Case Study

| May 19, 2015

Please address all FOUR case studies. All need to be completed in paragraph format and make sure that your answers are in complete sentences and in APA format.

1. P.N. is a 28 year-old man who has a B/P of 140/100 mmHg. What is the primary problem? What subjective and objective data support the problem, and what additional subjective and objective data are not provided but usually are needed to define this particular problem?

2. D.L. is a 36-year-old construction worker who tripped on a board at the construction site 2 days ago, sustaining an abrasion of his left shin. He presents to the emergency department with pain, redness, and swelling in the area of the injury. He is diagnosed as having cellulitis. What is the primary problem? What subjective and objective data support the problem? What additional subjective and objective data are not provided but usually are needed to define this particular problem?

3. C.S. is a 58-year-old woman who has had complaints of fatigue, ankle swelling, and SOB, especially when lying down, for the past week. Physical examination shows distended neck veins, bilateral rales, and S3 gallop rhythm, and lower extremity edema. A chest radiograph shows an enlarged heart. She is diagnosed as having HF and is being treated with furosemide and digoxin. What is/are the primary problem(s)? What subjective and objective data support the problem(s)? What additional subjective and objective data are not provided but usually are needed to define this (these) particular problem(s)?

4. J.O. is a 46 year-old-woman with a 32-pack/year history of cigarette smoking, presents with increasing shortness of breath. She quit smoking 2 years ago. The chronic cough that she previously had lessened after smoking cessation but the dyspnea is now somewhat worse, despite use of an albuterol inhaler on a PRN basis. On examination, mild wheezing is noted. A CXR is unremarkable. Office Spirometry demonstrates an FEV1/FVC of 0.54 and an absolute FEV 1 of 2.0 L or 60% of predicted. Postboronchodilator treatment demonstrated an FEV 1 increase by 100 mL, 5% increase. How should J.O. be treated?

Five years later, she has been doing reasonably well. She now presents to your clinic with difficulty carrying laundry up from her basement and she has noticed that her overall activity level has been curtailed. Repeat office spirometry now shows an FEV 1/FVC of 0.49 and an absolute FEV1 of 49% of predicted. What therapeutic intervention (s) should be considered at this point?

She calls you the next day, having read something on the internet regarding possible increased risk of death in people with obstructive lung disease who take long acting bronchodilators. She is reluctant to take it. What should you tell her?

J.O. also wonders if anything else other than her medication can be done for her. What advice might be given?

 
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