Case Study for NP Program
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Session5CaseStudy1.docx
Session 5 Case Study 1
An 82-year-old woman with mild dementia is hospitalized in the intensive care unit (ICU) for urosepsis and treated with intravenous antibiotics. On hospital day 3, despite improvement of her sepsis, she becomes acutely confused. Her other medications include opioids for pain and diphenhydramine for insomnia. On physical examination, she is alert and can remember her name but has poor attention and believes that she is in a grocery store and that the year is 1952. Her neurologic examination findings are otherwise normal. She appears agitated and has been aggressive with the nursing staff. On subsequent examination later in the day, her symptoms are significantly better.
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History o What are your top 3 questions for this patient? o Pertinent to Case Study Scenario o Questions are focused-leading to your top 3 differentials o What are some questions you would ask related to the clinical presentation? Why? o What history data should you collect from this pt in order to narrow your diff? Why?
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Physical Examination o What physical examination findings would CONFIRM or RULE OUT your diagnosis? List 3 with your explanation as to how you confirmed or ruled out your differentials o What POS/NEG. Physical Examination data would you find? o Include ALL systems needed to complete your assessment of your patient o Pertinent positive & negatives emphasized
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Screening and Diagnostic Testing What tests would you order today to confirm or narrow your suspected diff dx, & why? “What are you looking for…?”
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Differential Diagnosis with Rationale Formulating the 3 Most Likely Differential Diagnosis with Rationale o #1-being the most likely diagnosis o What are some probable causes of the presenting symptoms? Include physical, environment, organisms, lifestyle, etc.
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Health Maintenance o Appropriate to age, gender, and risk factors o Health maintenance recommendations/precautions you would consider for this patient?
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Evidence-Based Plan of Care o Specific treatment options are defined including EBP guidelines o Accurate first-line pharmacotherapy, drug, dose o What are some non-pharmacological treatment options that you would recommend o What is your follow-up plan? Education specific? At what point is a referral indicated? o On the follow-up visit, what alarming symptoms would prompt you to refer o What would your diff. be for a 20-yr-old female with the same presenting symptoms? o What would your diff. be for a 3-yr-old female with the same presenting symptoms? o In considering her developmental stage and family issues, what are some relevant issues that you would address in your plan of care for this patient? o Further assessment, referrals, medications, and treatment are delineated, as appropriate.
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