Case Study 3:

Mrs Lee, 44 years old, had returned from an emergency Lower Segment Cesarean Section (LSCS) four hours ago. This is her third pregnancy, and she was diagnosed with pre-eclampsia. At 0630 hr, her Blood pressure: 78/45mmHg, Heart rate: 124 beats/min, Respiration rate: 30 breath/min. She appears cold and clammy.

Upon inspection, petechiae was present on both her lower limbs, her bedsheet was soaked with blood, and her in-dwelling catheter showed haematuria. Her dressing site (LSCS) was spotting with blood.

Her obstetrician was informed and had ordered the following test: FBC, RP, PT/PTT, INR and GXM. After a period of extensive resuscitation, the patient underwent a hysterectomy.

The Probable Diagnosis is: DIC

Guideline:

INSTRUCTIONS:
Based on the case scenario,
(a) Identify the probable diagnosis/diagnoses of the patient based on the patient’s symptoms and the doctor’s order.
(b) Outline the pathophysiology of the disease condition.
(c) Describe the risk factors and clinical manifestations.
(d) List the diagnostic tests and/or assessments and the relevance to disease conditions.
(e) Discuss the medical and/or surgical management related to the case scenario.
(d) Identify the reason/ reasons for ordering the drugs (indication) for the patient in relation to the disease.
(f) Explain three (3) nursing considerations related to the medications that might be prescribed for the patient.
(g) Create three (3) nursing care plans related to the case scenarios, with three (3) interventions and rationales.
(h) Explain at least three (3) health education points for pharmacological treatment OR general discharge planning related to disease conditions.

Case Study 1:

Melissa, 37 years old, is a part-time hairdresser. Seven months ago, she began noticing stiffness in both hands in the morning that lasted longer and longer. Stiffness now lasted more than an hour every morning and extended to hands, wrists and ankles. She also had increasing difficulty standing for long periods due to foot and ankle pain. She began taking Ibuprofen 800mg 3 times daily and found it helped her get through her day with less pain and stiffness. Three months ago, she noticed pain in both her shoulders when she would cut or blow dry her client’s hair. She also began feeling extremely tired and short tempered. She had no energy to do her usual activities. Ultimately, Ibuprofen was no longer very effective for her pain or stiffness.

One morning, Melissa could not lift her arms at all without extreme shoulder pain. She saw a doctor at the polyclinic, who examined her and ran a few preliminary blood tests. The blood tests revealed positive rheumatoid factor and CCP antibodies, elevated ESR and C-reactive protein. She was informed of these results and her doctor referred her to a Rheumatologist for further evaluation.

Case Study 2:

Maureen, 48 years old, presented to the doctor with two days of itching and burning sensation on the left side of her chest. Maureen works as a childcare teaching assistant, and there has been an outbreak of chickenpox among the students. She had recently recovered from an episode of severe exacerbation of asthma, in which she was treated with high doses of hydrocortisone, MDI Ventolin and Pulmicort.

Physical examination of the skin showed clusters of confluent vesicles on the left side of the patient’s chest and on her back and side along the sixth intercostal space without crossing the midline. There was tenderness upon palpation, with increased itching and burning sensation. A preliminary  PCR swab and antibody blood test returned positive. She was discharged with oral medications and an extended period of hospitalization leave.

Case Study 3:

Chloe,  16 years old, presented with a slowly-enlarging painless mass in her front neck. This mass had grown over a three-year period. This mass initially was egg-sized, symmetrical in both sides of the upper throat, but no swallowing difficulties, and no voice change. She was also complaining lack of concentration and attentiveness. She reports an increasing appetite, but her weight has been dropping. She was still able to do her normal activities such as go to school and others, but she tends to easily get tired when doing excessive exercise. Her developmental milestones and physical assessment have been unremarkable.

Her vital signs were within normal limits. No exophthalmos was found. Her thyroid gland was palpable, enlarged with a size of 8x5x2cm, mobile, not tender, warm and moist. No lymph node enlargement was found. The admission of thyroid function tests showed low levels of TSH and high T3 and Free T4 levels. Electrocardiography shows sinus tachycardia. 

Case Study 4:

Gary, 17 years old, was transported to the emergency department after being involved in a road traffic accident. He was a pillion rider on his friend’s bicycle, when they were hit by a truck. Both teenagers were drunk, and were not wearing protective gear. Gary was thrown a distance away and his back hit a street light on landing. Upon paramedic’s arrival, his GCS score was 4, immediate interventions were applied and he was rushed to the hospital. Head CT was unremarkable but Spinal CT scan revealed fractures at T10-L5. Gary was unable to move his lower body and had no sensation in his lower limbs.  Two months later, Gary was scheduled to be transferred to a community hospital.

Case Study 5:

Chester, 70 years old, has been complaining of mild eye burning feeling and blurry vision  after reading for long periods of time, especially in the afternoons. He reported seeing halos around lights, and is no longer confident driving at night. He denies any pain and redness in both eyes, and has no other problems with his movement around the house or neighborhood. He uses over-the-counter readers for close work. He has a history of hypertension and is on PO Amlodipine 10mg. He lives alone in a two bedroom apartment, and does volunteer work at the community library during the weekdays. Both his parents had undergone cataract surgery.