Case Study 1: Congestive Heart Failure
Patient Background
Mr. John Smith, a 68-year-old male, presents to the emergency department with shortness of breath, bilateral leg swelling, and fatigue. He has a history of hypertension, type 2 diabetes, and obesity.
Assessment
- Blood pressure: 160/95 mmHg
- Heart rate: 98 bpm
- Respiratory rate: 24 breaths/min
- SpO2: 92% on room air
- Bilateral crackles on lung auscultation
- 2+ pitting edema in bilateral lower extremities
Diagnosis
Congestive heart failure (CHF) exacerbation
Intervention
- Administer furosemide 40 mg IV
- Start nitroglycerin drip at 10 mcg/min
- Initiate oxygen therapy at 2 L/min via nasal cannula
- Monitor vital signs, intake, and output
- Educate the patient on a low-sodium diet and medication adherence
Evaluation
After 24 hours, the patient’s shortness of breath improved, and leg swelling decreased. The patient verbalized understanding of the importance of a low-sodium diet and medication adherence in managing CHF.
Case Study 2: Acute Pancreatitis
Patient Background
Ms. Sarah Johnson, a 42-year-old female, presents to the emergency department with severe epigastric pain radiating to the back, nausea, and vomiting. She has a history of gallstones and alcohol abuse.
Assessment
- Blood pressure: 130/80 mmHg
- Heart rate: 110 bpm
- Temperature: 101.2°F (38.4°C)
- Tenderness to palpation in the epigastric region
- Positive Cullen’s sign and Grey Turner’s sign
Diagnosis
Acute pancreatitis
Intervention
- Administer IV fluids for hydration
- Provide pain management with morphine 2 mg IV
- Start nasogastric tube for decompression
- Monitor vital signs, intake, and output
- Educate the patient on alcohol cessation and low-fat diet
Evaluation
After 48 hours, the patient’s pain was well-controlled, and nausea and vomiting subsided. The patient verbalized understanding of the importance of alcohol cessation and a low-fat diet in preventing future episodes of pancreatitis.
Case Study 3: Diabetic Ketoacidosis
Patient Background
Mr. David Brown, a 24-year-old male with type 1 diabetes, presents to the emergency department with polyuria, polydipsia, and fruity breath odor. He reports missing his insulin doses for the past 2 days.
Assessment
- Blood glucose: 550 mg/dL
- pH: 7.2
- Bicarbonate: 12 mEq/L
- Positive serum and urine ketones
- Kussmaul breathing
Diagnosis
Diabetic ketoacidosis (DKA)
Intervention
- Start IV fluids with 0.9% normal saline
- Administer regular insulin drip at 0.1 units/kg/hour
- Monitor blood glucose hourly and adjust insulin drip accordingly
- Replete electrolytes as needed
- Educate the patient on the importance of insulin adherence and sick day management
Evaluation
After 12 hours, the patient’s blood glucose levels stabilized, and acidosis resolved. The patient verbalized understanding of the importance of insulin adherence and sick day management in preventing DKA.
Case Study 4: Postoperative Pain Management
Patient Background
Mrs. Emily Davis, a 58-year-old female, is in the post-anesthesia care unit (PACU) after undergoing a total knee replacement. She reports severe pain in her operative leg.
Assessment
- Pain score: 8/10
- Blood pressure: 145/90 mmHg
- Heart rate: 92 bpm
- Respiratory rate: 18 breaths/min
- Limited range of motion in the operative leg
Diagnosis
Acute postoperative pain
Intervention
- Administer oxycodone 5 mg PO
- Apply ice pack to the operative site
- Elevate the operative leg
- Encourage deep breathing exercises
- Educate the patient on the importance of pain management and early mobility
Evaluation
After 30 minutes, the patient’s pain score decreased to 4/10, and she was able to perform deep breathing exercises and tolerate passive range of motion exercises. The patient verbalized understanding of the importance of pain management and early mobility in the postoperative period.
Case Study 5: Urinary Tract Infection
Patient Background
Ms. Jennifer Wilson, an 80-year-old female in a long-term care facility, presents with fever, dysuria, and increased confusion. She has a history of dementia and multiple comorbidities.
Assessment
- Temperature: 101.8°F (38.8°C)
- Blood pressure: 100/60 mmHg
- Heart rate: 98 bpm
- Respiratory rate: 20 breaths/min
- Positive costovertebral angle tenderness
- Cloudy, foul-smelling urine
Diagnosis
Urinary tract infection (UTI)
Intervention
- Obtain urine sample for culture and sensitivity
- Start empiric antibiotic therapy with ciprofloxacin 500 mg PO BID
- Encourage fluid intake
- Monitor vital signs and mental status
- Educate the patient’s caregivers on the importance of hydration and perineal hygiene
Evaluation
After 48 hours, the patient’s fever resolved, and mental status improved. The urine culture confirmed the presence of Escherichia coli, and the antibiotic therapy was continued for a total of 7 days. The patient’s caregivers verbalized understanding of the importance of hydration and perineal hygiene in preventing UTIs.
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