Dialogue #1
Analysis, Symptom and Sickness Administration
MSN5600
Case #1
• M.R. is a 28-year-old female patient in good well being that visits the clinic for the primary time. She not too long ago moved to Florida
from New York because of work relocation. She admits not visiting her PCP ceaselessly however requires medical clearance for her
new clerical place. She is sexually lively, unprotected, in a monogamous relationship. ROS and bodily examination are
unremarkable. What to do? She says she does not see her physician fairly often, however she wants medical clearance for her
new job within the workplace. She is sexually lively, has no safety, and is in a relationship with just one particular person. ROS and the bodily examination are each
unremarkable. Learn how to act?
case #1
• Is there a type to fill? sure or not. If sure, what are the necessities?
• Laboratory work-up:
ØRoutine: CBC w/ differential; CMP; U/A
ØTitters?
• Is a 12-Lead EKG required?
• Is a CXR vital?
• Would you do HCG?
• What about different suggestions for screening? Which sort of stage of care is this?
—>
case #2
• A 58-year-old male patient with historical past of HTN and T2DM presents to the clinic for a common examine up. He denies present
symptomatology and his final examine up was 2 years in the past. Along with a thorough bodily examination. Which laboratory check would
count on to be ordered? (Choose all that apply)
qCBC, BMP, U/A
qCBC, CMP, U/A
qLipid profile
qCardiac enzymes
qHgbA1c
qTSH
qCXR
case #2
• The patient’s anti-HTN remedy consists of Lisinopril 10 mg PO each day and Amlodipine 5 mg PO each day. Are there any findings
bodily or laboratory anticipated from this drugs?
case #2
• You’d have a look at the degrees of Magnesium and Phosphorus for the alternative of Potassium if relevant. Which of the
following checks would come with these two electrolytes?
ØBMP
ØCMP
ØLiver profile
ØLipid profile
—>
M.R is a 68-year-old female, who was admitted to the hospital with…
M.R is a 68-year-old female, who was admitted to the hospital with loss of appetite and fatigue and was evaluated to rule out gastrointestinal (GI) bleeding. She states that her stools have been darker than they normally are. patient has a medical history of OA, DM, & HTN. She has no known drug allergies (NKDA) and is a full code. patient says she don’t have the energy to do anything anymore. and don’t know what’s wrong with her.
Vitals on admission:
Temp: 98.7 degree oral
HR: 110
RR: 26, labored
BP: 106/52
SpO2: 91% on room air
Abnormal blood work:
RBCs: 3.8 cells/mm3
Hgb: 8.6 g/Dl
Hct: 34%
Glucose: 210 mg/dL
During the assessment, M.R. says, she is worried about that test tomorrow. I just know they’re going to find cancer. My father died of stomach cancer, and it was horrible!” She denies being in pain but states she is “Very tired”
The patient states she takes regular aspirin every day. She says, “I saw on TV that it’s suppose to prevent heart attacks.”
She is schedule for an esophagogastroduodenoscopy (EGD) tomorrow.
PHYSICIAN ORDERS
Sliding scale insulin for Humilin R SQ PRN
Less than 150 mg/Dl No insulin needed
150-200 mg/dl 4 units
200-249 mg/dl 6 units
250-299 mg/dl 8 units
300 mg/dl or higher Call provider
IV 1000 mL D5 0.45% normal saline (NS) at 50 mL/hr
Midazolam 2.5 mg IV PRN for EGD
Vital signs q 4 hr
2 to 4 L O2 via NC; titrate to keep SpO2 >92%
Clear liquids; NPO after midnight
EGD in AM
AC/HS BG checks
Bedrest with bathroom privileges
CBC q AM
Stools x3 for occult blood
CASE STUDY QUESTIONS
Explain the relationship between M.R.’s abnormal lab results and her vital signs. Provide possible explanations for the abnormal results.
List at least 3 focused assessments for M.R. before her EGD
What can the RN do to address her fear statement?
What does the RN need to ask M.R. about her medications?
What nursing interventions would you perform for M.R. during her hospital stay?
What patient education does M.R. require currently?
This is a scenario of a patient visiting a clinic for the first time and requiring medical clearance for her new job. The patient is a 28-year-old female in good health, but has not visited her primary care physician regularly. She is sexually active and in a monogamous relationship. The physical examination and review of symptoms are unremarkable.
—>
Writing Guide:
In this case, the physician would likely fill out a form for medical clearance and order some routine laboratory tests, such as a Complete Blood Count (CBC) with differential, a Comprehensive Metabolic Panel (CMP), and a urine analysis (U/A). A 12-Lead EKG and CXR are not typically required for this type of visit. A human chorionic gonadotropin (HCG) test may be ordered if the patient is pregnant or has a reason to suspect pregnancy. Additional screening or recommendations may depend on the patient’s individual risk factors and medical history.
In the second case, a 58-year-old male patient with a history of hypertension (HTN) and type 2 diabetes (T2DM) presents for a general check-up. The physician would likely order laboratory tests such as a CBC, CMP, and U/A, a lipid profile, and HgbA1c. TSH and CXR may also be ordered. The patient’s medication regimen of Lisinopril and Amlodipine may be expected to have some physical or laboratory findings. The physician would check the levels of magnesium and phosphorus as part of electrolyte replacement if necessary, which would be included in a Basic Metabolic Panel (BMP) or CMP.
In the third case, a 68-year-old female patient was admitted to the hospital with symptoms of loss of appetite, fatigue, and darker stools, which may indicate gastrointestinal (GI) bleeding. The patient has a history of Osteoarthritis (OA), diabetes, and hypertension. The abnormal blood work shows low red blood cell count, hemoglobin, and hematocrit levels, and high glucose levels. The patient is concerned about the possibility of stomach cancer, as her father died from it. She is schedule for an esophagogastroduodenoscopy (EGD) and the physician orders sliding scale insulin, IV fluids, and medication for sedation during the procedure, as well as monitoring of vital signs and oxygen therapy.
