Week 4 Clinical Case Study Scenario

Identify a minimum of three subjective cues (risk factors) that are clinically significant and provide a brief rationale for each cue.

Case 1

A 55-year-old Caucasian woman presents to the occupational health nurse asking for help with her back pain. She reports, “I have pain and stiffness in my lower back increasing over the past 2-3 days .” She describes the pain as dull and achy. She states that the pain worsens in the morning and with certain movements such as getting in and out of the car, bending over, and suddenly changing positions. She has also noted that the pain increases after standing for long periods. Despite taking ibuprofen and resting, the pain continues. The client rates pain as seven on a scale of 0–10 before taking ibuprofen. An hour after taking ibuprofen, rates pain as 3–4 on a scale of 0–10. Ibuprofen, resting, and stretching alleviate the pain somewhat; however, the pain never goes away. The client denies paresthesia and bowel/bladder incontinence.

She works on an assembly line and believes her back pain may be related to her job. She picks up small parts and places them in a motor. She twists from side to side throughout the work day. She has one 15-minute break in the morning, 30 minutes for lunch, and one 15-minute break in the afternoon. She stands while at work and is required to wear steel-toed shoes. She denies difficulty performing ADLs. She does not require the use of assistive devices for mobility. The client denies any change in body image or self-esteem.

She reports that she is postmenopausal and not taking any estrogen replacement therapy. She reports that she tries to walk 30 minutes three times weekly and is usually successful. The client denies weight gain or loss issues but feels she needs to lose weight. Medications include Calcium with vitamin D supplement twice daily, ibuprofen 400 mg every 8 hours as needed.

  1. Identify a minimum of three subjective cues (risk factors) that are clinically significant and provide a brief rationale for each cue.
  2. Based on the clinically significant data, What health condition is the client experiencing
  3. Using your words, describe the pathophysiology consistent with this condition.
  4. What objective signs will you anticipate on inspection and palpation
  5. Discuss one health promotion teaching topic
  6. Based on the information, discuss one older adult’s consideration.

Case 2

N.T., a 59-year-old woman, arrives at the emergency room with expressive aphasia, left facial droop, left-sided hemiparesis, and mild dysphagia. Her husband states that when she awoke that morning at 0600, she stayed in bed, complaining of a mild headache over the right temple and feeling slightly weak. He went and got coffee, then, thinking it was unusual for her to have those complaints, went back to check on her. He found she was having some trouble saying words and had developed a left-sided facial droop. When he helped her up from the bedside, he noticed weakness in her left hand and leg and brought her to the emergency department. Her past medical history includes paroxysmal atrial fibrillation (PAF), hypertension (HTN), and hyperlipidemia. A recent cardiac stress test had normal findings, and her blood pressure (BP) has been well controlled. N.T. is currently taking hormone replacement therapy(estrogen) for menopause, amlodipine (Norvasc), and lisinopril (Zestril) for high blood pressure, simvastatin (Zocor) for high cholesterol.

  1. Identify a minimum of three subjective cues (risk factors) that are clinically significant and provide a brief rationale for each cue
  2. Based on the clinically significant data, what health condition is the client experiencing
  3. Using your words, describe the pathophysiology consistent with this condition
  4. What objective signs will you anticipate on inspection and palpation
  5. Discuss one health promotion teaching
  6. Based on the information, discuss one older adult’s consideration

Answer preview identify a minimum of three subjective cues (risk factors) that are clinically significant and provide a brief rationale for each cue.

APA

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