Chap 2 Case Study

Case Study #7: A 58-year old lawyer presents in the emergency room with headache, irritability, generalized muscle pain and uncontrollable back spasms. He has become very restless and worried because he has had the back spasms all through his court case that afternoon and they became extremely painful. In his history, the lawyer states that he has a very busy practice. He is on medication for high blood pressure (beta blocker) and has mild asthma. He injured himself about 10 days earlier, puncturing his left arm with a nail from an old barn he is tearing down. The wound has produced moderate quantities of pus, but he has been keeping it clean. When asked, he did not remember having a tetanus shot since he was a kid. The wound was sampled for microscopic examination and culture. The back appears to have very tight contractions and spasms. The patient is in obvious agonizing pain. 1. What is your presumptive diagnosis? 2. What bacterium is most likely causing the problem? 3. Which…

Case Study 2 The first sign family members had that something was not right was Julie getting lost while driving to church. Although she was new to the community, she had been to the church many times. She never did find the church that Sunday morning, but she eventually found her way home. Julie's speech and her writing became very disconnected and disjointed. Her husband, Phil, was taking over more of the household activities. After an extensive history and physical examination that included a CT scan, a mental health assessment was performed. The diagnosis was some form of dementia-likely Alzheimer disease. Case Study Questions 1. What steps must Julie and her husband take at this point? 2. Describe any treatment for this disorder.

10 pts Long Answer Essay A 75-year-old male is brought to the emergency department by their spouse at 8 pm. The spouse reports that they were cleaning up after dinner at approximately 6:30 pm, and she noticed that her husband's speech was very unclear. When she asked him what was going on, he said that he didn't know and that the entire right side of his face felt numb. She reports that he is very active, but he has a past medical history of atrial fibrillation. Based upon these symptoms and past medical history, what do you suspect this patient is experiencing? How would you confirm this diagnosis? What treatment should be administered? Explain why you chose that treatment. Edit View Insert Format Tools Table 12pt v Paragraph v

Case Study 1   Morphine Suspension (1 mg/mL)   One of your long-term patients who you have known for many years has progressed to end-stage prostate cancer and been placed on a palliative care program. The currently commercially available morphine liquids he has been using contain a flavouring agent that makes him nauseous. His Physician has requested you compound a morphine liquid for him without flavour as his pain is well controlled on this medication and he does not want to change to another pain reliever. Your pharmacy team and the Physician would like to make his end-of-life process as comfortable as possible. A formulation for a suspension appears to be a good option to try.   RX: Morphine liquid 1 mg/mL Sig: Take 1-2 mL q1h prn Mitte: 100 mL   Formulation: Morphine HCl 10 mg Glycerol 1 mL Compound Hydroxybenzoate Solution 0.1 mL Purified water to 10 mL Use within 1 month Questions:   Calculate the quantities you will require for each ingredient and create a worksheet. (You may…

Case Study 1   Morphine Suspension (1 mg/mL)   One of your long-term patients who you have known for many years has progressed to end-stage prostate cancer and been placed on a palliative care program. The currently commercially available morphine liquids he has been using contain a flavouring agent that makes him nauseous. His Physician has requested you compound a morphine liquid for him without flavour as his pain is well controlled on this medication and he does not want to change to another pain reliever. Your pharmacy team and the Physician would like to make his end-of-life process as comfortable as possible. A formulation for a suspension appears to be a good option to try.   RX: Morphine liquid 1 mg/mL Sig: Take 1-2 mL q1h prn Mitte: 100 mL   Formulation: Morphine HCl 10 mg Glycerol 1 mL Compound Hydroxybenzoate Solution 0.1 mL Purified water to 10 mL Use within 1 month Questions:   What are the purposes of each excipient in this mixture?   What counselling instructions should…

Case Study 1   Morphine Suspension (1 mg/mL)   One of your long-term patients who you have known for many years has progressed to end-stage prostate cancer and been placed on a palliative care program. The currently commercially available morphine liquids he has been using contain a flavouring agent that makes him nauseous. His Physician has requested you compound a morphine liquid for him without flavour as his pain is well controlled on this medication and he does not want to change to another pain reliever. Your pharmacy team and the Physician would like to make his end-of-life process as comfortable as possible. A formulation for a suspension appears to be a good option to try.   RX: Morphine liquid 1 mg/mL Sig: Take 1-2 mL q1h prn Mitte: 100 mL   Formulation: Morphine HCl 10 mg Glycerol 1 mL Compound Hydroxybenzoate Solution 0.1 mL Purified water to 10 mL Use within 1 month. What special prescription requirements will you need from the doctor? Can he prescribe refills over the…

Case Study 1 You have a 52- year old male patient who comes in stating, “I feel like I can’t breathe.” Patients’ respirations are 28 breaths per minute and their heart rate is 115 beats per minute. The patient then grabs his chest and says, “My chest hurts so bad, please help!” You ask the patient to rate the pain on a scale from 0-10, 10 being the worst pain ever. The patient replies, “10, it hurts so badly!” You then ask the patient to describe what the pain feels like, the patient reports that his pain feels like pressure. Your patient then starts to become diaphoretic and pale. You take an EKG that shows Sinus Tachycardia. The pulse oximeter shows 100% on room air and the patients’ blood pressure is 120/80 mmHg. Identify the Objective and Subjective Data.

Case Study Kim has been a patient at your pharmacy since moving to the area approximately 2 years ago when she bought her first home.  She is 28 years old, collects her prescription for Cerazette every 3 months or so and between times, pops in to buy vitamins and sundries and generally have a chat with the staff in the store.  She has called in today and asked for some advice from the pharmacist; as you approach the counter to speak to her, you notice that she seems quite pale and is heaving.  You ask a member of staff to get Kim a drink of water and offer her a seat in the consultation room where you begin to get some more information from her. Kim tells you the reason she has come in today is because she is suffering from a really severe headache and what she has tried so far has provided no relief. In fact, she tells you that this is not the first time she has suffered with a headache like this, although this is the worst one yet. Kim works for the local council in the human…

Pharmacology RNSG 1301 Midterm Study Guide Anti-inflammatory medications that are contraindicated in elderly clients

Case Study “A Football Player’s Nightmare” Objective:  Apply knowledge of skeletal, muscular and nervous physiology to clearly, accurately and logically analyze a case study.  Scenario Brandon Wilkes is a star quarterback and is looking forward to next week’s game when scouts from his top pick school will be attending.  Brandon confided to the coach that he had been depressed recently and last week began feeling weaker in the weight room during training sessions.  The coach explained that he was working hard and he could rest after the season was over.  One minute three seconds before half time, Brandon ran out of the pocket when he couldn’t find anyone open, made it 15 yards before a defender took him down at the knee.  At the hospital, X-rays confirmed a spiral fracture of the tibia and fibula.  As the radiologist examined the pictures, she noticed excessive bone loss in the shaft of the tibia.  Bloodwork came back from the lab and revealed a blood calcium level of 12.5 mg/dL.  The…

Case Study A 35 year old male is the driver of a vehicle observed to 'drift' off the shoulder of an interstate highway, and with no evidence of breaking strikes an abutment of a bridge at about 35 mph. The driver is belted and air-bags deploy. He is found to have NO vital signs when paramedics arrive several minutes after the impact, and the patient is pronounced dead. Autopsy shows abrasions on the chest, and several fractured ribs with no associated hemorrhage. NO contusions are present in the brain, but a large amount of subarachnoid blood is present, associated with a ruptured aneurysm of the anterior communicating cerebral artery. Cocaine metabolites are found on urine drug screen. NO drugs are present in the blood. What is the probable Cause and Manner of Death? In many jurisdictions, this case would have been signed out as blunt force trauma due to automobile collision, and no autopsy would have been performed. Why is it important to conduct a complete autopsy in all sudden…

RON is suspected of DKA. Formulate a plan of education for Ron's wife, so she will better understand his condition and be able to assist him to manage those days when is unwell. What areas would you cover? How would you ascertain her understanding?

Patient C., 32 y/o, was delivered unconscious to the intensive care department. The patient has a medical history of diabetes. Insulin was not found. The breathing is noisy, of Kussmaul’s type; acetone breath, the skin is dry, turgor is lowered, the facial features are sharp, periosteal reflexes are absent, eye ball tone is lowered. Blood contains 1.2 mmol/l of lactic acid (norm - 0.62-1.3 mmol/l), glycemia - 29 mmol/l. What kind of coma can be suspected?A. KetoacidoticB. Brain comaC. HyperosmolarD. HypochloremicE. Lactacidemic

Case Study B: 22 year old nursing student went to a friend’s Birthday party on Tuesday night. At the party, alcohol, pizza, ice cream and cake was served. When she left the party, she realized that she was out of cigarettes and coffee, and texted her roommate that she was stopping by the grocery store. As she was texting (while driving), she drove off the road and hit a tree!. She suffered a broken leg (L tibia and fibula). She called her roommate and family crying, in pain and very stressed: She has a Pharmacology test on Friday! The surgeon has scheduled her surgery for Friday noon.   Her assessment findings include: Vital signs WNL, SaO2 – 96%, pain at a level 8 prior to medication with morphine 20 minutes ago, her broken L leg is wrapped and immobile with toes visible, pink and with strong and equal bilateral pedal pulses. She vomited upon arrival and still feels nauseous. She is requesting a cigarette break to “soothe her nerves”. Medications she takes include: oral hormonal…

Case Study Amelia is a 68 years old woman who was brought in to ED by her neighbour. Amelia awoke this morning at 0600 hours with a 5/10 headache. At 0700 she called their neighbour and asked her to take her to hospital as she began to feel weak and her headache increased to 7/10.  Upon arrival to ED  one side of her face began to “feel strange”. Amelia has a past medical history of Atrial fibrillation (AF), hypertension (HT) and dyslipidaemia which she manages with Apixaban 2.5mg BD, Sotolol 80mg daily, Amlodipine 5mg daily, Irbesartan/hydrochlorothiazide 300/25mg daily, Rosuvastatin 10mg daily. Amelia used to smoke 20 cigarettes/day but states she quit 5 years ago. When she was brought in to ED, she told staff that she did not take her medications this morning as she was too distracted by her increasing headache. You are assigned to care for Amelia. As you are about to enter her room, you overhear Amelia crying to her neighbour, explaining that she is worried as her mother had died…

Case Study She is not sleeping and acts like her ear hurts HPI:  10-mo-old girl, who is scheduled to be seen for an “ear infection.” Her mother reports that she was awake a lot during the night. “I think she was pulling at her right ear. Amoxicillin does not work for her.” She also reports that last week she had a runny nose and a mild cough treated with Tylenol. Hasn’t been eating as well as usual.  Baby does not go to daycare, although her mother does meet other mothers and babies in the park on nice days, and they play together. She did that over the past week. She also reports that no one else in the household has been sick. Baby was full term, normal vaginal delivery with good Apgar scores. Still breastfeeding.  She has a positive history for an ear infection at age 2 mo (treated with Amoxicillin), at 3 mo (treated with Bactrim), and at 4 mo (also treated with Bactrim). A mild effusion was noted at her 6-mo well child visit, but she was not treated, as she was asymptomatic at that…

CASE STUDY A 36-year-old man was admitted to the hospital after presenting at the emergency department with a self-reported, 7-month history of numbness and weakness in his right leg. He had lost 25 lb in body weight, was experiencing fecal incontinence, and had been unable to urinate for 3 days. Two years previously, the patient had been diagnosed with human immunodeficiency virus (HIV) infection. A physical examination demonstrated bilateral lower extremity weakness, and his reflexes were slowed throughout his body. Kaposi sarcoma (KS) lesions were noted, especially on the lower extremities, along with thrush and herpes lesions in the perianal region. The patient had no fever, and magnetic resonance imaging (MRI) ruled out spinal cord compression. The patient had a history of intravenous (IV) drug abuse, chronic diarrhea for 1.5 years, KS for 2 years, and pancytopenia for several weeks. The patient had large right arachnoid cysts of congenital origin. No previous laboratory reports…

*Case Study* A 2-year-old boy fell from a backyard gym set. His shoulder and upper arm became very swollen shortly after the fall. The boy’s mother took him to the emergency department a few hours after th incident because he was complaining of pain. On physical examination, the physician noted that large hematoma had formed in the upper part of the boy’s right arm. There was no history of surgery (he had not been circumcised), injury, or illness. The boy was receiving no medication. Emergency department treatment consisted of aspirating the hematoma Subsequent to this treatment, the boy began to bleed extensively. He was admitted to the hospital. The following laboratory tests were ordered: a hemoglobin and hematocrit, platelet count, and bleeding time. Because the bleeding continued, a type and crossmatch for two units of fresh blood were ordered on a standby basis. Additional information from the mother revealed that the boy’s cousin had “bleeding problem.” Laboratory Data…

For 11-15. Modified True or False. Write True if the statement is true. If false identify the word that makes it fals and provide explanation that will make it true. substances. W. Tonic control allows the body to be modulated while turning off the system. 72. Tonic control can be considered an essential regulator of blood flow to the organs. 13. ICF consists of high concentration of K+, but low concentrations of Na+ and positively- charged proteins. JA. Homeostasis is maintaining the stability of the ICF through t self-regulatory mechanisms which allows the body to adapt to a changing environment. 15. The ECF acts a buffer zone where nutrients are delivered and cellular wastes removed.

CASE STUDY CONNECTION You work for a public health organization and have been asked to educate the public about BPA and to suggest ways to minimize exposure to the chemical. You begin by examining your lifestyle and finding ways to use alternatives to BPAcontaining products. Create a list of five ways you are exposed daily to BPA, and then list approaches that would avoid or minimize these exposures. Do these steps require more time and/or money? What are some costs of embracing these changes? What would you tell an interested person about BPA as it relates to human health?

Case study: Jack is a 77-year-old retired bank executive. During the last 15 years of his employment, he played golf regularly and frequently met with the 'boys' after that last hole for dinner and drink. Jack retired 5 years ago at age 68. Since his wife passed away 2 years ago, Jack has found his golfing outings to be more important than ever. Last month Jack had a righ knee replacement that 'went wrong.' His incision became infected and he had to have the procedure redone. Jack now has orders for 'no weight bearing' and is being seen by a home health nurse for daily IV antibiotics. Last week when his nurse visited and asked if he needed anything, Jack replied "I need a fifth of whiskey and a handgun." 1) What disciplines would you involve in a care-planning meeting for Jack? Provide rational for your choices of inclusion and exclusion 2) What teaching might be appropriate for Jak?

PATIENT: Joseph Greeson   S: The last time I saw this 29-year-old male was 6 months ago for his annual checkup. He came in today stating that he has been feeling feverish × 3 days and noticed increased redness on his arm last night and this morning. He denies joint pain. He explained that yesterday he was playing with his girlfriend’s new dog and it bit him on the right forearm. The dog is a stray and has had no shots, and the patient states that he believes he accidentally provoked the dog by getting too rough with it.   O: Temp 99.2 degrees, pulse 68, resp 20, weight 142. Right arm reveals four puncture wounds with secondary cellulitis around the area. The area is warm to the touch and is erythematous.   A: Infected dog bite.   P: Patient is given 1 gram of Rocephin IM today. Follow up in 24 hours. A bandage was applied. He was given a rabies immune globulin (Rlg), human, IM. Tylenol is recommended PRN for pain. The patient is given a prescription for Erythromycin 333 mg t.i.d. for…