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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Required Resources
Read/review the following resources for this activity:

• Textbook: Chapter 28, 29, 30
• Lesson
• Minimum of 1 primary source
• Minimum of 4 scholarly sources (in addition to the textbook)

Optional Resources to Explore
Feel free to review the library guide for scholarly sources and videos at the following link:

• Link (website): History Library Guide (Links to an external site.)

Introduction
The purposes of each case study assignment include the following:

• To hone your abilities to research using scholarly sources
• To advance critical thinking and writing skills
• To compile a response to the prompts provided
• To explore a historical topic and make connections to change over time

Instructions
Pick one (1) of the following topics. Then, address the corresponding questions/prompts for your selected topic. Use at least one (1) documented example of the corresponding primary source in your writing.

Option 1: McCarthyism and Anti-Communist Campaigns
The Cold War brought about an irrational fear of communism and communist activities in the United States. As we are learning this week, one of the most vocal instigators of this paranoia was Senator Joseph McCarthy. McCarthy delivered a speech about the imminent threat of communism on February 9, 1950. Perform a search on the internet and locate and read Joseph McCarthy’s speech given in Wheeling, West Virginia on February 9, 1950. Copy and paste the following keywords into your Google search bar: “Joseph McCarthy, Wheeling, West Virginia.” The speech is also referred to as “Enemies from Within.”

Construct the case study by responding to the following prompts:

• Explain how Senator Joseph McCarthy defined communist nations within the speech. What specific threats did these nations pose?
• Assess if Senator Joseph McCarthy charges were accurate.
• Analyze anti-communist sentiments during the Cold War era, were these sentiments valid. If so, how? If not, why not?
• Explain if there are other examples of events similar to the Red Scare that have occurred throughout history and modern day.
• Examine what happened to people who invoked the Fifth Amendment, refused to appear or were found in violation of the law as defined by the Congressional Committee.

Option 2: The Civil Rights Movement
Using the Internet, locate and read Martin Luther King Jr’s “I Have a Dream” speech given in Washington D.C., August 1963. Copy and paste the following keywords into your Google search bar: “I Have a Dream by Martin Luther King, Jr.” Feel free also to locate and incorporate additional scholarly sources to respond to this case study, including information on the Civil Rights Movement.

Construct the case study by responding to the following prompts:

• Explain if the Civil Rights Movement of the 1960s effectively changed the nation.
• What effect would the Civil Rights Acts have across the continent on minority groups?
• Do you think that the tactics and strategies that civil rights activists used in the 1960s would apply to today’s racial and ethnic conflicts? Why or why not?
• Do the ideas of the 1960s still have relevance today? If so how? If not, why not?
• Analyze how the Civil Rights Movement would impact diversity in America today.

Option 3: American Domestic and Foreign Policies (1953-1991)
Complete a search either in the Chamberlain Library or internet for domestic and foreign polices of four (4) of the following Presidents. Please incorporate at least one primary source of either a policy or act that you have chosen to write about.

• Eisenhower
• Kennedy
• Johnson
• Nixon
• Ford
• Carter
• Reagan

Then, compare domestic and foreign polices of your four (4) presidents by answering the following prompts:

• Explain how your selected presidents worked to improve the United States economically and socially. Give at least one example of each president.
• Assess if the policies of your choice of presidents strengthen or weaken the United States.
• Explain how you see your choice of presidents served the public interest and further the cause of democracy.
• Determine if it is constitutional for the United States to fight preemptive wars.
• Determine if human rights and morality should be the cornerstones of United State foreign policy.

Writing Requirements (APA format)

• Length: 4-5 pages (not including title page and references page)
• 1-inch margins
• Double spaced
• 12-point Times New Roman font
• Title page
• References page
• In-text citations that correspond with your end reference

references: .S. history. OpenStax CNX. Retrieved from https://cnx.org/contents/[email protected]:[email protected]/IntroductionLinks to an external site.

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Create your APA formatted essay-style submission, with references, be sure to cite your sources and check your spelling.

Assignment:

Complete the following:

• German case study
• Irish case study

GERMAN CASE STUDY  
Margaret Schmidt, a terminally ill 60-year-old American of German descent, was
recently admitted to a hospice service and is
receiving care at home. Diagnosed with
metastatic breast cancer, Margaret’s prognosis
is less than 6 months. Margaret’s cancer
has metastasized to her ribs and liver and
often causes intense pa
in. Although Margaret
speaks freely of her impending death, her family
has expressed their discomfort at her
decision to secure hospice care.
Over the last 10 years, Margaret, a nurs
e, has practiced homeopathy (for herself
and others) and consults frequently with a
medical intuitionist. She follows the medical
intuitionist’s recommendations to attenuate
her symptoms but avoids, when she can, the
traditional cancer pain
–management therapies.
Medical staff and her family have entere
d into continuous discussions with her
about her lack of acceptance of traditiona
l medical approaches. Margaret remains
unconvinced of their value within her scheme
of care. Margaret main
tains a strong belief
in an afterlife, believing that
she will be reunited with
her husband. Margaret meditates
daily, calling upon her spiritual guides and angels for strength and peace in the dying
process. She often asks those around
her to join her during this time.
Study Questions
1.
What experiences have you had with patients of German descent?
2.
How does Margaret’s German ancest
ry mold her beliefs about medical
treatment?

3.
What Western medicine concepts
complicate the staff and family’s
understanding of Margaret’s self
-prescribed medical regimen?
4.
How do you, as a health-care prof
essional, feel about the use of
homeopathic remedies?
5.
What is your view of the use of
medical intuitionists and other non-
Western health practices?
6.
How do Margaret’s health-care c
hoices differ or match your own?
7.
How do you deal with cultural health practices unlike your own?
8.
Discuss Margaret’s desire to contro
l her life even through terminal illness.
9.
Relate Margaret’s strong spiritual beli
efs in an afterlife to her ability to
cope with her impending death.
10.
Describe a plan of care that is cultu
rally sensitive to the patient and her
family.
11.
How can your knowledge of the German American culture positively
influence health outcomes for Margaret?
12.
Discuss the cultural filters you may
use as you assist Margaret in her
health-care decisions.
13.
Describe the enculturation you, as
a health-care professional, have
experienced and how this influences
your own health-care decisions.

RISH CASE STUDY  
The O’Rourke family lives on a small farm in Iowa and comprises David, aged 30; his
wife, Mary, aged 29; and two children: Bridge
t, aged 7, and Michael, aged 6. Both David
and Mary are second-generation Irish. Before
purchasing their farm 5 years ago, David
sold farm equipment in Ohio. The O’R
ourkes are Catholic; Mary converted to
Catholicism when they married.
David, who works long hours outdoors, is
concerned about profitability from
his corn crop because of the unpredictable size of the harvest, and thus, his income
varies depending on the weather. Mary di
d not work outside the home because she
wanted to be with their children until they started school. However, because both
children are now school age, Mary has discus
sed with David the possibility of working
part time to supplement the family income. He
would prefer that she stay at home, but
Mary is anxious to return to the wo
rkforce and believes the timing is right.
Both David and Mary are happy with ju
st two children and do not desire more.
They use the rhythm method for family planning.
Eating a healthy breakfast is important
to the O’Rourkes. Because eggs are
readily available on the farm, they have frie
d eggs with potato bread and juice at least
four times a week. Their main meal in the
evening usually includes meat, potatoes, and
a vegetable. David enjoys a
glass of beer with dinner.
David has been a little edgy lately becau
se of his concerns about the corn crop.
He admits to having some minor chest pain, wh
ich he attributes to indigestion. His last
visit to a physician was before their marri
age. Mary knows David is concerned about
finances and believes it would help if she had a job.

Bridget and Michael spend
a lot of time outside playing and doing some minor
chores for their parents. Both children
enjoy school and are looking forward to
returning in the fall. Bridget is starting to
show concern over her appearance. She does
not like her red hair and all the freckles on he
r face. Her teacher has noted that Bridget
has trouble reading and may need glasses.
Michael wants to be a farmer like his Dad
but worries about his Da
d being tired at night.
The O’Rourkes have not taken a vacati
on since they were married. They go to
the state fair in the summer, which is the extent of their trips away from home. They
are active in the church and
attend services every Sunday.
Study Questions
1.    Describe the O’Rourke family st
ructure in terms of individual roles.
2.    Identify two potential health problems re
lated to the O’Rourke
’s dietary practices.
3.    Identify potential health-risk
factors for the O’Rourkes as a family unit and for each
family member.
4.    Explain the relationship be
tween risk factors a
nd ethnicity specific
to the O’Rourke
family and their Irish heritage.
5.
Describe culturally competent health-promotion strategies for the identified risk
factors for the O’Rourke family.
6.    Describe the O’Rourke family’s fertility
practices. Are they congruent with their
Irish background and religious beliefs?
7.
Describe the O’Rourke fam
ily’s communication patterns. 

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8.
  What are the predominant health
conditions among Irish immigrants?
9.    Explain the significance of the Great
Potato Famine for Irish Americans.
10.   Name two genetic diseases common among Irish Americans.
11.
Identify accepted fertility practices
for Irish American Catholics.
12.   Identify three sources of strength for
the Irish American in times of illness.
13.   Identify traditional home remedies commonly used by Irish Americans.

ITALIAN CASE STUDY #1
Rosa and Mario Gianquito live on the ground fl
oor of a three-family house in Brooklyn,
New York. Although they completed only gram
mar school in Italy, they speak English
and have little difficulty understanding mo
st verbal communication. They have a
daughter, Lucia, aged 25, and a son, An
thony, aged 28, who were born in this
neighborhood but now live in Manhattan. Both
children speak fluent Italian. Anthony is
an attorney and does not visit with his si
ster very often. Luci
a is a grammar school
teacher, married to an Italian man, Guido
Venetto, who recently immigrated from
southern Italy and is 10 years older than Lu
cia. Guido speaks mostly Italian at home but
does speak broken English. In addition to sm
oking two packs of cigarettes a day, Guido
is emotionally abusive to Lucia. He is ve
ry jealous and does not want Lucia to go out
after work with her friends or
to spend much time visiting with her parents. Lucia has
allergies, and the last time she visited the docto
r, he told her that her blood pressure was
elevated. She has noticed lately that, after st
anding all day at work, she often has swollen
ankles and leg pain.
Lucia’s husband works 12 hours a day as a construction worker and expects her
to cook Old-Country–style Italian food, which re
quires that she use a great deal of salt.
She is often depressed and feel
s isolated and powerless. She has been trying to have a
baby for 3 years.
Rosa comes to visit her daughter wh
en she can. She often brings homemade
manicotti or tortellini when she comes. She
is very concerned about Guido’s behavior
toward her daughter but does not feel that
she can challenge Guido because he is the
capo di famiglia
. Rosa is concerned about Lucia’s
swollen feet and suggests that she

drink red wine and eat more garlic and dandeli
ons. She tells Lucia to pray to the Virgin
Mary to ask for help in conceiving a ch
ild and to make Guido treat her better.
Lucia and Guido attend the neighborhood Catholic Church on Sunday. Lucia
always wears the
cornicelli
around her neck that her mother gave her to protect her
from
il mal occhio
. Lucia says her faith and her fa
mily help her cope with life
challenges with
pazienza
.
Study Questions
1.    Identify three problems and a
related plan of care for Lucia.
2.
  Identify two health-teaching goals for this family that are congruent with family
order and rituals.
3.
  Identify three socioeconomic factors that in
fluence the health of the Venetto family.
4.
How might the health-care provider involve
Lucia in a mutual-planning process for
her holistic health-care needs,
including mind, body, and spirit?
5.    Knowing that many first-generation Italia
ns generally mistrust health-care providers,
how would you encourage Lucia to enga
ge in health-promotion behaviors?
6.    Discuss at least two preventive health
maintenance–teaching activities that respect
the folk practices used to treat illness in this family.
7.    Define the Italian’s unique relationship w
ith food and discuss implications this could
have on the health of the Venetto family, particularly Lucia.
8.
Discuss the status and role of elderl
y Italians in the extended family.  

9.     Identify two practices common among Ital
ian women that might affect conception
and pregnancy.
10.   Name two dietary health-car
e risks and two dietary health
-care assets for Italians.
11.   What are some of the primary religious
practices and use of prayer for Italian
people?
12.   Define the terms
capo di famiglia
,
il mal occhio
, and
pazienza
.

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1.  Pick one of the grand nursing theories from chapters 7-9 (except Henderson or Peplau)

2.          Obtain an original work of the theorist (i.e., primary source).  You may not be able to so get a source that exemplifies the theory. Do not use your textbook. Provide the reference in your post.

3.          Read the following case study and think about how your theorist would interpret the assessment information provided and intervene. All of this should be consistent with the grand nursing theory you choose.

Address the following items.

1. State which theory you are using In your initial post. Try to be the theorist and see the case from the theory.  For example if you were Roy  you will write about maintaining infection control for the baby in the NICU since her theory is on adaptation to the environm 

3. Write a nursing diagnosis (see PP in lecture)

4.  Write one intervention for the diagnosis that could be applied to the family in the case study. You may choose either the mother, the infant, or the family as your focus.  THE 

INTERVENTION MUST BE CONGRUENT WITH THE THEORY. 

200-270 words

PLEASE DO NOT CHOOSE A CULTURE THEORY. 

Here are some suggestions for concepts to discuss within your theory – depression, post partum. guilt, stress,  family,  premature,transitions, adaptation. 

Case Study

Mrs. Bedlam gave birth to a premature boy baby 3 weeks ago. The baby is still in the NICU at the major medical center 45 miles away. Mrs. Bedlam has only been able to visit once a week when her husband has a day off and can watch their other children, all girls, ages 1, 3, 4, and 6.

The Bedlam family moved from Saudi Arabia 2 years ago. Prior to this pregnancy, Mrs. Bedlam was taking Prozac for depression. She states she feels so guilty because she can’t come to see the baby more often and can’t breast feed him as her culture demands.

Baby Boy Bedlam has necrotizing entercolitis and at least one intracranial bleed. He now weighs 1800 grams. His ventilator is set to deliver 85% oxygen.

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