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,

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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.

 

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 Pediatric: Undescended Testes Case Study. Please follow instruction and respond each part, be clear and specific. Apa format and low similarity. My condition that I choose is undescended testicle

Instruction: 

1. Your chosen disease/condition
2. Population most affected (ex: Older Adults, Middle Adults, Young Adults, Teenagers, Child, Infants)
3. Age related milestone for your chosen population
4. Socio-Demographic/Risk factors for getting the disease/condition
5. Impact on QOL
6. Current/new/recent research/EBP that will benefit/support this patient with the specific disease (If there are none please state so)
7. Recommendation for treatment or Gold standards for treatment if any (can be tied into the current research as above) (If there are no gold standards then please state so, but there should be some recommendations)
8. Please tell what/how you (speak in the first person) as the FNP caring for this patient with this specific disease can make a difference in his/her care and incorporate patient care/self-help teaching that can help him/her minimize disease symptoms.
9. Red flags for this condition (what specific S/S require urgent/ER care) or when should you refer patient to specialist.

Again, please follow the directions of what I am looking for and keep it to the point, as simple/concise as possible.

Points will be taken of for incorrect grammar and incorrect APA format/citations.

 

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Read case study and make 10 PowerPoints 

 

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amily nurse practitioner

You need to answer the questions brief and right to the point

Disease:  Prostatitis

1. Population most affected (ex: Older Adults, Middle Adults, Young Adults, Teenagers, Child, Infants)

2. Age related milestone for your chosen population

3. Socio-Demographic/Risk factors for getting the disease/condition

4. Impact on Quality Of Life

5. Current/new/recent research/Evidence Base Practice that will benefit/support this patient with the specific disease (If there are none please state so)

6. Recommendation for treatment or Gold standards for treatment if any (can be tied into the current research as above) (If there are no gold standards then please state so, but there should be some recommendations)

7. Please tell what/how you (speak in the first person) as the FNP caring for this patient with this specific disease can make a difference in his/her care and incorporate patient care/self-help teaching that can help him/her minimize disease symptoms.

8. Red flags for this condition (what specific Sign/Symptoms require urgent/ER care) or when should you refer patient to specialist.

 

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 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.

 

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