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 and upload 1 document to Moodle.

Case Studies will be uploaded to Moodle and put through TURN-It-In (anti-Plagiarism program)

 

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CASE STUDY- Must Include 1 Scholarly Reference

You are working as a clinician in a clinic that serves the indigent population. Many of the patients are 50 years of age and older and have chronic congestive heart failure. Your manager asked you for evidence-based resources to identify strategies to reduce frequent hospital readmissions. The hospital use “Cerner” for health information.

-What is your PICO (PICOT, PICOTT) question?

-What strategies will you use to identify evidence-based resources?

-What timeframe for publication will you use?

-Would you use information from websites? Why or why not?

Outline for the paper

Clearly state your PICO question

What strategies will you use to identify evidence-based resources?

What timeframe for publication will you use?

Would you use information from websites? Why or why not?

Title Page
Use of headings
Use a minimum of 1 reference from a scholarly source or peer review NO blogs or Wikipedia

Logical flow, free of grammatical errors, and adherence to directions/ Page limit- not more than 2 pages

No plagiarism

 

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Case Studies  

1- Knee Injury 

A 15-year-old gymnast has noted knee pain that has become progressively worse during the past several months of intensive training for a statewide meet. Her physical examination indicated swelling in and around the left knee. She had some decreased range of motion and a clicking sound on flexion of the knee. The knee was otherwise stable. 

Studies and Results:

Routine laboratory values: Within normal limits (WNL)

Long bone (femur, fibula, and tibia) X-ray: No fracture

Arthrocentesis with synovial fluid analysis

Appearance: Bloody (normal: clear and straw-colored)

Mucin clot: Good (normal: good)

Fibrin clot: Small (normal: none) 

White blood cells (WBCs) <200 WBC/mm3 (normal: <200 WBC/mm3)

Neutrophils <25% (WNL) 

Glucose 100 mg/dL (normal: within 10 mg/dL of serum glucose level)

Magnetic resonance imaging (MRI) of the knee Blood in the joint space. Tear in the posterior aspect of the medial meniscus. No cruciate or other ligament tears

Arthroscopy Tear in posterior aspect of medial meniscus 

Diagnostic Analysis  

The radiographic studies of the long bones eliminated any possibility of fracture. Arthrocentesis indicated a bloody effusion, which was probably a result of trauma. The fibrin clot was further evidence of bleeding within the joint. Arthrography indicated a tear of the medial meniscus of the knee, a common injury for gymnasts. Arthroscopy corroborated that finding. Transarthroscopic medial meniscectomy was performed. Her postoperative course was uneventful. 

Critical Thinking Questions  

1. One of the potential complications of arthroscopy is infection. What signs and symptoms of joint infection would you emphasize in your patient teaching?

2. Why is glucose evaluated in the synovial fluid analysis? 

3. What are special tests used to differentiate type of Tendon tears in the knee ? Explain how they are performed (Always on boards) 

2-Testicular Cancer  

A 21-year-old male noted pain in his right testicle while studying hard for his midterm college examinations. On self-examination, he noted a “grape sized” mass in the right testicle. This finding was corroborated by his healthcare provider. This young man had a history of delayed descent of his right testicle until the age of 1 year old. 

Studies and Results 

Routine laboratory studies: Within normal limits (WNL) 

Ultrasound the testicle: Solid mass, right testicle associated with calcifications 

HCG (human chorionic gonadotropin): 550mIU/mL (normal: <5) 

CT scan of the abdomen: Enlarged retroperitoneal lymph nodes 

CT scan of the chest: Multiple pulmonary nodules 

Diagnostic Analysis 

At semester break, this young man underwent right orchiectomy. Pathology was compatible with embryonal cell carcinoma. CT directed biopsy of the most prominent pulmonary nodule indicated embryonal cell carcinoma, compatible with metastatic testicular carcinoma. During a leave of absence from college, and after banking his sperm, this young man underwent aggressive chemotherapy. Repeat testing 12 weeks after chemotherapy showed complete resolution of the pulmonary nodules and enlarged retroperitoneal lymph nodes. 

Critical Thinking Questions 

1. What impact did an undescended testicle have on this young man’s risk for developing testicular cancer? 

2. What might be the side effects of cytotoxic chemotherapy? 

3. What was the purpose of preserving his sperm before chemotherapy? 

4. Is this young man’s age typical for the development of testicular carcinoma?

 

 

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Assignment:

Complete the following:

• Mexican case study #2
• Puerto Rican case study #2

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MEXICAN CASE STUDY #2
Pablo Gaborra, aged 32, and his wife, Olga,
aged 24, live in a migrant-worker camp on
the eastern shore of Maryland. They have tw
o children: Roberto, aged 7, and Linda, aged
18 months. Olga’s two younger sisters, Floren
cia, aged 16, and Rosa, aged 12, live with
them. Another distant relative, Rodolpho, ag
ed 28, comes and goes several times each
year and seems to have no fixed address.
Pablo and Olga, born in Mexico, have lived
in the United States for 13 years, first
in Texas for 6 years and then in Delaware fo
r 1 year, before moving to the eastern shore
of Maryland 5 years ago. Neither of them have U.S. citizenship, but both children were
born in the United States.
Pablo completed the sixth grade and Olga
the third grade in Mexico. Pablo can
read and write enough English to function at
a satisfactory level. Olga knows a few
English words but sees no reason for l
earning English, even though free classes are
available in the community. Olga
’s sisters have attended school
in the United States and
can speak English with varying degrees of
fluency. Roberto attends school in the local
community but is having great difficulty w
ith his educational endeavors. The family
speaks only Spanish at home. Not much is
known about the distant relative, Rodolpho,
except that he is from Mexico, speaks mi
nimal English, drinks beer heavily, and
occasionally works picking vegetables. The Ga
borra family lives in a trailer on a large
vegetable farm. The house has cold runni
ng water but no hot water, has an indoor
bathroom without a shower or bathtub, a
nd is heated with a wood-burning stove. The
trailer park has an outside shower, wh
ich the family uses in the summer.

The entire family picks asparagus, squash, peppers, cabbage, and spinach at
various times during the year. Olga takes the
infant, Linda, with her to the field, where
her sisters take turns watching the baby a
nd picking vegetables. When the vegetable-
picking season is over, Pablo helps the farmer
to maintain machinery and make repairs on
the property. Their inco
me last year was $30,000.
From the middle of April until the
end of May, the children attend school
sporadically because they are needed to
help pick vegetables. During December and
January, the entire Gaborra family travels to
Texas to visit relatives and friends, taking
them many presents. They return home in early February with numerous pills and herbal
medicines.
Olga was diagnosed with anemia when she had an obscure health problem with
her last pregnancy. Because she frequently
complains of feeling tired and weak, the
farmer gave her the job of handing out “chits”
to the vegetable picker
s so that she did not
have to do the more-strenuous work of picking vegetables.
Pablo has had tuberculosis for years a
nd sporadically takes medication from a
local clinic. When he is not traveling or is t
oo busy picking vegetables to make the trip to
the clinic for refills, he generally takes his medicine. Twice last year, the family had to
take Linda to the local emergency room because she had diarrhea and was listless and
unable to take liquids. The Gaborra family s
ubscribes to the hot and cold theory of
disease and health-prevention maintenance.

Study Questions
1.
Identify three socioeconomic factors
that influence the health of the
Gaborra family.
2.
Name three health-teaching interven
tions the health-care provider might
use to encourage Olga to seek treatment for her anemia.
3.
Identify strategies to help improve
communications in English for the
Gaborra family.
4.
Identify three health-teaching
goals for the Gaborra family.
5.
Name three interventions Olga must
learn regarding fluid balance for the
infant, Linda.
6.
Discuss three preventive maintenanc
e–teaching activities that respect the
Gaborra family’s belief in the hot an
d cold theory of disease management.
7.
Identify strategies for obtaining h
ealth data for the Gaborra family.
8.
Identify four major health problems of
Mexican Americans that affect the
Gaborra family.
9.
If Olga were to see a folk practitioner, which one(s) would she seek?
10.
Explain the concept of familism
as exhibited in this family.
11.       Distinguish       between       the       
two culture-bound syndromes
el ataque
and
susto
.
12.
Discuss culturally conscious health-car
e advice consistent with the health-
belief practices of the pregnant Mexican American woman.
13.
Discuss two interventions to encour
age Mexican American clients with
tuberculosis to keep clinic appointment
s and to comply with the prescribed

medication regimen.
14.
Identify where the majority of Mexican Americans have settled in the
United States.

NAVAJO CASE STUDY
Mr. Begay, aged 78, lives with his wife in
a traditional Navajo hogan. He has lived in
the same area all his life and worked as
a uranium miner until the government closed
the mines. His hogan has neither electricity
nor running water. Heat is provided by a
fire, which is also used for cooking. Lighting
is obtained from propane lanterns. Water
is hauled from a windmill site 20 miles aw
ay and stored in 50-gallon steel drums.
Because the windmill freezes and the roads are
often too muddy to travel in the winter,
sometimes he must travel an additional 10 miles to the trading post to obtain water.
Because Mr. Begay does not own a car, he must depend on transportation from
extended family members who live in the same vicinity.
Mr. Begay has continually experienced
shortness of breath,
and it is getting
worse. He has been hospitalized with pne
umonia several times as a result of the
uranium poisoning. He had a cholecystectomy at
age 62. His diet is traditional and is
supplemented by canned foods, which ar
e obtained at the trading post.
All health care is obtained at the Publ
ic Health Service Hospital in Shiprock.
Neither Mr. Begay nor his wife obtain routin
e preventive-health care. He was admitted
from the clinic to the hospital
with a diagnosis of pneumonia.
Mr. Begay shows clinical improvement after initial intravenous antibiotic
therapy. However, his mental status continue
s to decline. His family feels that he
should see a traditional medicine man a
nd discusses this with his physician. The
physician agrees and allows Mr. Begay to
go to see the medicine man. Several
members of the nursing staff disagree with
the physician’s decision and have requested
a patient-care conference with
the physician. The physician agrees to the conference.

Study Questions
1.    Identify three physical barriers Mr. Be
gay must overcome to obtain health care.
2.    Discuss the benefits of Mr. Bega
y’s seeing the traditional medicine man.
3.    Identify some potential negative outcomes of Mr. Begay’s seeing the traditional
medicine man.
4.
Identify culturally relevant interventions to
reduce the potential for the recurrence of
pneumonia.
5.    Identify at least two majo
r health risks that the Begays
face, based on their current
lifestyle.
6.    Discuss potential outcomes fo
r negotiation during the conference.
7.    Mr. Begay’s diet is described as traditi
onal Navajo. What foods
are included in this
diet?
8.    Because of his continued need for
oxygen, what services do you anticipate for Mr.
Begay when he returns home?
9.    What might the nurse do to encourag
e preventive-health measures for the Begay
family?
10.   Identify at least three types of
traditional Navajo healers.
11.   Identify contextual speech patterns of the Navajo Indians.
12.   Distinguish differences in ge
nder roles among Navajo Indians.
13.   Identify two culturally congruent teac
hing methods for the Navajo client.

14.   Discuss the meaning of the First Laugh Ceremony for the Navajo.
15.   Identify two culturally congruent approach
es for discussing a fatal illness with a
Navajo client.

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PUERTO RICAN CASE STUDY #2
Carmen Medina, aged 39, lives with he
r husband, Raúl, aged 43, who works as a
mechanic in a small auto shop. Mr. Medina has
worked in the same place since he and his
wife came to the United States from Puerto
Rico 15 years ago. The Medinas have a 4-
year-old son, José; a 16-yea
r-old daughter, Rosa; and an
18-year-old son, Miguel. The
Medinas both attended vocational school afte
r completing high school. Mrs. Medina is
employed 4 hours a day at a garden shop. She
stopped working her full-time job to care
for her ill mother and aged father, who
do not speak English and depend on government
assistance. The family income last year was $28,500.
The family has health insurance through
Mr. Medina’s job. They live in a three-
bedroom apartment in a low-income Illinoi
s community. Miguel works in a fast-food
store a few hours a week. Because Rosa has re
sponsibilities at home, the Medina’s do not
allow her to work outside the home. She is
very close to her grandmother but avoids
talking with her parents. Both Rosa and Mi
guel are having difficulties in school. Rosa is
pregnant and the family does not know. She is
planning to drop out of school, get a job in
a beauty shop, and leave home without telli
ng the family. Miguel frequently comes home
late and, on occasion, sleeps out of the home.
He is beginning college next semester and
has plans to move out of
the house during the summer.
The family is having difficulty dealing
with Rosa’s and Miguel’s developmental
and behavioral challenges. Although Mrs. Medi
na is outspoken about these concerns, Mr.
Medina is quiet and not actively involved in
the discussion. He is mo
re preoccupied with
the family’s financial situati
on. Mrs. Medina’s parents are en
couraging them to return to

Puerto Rico.
Mr. Medina was diagnosed with hypertensi
on 2 months ago, when he went to the
emergency room for a respiratory infection. He
smokes cigarettes and drinks two to three
beers every evening after work. He has not
followed up on his blood pressure treatment.
Miguel is beginning to smoke, but not at home.
José has had frequent colds and sinus
allergies. He has been to the emergency
room three times during the past year for
respiratory infections. Mrs. Medina’s last
physical examination was after she had José.
She is experiencing insomnia, tiredness, headach
es, and gastrointestinal problems. She is
very concerned about Rosa and Miguel, her
parents, and the family’s finances. Mrs.
Medina is Catholic and recently has been visiting her church more often.
Study Questions
1.
Explain Mrs. Medina’s attitude in
her relationship with her adolescent
daughter.
2.
Identify strategies to ensure
that Rosa seeks prenatal care.
3.
Identify barriers to accessing heal
th care for the Medina family.
4.
What are the high-risk behaviors exhibited by this family?
5.
What communication barriers
exist in this family that affect care delivery?
6.
Discuss gender and family roles in th
e context of traditional Puerto Rican
culture.
7.
Identify sociodemographic factors af
fecting the physical- and mental-
health well-being for this family.
8.
Identify Puerto Rican folk practices appropriate for this family.

 

 

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Please do case number 2

Septic shock

 

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