there are coexisting medical conditions). Bariatric surgery has been shown to result in substantial weight loss and resolution of associated conditions. A successful clinical outcome requires an experienced multidisciplinary management team and an informed patient who will follow a long-term management plan and self-care plan.

Questions

Please discuss who would be included in the multidisciplinary team.

What are the updated guidelines for bariatric surgery?

Please discuss the various types of bariatric surgeries available.

Discuss cost and insurance coverage

Discuss a minimum of 3 complications related to Bariatric Surgery

Discuss the global approach to obesity includes 2 countries. 

Discuss obesity in your clinical setting( gender, race, age, etc.). How is it addressed, if at all?  As a future APN, what will be your approach? What resources are available?

 

Don’t forget to use a minimum of  3 scholarly references, no later than 2016, and  7th edition APA

 

Thank you

A 38 -year-old morbidly obese Caucasian woman inquires about bariatric surgery, a treatment option for patients with a body-mass index of 40 or more (or 35 or more when there are coexisting medical conditions). Bariatric surgery has been shown to result in substantial weight loss and resolution of associated conditions. A successful clinical outcome requires an experienced multidisciplinary management team and an informed patient who will follow a long-term management plan and self-care plan.

Questions

Please discuss who would be included in the multidisciplinary team.

What are the updated guidelines for bariatric surgery?

Please discuss the various types of bariatric surgeries available.

Discuss cost and insurance coverage

Discuss a minimum of 3 complications related to Bariatric Surgery

Discuss the global approach to obesity includes 2 countries. 

Discuss obesity in your clinical setting( gender, race, age, etc.). How is it addressed, if at all?  As a future APN, what will be your approach? What resources are available?

 

Don’t forget to use a minimum of  3 scholarly references, no later than 2016, and  7th edition APA

 

Thank you