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NSG2NCI Nursing Patients With Chronic Illness

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  • Course Code: NSG2NCI
  • University: La Trobe University
  • Country: Australia


Patient Case Study

Mr Bob Jackson is a 55 year old man admitted to ED with a presenting complaint of diarrhoea, nausea and malaise. His Subjective and Objective examinations are as follows:

History of presenting complaint:

1 week history of increasing Left Lower Quadrant (LLQ) abdominal pain and diarrhoea

Medical History:

Osteoarthritis Right knee
Seasonal rhinitis

Surgical History:

Appendicectomy as a child
Knee arthroscopy 2005





Review of Systems


Currently not on antidepressants, describes normal mood in last year
No dizziness, headache, vision change noted, except some headache during last few days


Recurrent bronchitis and colds over last year
CXR NAD 12 months ago
Recent haemoptysis and persistent cough with mild pleuritic pain over 1/12


Regular antihypertensives (Ramipril)

No central chest pain/ palpitations/dizziness reported


3/12 Hx of occasional loose stools and frank blood in bowl.
States that over the years that he has often had runs of watery diarrhoea that he treats with ‘gastro-stop’
States a history of ‘piles’


No retention/hesitancy/pain


Nocturnal bone pain in hips and back noted last 2/12 - treated with OTC Ibuprofen
Hx of knee and lumbar pain

Social History

Sheep farmer at Patersons Plains, a rural community 100 km Northwest of Melbourne. Married with 2 adult children.


Currently smokes – pack a day for the last 35 years
Alcohol: 6 stubbies of heavy beer a week
Denies illicit drug use

On examination:

Vital signs: T-37, HR -96 Sinus Rhythm,  RR 20, BP 165/110, SpO2 98% on RA


Alert and orientated


Chest clear on auscultation


Warm and well perfused, cap refill < 3 sec, slight pallor


- Pain Left lower Quadrant
- 6/10 at rest 8/10 on movement
- Mildly obese
- abdo soft and tender in LLQ
- Lower abdominal distension noted


Urinalysis shows SG 1.05, otherwise NAD


Answer the following questions in regards to Mr Jackson’s presentation.
  1. Hypothesise the most likely chronic disease process that fits Mr Jackson’s symptoms and history. Your hypothesis must be justified by aetiology and pathophysiology relevant to Mr Jackson’s presentation.
  2. Name one other chronic disease that explains Mr Jackson’s symptoms. Justify what further data, such as diagnostic tests and/or further history, which would enable a clinician to discriminate between these two diseases.
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