Week 12 Case Study III 

 

Use APA 6th Edition Format and support your work with at least 3 peer-reviewed references within 5 years of publication. Remember that you need a cover page and a reference page. All paragraphs need to be cited properly. Please use headers.  All responses must be in a narrative format and each paragraph must have at least 4 sentences. Lastly, you must have at least 2 pages of content, no greater than 4 pages, excluding cover page and reference page.

 Due 11/25/2019 by 12 Midnight. If submitted after 11/27/2019,

.

Case Study #3: Insomnia and Sleep Disorders 

S.H., age 47, reports difficulty falling asleep and staying asleep. These problems have been ongoing for many years, but she has never mentioned them to her health care provider. She has generally “lived with it” and selftreated the problem with OTC Tylenol PM. Currently, she is also experiencing perimenopausal symptoms of night sweats and mood swings. Current medical problems include hypertension controlled with medications. Past medical history includes childhood illnesses of measles, chickenpox, and mumps. Family history is positive for diabetes on the maternal side and hypertension on the paternal side. Her only medication is an angiotensinconverting enzyme inhibitor and diuretic combination for hypertension control. She generally does not like taking medication and does not take any other OTC products.

Diagnosis: Insomnia

1. List specific goals of therapy for S.H.

2. What drug therapy would you prescribe? Why?

3. What are the parameters for monitoring the success of the therapy?

4. Discuss specific patient education based on the prescribed therapy

5. List one or two adverse reactions for the selected agent that would cause you to change therapy.

6. What would be the choice for second-line therapy?

7. What OTC and/or alternative medicines might be appropriate for this patient?

8. What dietary and lifestyle changes might you recommend?

9. Describe one or two drug–drug or drug–food interactions for the selected agent.

 

"Looking for a Similar Assignment? Get Expert Help at an Amazing Discount!"

See attached files

 

"Looking for a Similar Assignment? Get Expert Help at an Amazing Discount!"

Assignment Details

Case Study: Prescribed Drugs with CAMs

A 35-year-old male, Mr. NX, presents to your clinic today with complaints of back pain and “just not feeling good.” Regarding his back, he states that his back pain is a chronic condition that he has suffered with for about the last 10 years. He has not suffered any specific injury to his back. He denies weakness of the lower extremities, denies bowel or bladder changes or dysfunction, and denies radiation of pain to the lower extremities and no numbness or tingling of the lower extremities. He describes the pain as a constant dull ache and tightness across the low back.

He states he started a workout program about 3 weeks ago. He states he is working out with a friend who is a body builder. He states his friend suggested taking Creatine to help build muscle and Coenzyme Q10 as an antioxidant so he started those medications at the same time he began working out. He states he also takes Kava Kava for his anxiety and garlic to help lower his blood pressure.

His historical diagnoses, currently under control, are:

Type II diabetes since age 27

High blood pressure

Recurrent DVTs

His prescribed medications include:

Glyburide 3 mg daily with breakfast

Lisinopril 20 mg daily

Coumadin 5 mg daily

Directions:

1. Present this Assignment as a PowerPoint presentation with at least 10 slides 
2. Be sure to complete the assignment as the NP treating this family, not as a third party.  
3. You will use the Narrative notes section of the presentation to include the majority of your evidentiary support of your treatment choices and education of family complete with in-text citations using APA formatting, remember if you use photos from outside sources, they must be cited below within the Power Point.  

Due by Day 7 at 11:59 p.m. ET

Assignment Requirements:

Before finalizing your work, you should:

• be sure to read the Assignment description carefully (as displayed above);
• consult the Grading Rubric (under Course Resources) to make sure you have included everything necessary; and
• utilize spellingand grammar check to minimize errors.

Your writing Assignment should:

• follow the conventions of Standard English(correct grammar, punctuation, etc.);
• be well ordered, logical, and unified, as well as original and insightful;
• display superior content, organization, style, and mechanics; and
• use APA 6th edition format

 

"Looking for a Similar Assignment? Get Expert Help at an Amazing Discount!"

 Inflammatory Bowel Disease 

Case Study 

The patient is an 11-year-old girl who has been complaining of intermittent right lower quadrant pain and diarrhea for the past year. She is small for her age. Her physical examination indicates some mild right lower quadrant tenderness and fullness. 

Studies Results 

Hemoglobin (Hgb), 8.6 g/dL (normal: >12 g/dL) 

Hematocrit (Hct), 28% (normal: 31%-43%) 

Vitamin B12 level, 68 pg/mL (normal: 100-700 pg/mL) 

Meckel scan, No evidence of Meckel diverticulum 

D-Xylose absorption, 60 min: 8 mg/dL (normal: >15-20 mg/dL) 

120 min: 6 mg/dL (normal: >20 mg/dL) 

Lactose tolerance, No change in glucose level (normal: >20 mg/dL rise in glucose) 

Small bowel series, Constriction of multiple segments of the small intestine 

 Diagnostic Analysis 

The child’s small bowel series is compatible with Crohn disease of the small intestine. Intestinal absorption is diminished, as indicated by the abnormal D-xylose and lactose tolerance tests. Absorption is so bad that she cannot absorb vitamin B12. As a result, she has vitamin B12 deficiency anemia. She was placed on an aggressive immunosuppressive regimen, and her condition improved significantly. Unfortunately, 2 years later she experienced unremitting obstructive symptoms and required surgery. One year after surgery, her gastrointestinal function was normal, and her anemia had resolved. Her growth status matched her age group. Her absorption tests were normal, as were her B12 levels. Her immunosuppressive drugs were discontinued, and she is doing well. 

Critical Thinking Questions 

1. Why was this patient placed on immunosuppressive therapy? 

2. Why was the Meckel scan ordered for this patient? 

3. What are the clinical differences and treatment options for Ulcerative Colitis and Crohn’s Disease? (always on boards) 

4. What is prognosis for patients with IBD and what are the follow up recommendations for managing disease? 

 Urinary Obstruction 

Case Studies 

The 57-year-old patient noted urinary hesitancy and a decrease in the force of his urinary stream for several months. Both had progressively become worse. His physical examination was essentially negative except for an enlarged prostate, which was bulky and soft. 

Studies Results 

Routine laboratory studies Within normal limits (WNL) 

Intravenous pyelogram (IVP) Mild indentation of the interior aspect of the bladder, indicating an enlarged prostate 

Uroflowmetry with total voided flow of 225 mL 8 mL/sec (normal: >12 mL/sec) 

Cystometry Resting bladder pressure: 35 cm H2O (normal: <40 cm H2O) 

Peak bladder pressure: 50 cm H2O (normal: 40-90 cm H2O) 

Electromyography of the pelvic sphincter muscle Normal resting bladder with a positive tonus limb 

Cystoscopy Benign prostatic hypertrophy (BPH) 

Prostatic acid phosphatase (PAP) 0.5 units/L (normal: 0.11-0.60 units/L) 

Prostate specific antigen (PSA) 1.0 ng/mL (normal: <4 ng/mL) 

Prostate ultrasound Diffusely enlarged prostate; no localized tumor 

 Diagnostic Analysis 

Because of the patient’s symptoms, bladder outlet obstruction was highly suspected. Physical examination indicated an enlarged prostate. IVP studies corroborated that finding. The reduced urine flow rate indicated an obstruction distal to the urinary bladder. Because the patient was found to have a normal total voided volume, one could not say that the reduced flow rate was the result of an inadequately distended bladder. Rather, the bladder was appropriately distended, yet the flow rate was decreased. This indicated outlet obstruction. The cystogram indicated that the bladder was capable of mounting an effective pressure and was not an atonic bladder compatible with neurologic disease. The tonus limb again indicated the bladder was able to contract. The peak bladder pressure of 50 cm H2O was normal, again indicating appropriate muscular function of the bladder. Based on these studies, the patient was diagnosed with a urinary outlet obstruction. The PAP and PSA indicated benign prostatic hypertrophy (BPH). The ultrasound supported that diagnosis. Cystoscopy documented that finding, and the patient was appropriately treated by transurethral resection of the prostate (TURP). This patient did well postoperatively and had no major problems.

 

Critical Thinking Questions 

1. Does BPH predispose this patient to cancer? 

2. Why are patients with BPH at increased risk for urinary tract infections? 

3. What would you expect the patient’s PSA level to be after surgery? 

4. What is the recommended screening guidelines and treatment for BPH? 

5. What are some alternative treatments / natural homeopathic options for treatment? 

Students much review the case study and answer all questions with a scholarly response using APA and include 2 scholarly references. Answer both case studies on the same document.

The answers must be in your own words with reference to journal or book where you found the evidence to your answer.

All answers to case studies must have reference cited in text for each answer and minimum of 2 Scholarly References (Journals, books) (No websites)  per case Study.

 

"Looking for a Similar Assignment? Get Expert Help at an Amazing Discount!"