Medical Case Studies: Analyzing Symptoms and Interventions

Task:

Instructions: Please choose 1 of the following case studies to base your concept analysis paper.

1. Mr. Luke is a 58-year-old man who is currently a client on an outpatient rehabilitation unit following a left total knee replacement five days ago. This afternoon during physical therapy he complained that his left leg was very painful when walking. His left leg was noted to be swollen so he was sent to the emergency department to be examined. He has a history of smoking one pack per day.  Mr. Luke’s vital signs are:

a. Temp: 98.1⁰F

b. BP: 110/50

c. HR: 65

d. RR: 19

e. O₂ Sats: 98% on room air

f. D-dimer: 7mcg/mL

i. Left calf circumference is ¾ inch larger than right calf

ii. Left calf is warm to the touch

2. Mrs. Kidway is a 71-year-old woman who lives at home with her daughter’s family. Her daily medications prior to admission include digoxin 0.125 mg once a day.  She has a history of congestive heart failure, pneumonia, chronic obstructive pulmonary disease, and gastroesophageal reflux disease. Mrs. Kidway arrives in the emergency room with her daughter who explains, “She was fine this morning but this afternoon she developed terrible abdominal pain and got short of breath.” Mrs. Kidwell is lethargic. Her physical exam is unremarkable except for facial grimacing when palpating her abdomen. She is afebrile. Vital signs are:

a. BP: 105/50

b. HR: 60

c. RR: 18

d. Digoxin level 3.8mcg/mL

e. K⁺: 2.1 mEq/L

3. Mrs. Anderson, a 70-year-old presented complaining of weakness, fatigue, and an unexplained weight loss. Mrs. Anderson has a history of small bowel obstruction with resection and diverticulitis.  A complete blood count was performed. The results include:

a. RBC: 3.20 million/mm³

b. MCV: 130 mcg

c. Reticulocytes: 0.4%

d. Hct: 25%

e. Hgb: 7.9 g/dL

The provider also ordered a Shilling test and started the patient on vitamins B₁₂ injections.

4. Mrs. Darsana was sitting at a family cookout at approximately 2 p.m. when she experienced what she described as “nausea with some heartburn”. Assuming it was due to something she ate, she took Tums. After about 2 hours, she explained “My heartburn was not better and it was now more of a dull pain that seemed to spread to my shoulders. I also noticed that I was short of breath”. Mrs. Darsana told her son, who summoned emergency medical services.  She has a history of hypertension.

En route to the hospital, emergency medical personnel established IV access, gave 4 chewable baby aspirin and 3 sublingual nitroglycerin tablets without relief of chest pain. She was placed on oxygen at 2 liters via nasal cannula. Upon arrival to the emergency department, Mrs. Darsana was very restless and stated “it feels like an elephant is sitting on my chest”. Vital signs were:

a. Temp: 99.3⁰F

b. BP: 160/84

c. HR: 118

d. RR: 28

e. O₂ sats: 98% on 2L/NC

EKG showed sinus tachycardia with HR is 120 beats per minute. An occasional premature ventricular contraction, T wave inversion, and ST segment elevation were noted. Chest x-ray was WNL without signs of pulmonary edema. Lab values:

a. K⁺: 4.0mEq/L

b. Mg: 1.9 mg/dL

c. CK: 157 mcg/L

d. CK-MB: 7.6 ng/mL

e. Relative index: 4.8%

f. Troponin I: 2.8 ng/mL

g. Stool: negative for occult blood

5. Kiley Hastings, age 5 monts, spent a 3-day weekend with a babysitter when her parents went camping. Her parents returned to find Kiley very weak. The babysitter said, “I used up the disposable diapers; she has had diarrhea since you left. During the last 12 hours, I used at least eight diapers, and she filled them with watery poop.” Kiley’s parents called the pediatrician, who told them to take Kiley to the emergency department. The exam revealed Kiley to be lethargic, depressed anterior fontanel, sunken eyes, capillary refill delayed, peripheral pulses weak, skin mottled and cool to touch. Vital signs:

a. Temp: 98.9⁰F

b. HR: 176

c. BP: 90/58

d. RR: 56