(Done paper) Clinical Case Study Part Two Discussion Now, assume that you sent your patient for labs and she returns the following day, as instructed, to review the results.

(Done paper) Clinical Case Study Part Two Discussion Now, assume that you sent your patient for labs and she returns the following day, as instructed, to review the results.

Week 6: Clinical Case Study Part Two Discussion
Now, assume that you sent your patient for labs and she returns the following day, as instructed, to review the results.
CBC with differential
WBC 8.6 x10E3/uL
RBC 4.44 x 10E6/uL
Hemoglobin 14.0 g/dL
Hematocrit 41.2%
MCV 93fL
MCH 31.5 pg
MCHC 34.0 g/dL
RDW 13%
Platelet 241 x 10E3/uL
Neutrophils % 67%
Lymphocytes % 22%
Monocytes % 8%
Eosinophils % 3%
Basophils % 0%
Absolute Neutrophils 5.7 x 10E3/uL
Absolute Lymphocytes 1.9 x 10E3/uL
Absolute Monocytes 0.7 x 10E3/uL
Eosinophils Absolute 0.3 x 10E3/uL
Basophile Absolute 0.0 x 10E3/uL
Immature Grans % 0%
Absolute Immature Grans 0.0 x 10E3/uL
TSH with Reflex to FT4
TSH 6.770 uIU/mL
FT4 0.62 ng/dL
PHQ-9 Depression Score=10 (previous was 5 at last visit 6 months ago)
1. What is your primary diagnosis for this patient as the cause for the CC of fatigue? (support your decision for your diagnosis with pertinent positives and negatives from the case)
2. Identify the corresponding ICD-10 code.
3. Provide a treatment plan for this patient’s primary diagnosis which includes:
o Medication*
o Any additional testing necessary for this particular diagnosis*
o Patient education*
o Referral
4. Provide an active problem list for this patient based on the information given in the case.
5. Are there any changes that you would make to the patient’s overall plan at this time? Must provide an evidence-based medicine (EBM) argument to support any treatments or testing decisions.
6. Provide an appropriate follow-up plan (include any additional testing that you feel is necessary and include an EBM argument).

*If part of the plan does not warrant an action, you must explain why. ALL medication and testing decisions (or decisions not to treat with medication or additional testing) MUST be supported with an EBM argument. Over-the-counter (OTC) and RXs must be written in full as if handing a script to the patient in the office.

Clinical Case Study Part 2 Grading Rubric
Participation Guidelines
Enters initial post to part one by 11:59 p.m. MT on Tuesday; initial post to part two by 11:59 p.m. MT on Thursday; responds substantively to at least one topic-related post of a peer including evidence from appropriate sources in parts one and two, AND all direct faculty questions in parts one and two by Sunday, 11:59 p.m. MT.

Grading Rubric Guidelines-Part 2

Exceptional
(100%)
Outstanding or highest level of performance Exceeds
(88%)
Very good or high level of performance Meets
(82%)
Competent or satisfactory level of performance Needs Improvement
(40%)
Poor or failing level of performance Developing
(0)
Unsatisfactory level of performance
Criterion 15 Points 13 Points 12 Points 6 Points 0 Points
Application of Course Knowledge
1) Student chooses one appropriate diagnosis for the patient;
2) Diagnosis is supported with strong pertinent positive and negative subjective and objective data from parts 1 & 2;
3) The ICD code for the diagnosis is correct;
4) Treatment plan for primary diagnosis includes medication, additional testing, patient education, and referral;
5) Prescription and OTC medications are written appropriately as a RX and all components are correct;
5) Treatment decisions (medication, additional testing, referrals) are supported with appropriate EBM arguments;
6) An accurate problem list is presented based on case information;
7) Student discusses changes (or not) to the overall treatment plan for the patient for pertinent issues;
8) An appropriate F/U plan is provided

(8 critical elements) All eight (8) critical elements are present:
-Student chooses one appropriate diagnosis for the patient;
AND
-Diagnosis is supported with strong pertinent positive and negative subjective and objective data from parts 1 & 2;
AND
-The ICD code for the diagnosis is correct;
AND
-Treatment plan for primary diagnosis includes medication, additional testing, patient education, and referral;
AND
-Prescription and OTC medications are written appropriately as a RX and all components are correct;
AND
Treatment decisions (medication, additional testing, referrals) are supported with appropriate EBM arguments;
AND
An accurate problem list is presented based on case information;
AND
Student discusses changes (or not) to the overall treatment plan for the patient for pertinent issues;
AND
An appropriate F/U plan is provided
1-2 critical elements are missing. 3 critical elements are missing. 4-7 critical elements are missing. All 8 critical elements are missing.
Criterion 15 Points 13 Points 12 Points 6 Points 0 Points
Support from Evidence-Based Practice (EBP)
1) Discussion post is supported with appropriate, scholarly sources (see Course Resource documents);
2) Sources are published within the last 5 years (unless it is the most current CPG);
3) Reference list is provided and in-text citations match, and;
4) All testing decisions are fully supported with an appropriate EBM argument.

(4 critical elements required) All 4 critical elements are present:
-Discussion post is supported with appropriate, scholarly sources
AND
-Sources are published within the last 5 years (unless the most current CPG is used)
AND
-A reference list is provided with in-text citations that match
AND
-All testing decisions are fully supported with an appropriate EBM argument. 1 critical element is missing
BUT
all testing decisions are fully supported with an appropriate EBM argument
1 critical elements is missing
OR
testing decisions may only be partially supported with appropriate EBM arguments 2 critical elements are AND
testing decisions are not supported by appropriate EBM arguments Discussion posts contain no current, evidence-based practice references or citations. No EBM arguments are made for treatment decisions.

*Students should note that factitious sources, sources that are clearly not read by the student and used, or sources that have incorrect dates will result in an automatic ZERO (0) for this section for the week.
Criterion 10 Points 9 Points 8 Points 4 Points 0 Points
Interactive Dialogue
1) Student provides a substantive* response to at least one topic-related post of a peer;
2) Evidence from appropriate scholarly sources are included;
3) Reference list is provided and in-text citations match; and,
4) Student responds to all direct faculty questions

(*) A substantive post adds new content or insights to the discussion thread and information from student’s original post is not reused in peer or faculty response

(4 critical elements required) All 4 critical elements are present:
-Student provides a substantive* response to at least one topic-related post of a peer
AND
-Includes evidence from appropriate scholarly sources
AND
-Provides a reference list which match in-text citations
AND
-Student responds to all direct faculty questions 1 critical element is missing
OR
the student’s responses provide very limited content or insight to the discussion 2 critical elements are missing
AND
the student’s responses provide very limited content or insight to the discussion 3 critical elements are missing 4 critical elements missing
Criterion
5 Points 4 Points 3 Points 1 Point 0 Points
Organization
1) Case study responses are presented in a logical format;
2) Responses are in sequence with the numbered questions; 3) The case study response is understandable and easy to follow; and,
4) All responses are relevant to the case topic

(4 critical elements required) All 4 critical elements are present:
-Case study response is presented in a logical format,
AND
-Responses are in sequence with the numbered questions
AND
-The case study response is understandable and easy to follow
AND
-All responses are relevant to the case topic. 1 critical element is missing 2 critical elements are missing 3 critical elements are missing 4 critical elements are missing
Criterion 5 Points 4 Points 3 Points 1 Point 0 Points
Grammar, Syntax, Spelling, & Punctuation
Discussion post has minimal grammar, syntax, spelling, punctuation, or APA format errors*.

(*) APA style references and in text citations are required; however, there are no deductions for errors in indentation or spacing of references. All elements of the reference otherwise must be included.
0-1 errors in grammar, syntax, spelling, punctuation, or APA format*. 2-3 errors in grammar, syntax, spelling, punctuation, or APA format*. 4-5 errors in grammar, syntax, spelling, punctuation, or APA format*. 6-9 errors in grammar, syntax, spelling, punctuation, or APA format*. 10 or more errors in grammar, syntax, spelling, punctuation, or APA format*.
0 points deducted
Late Deductions 50 points deducted

Total Participation Requirements

Enters response to part two by 11:59 p.m. MT on Thursday; Peer and responses to direct faculty questions are posted by Sunday, 11:59 p.m. MT. 10% deduction for discussion post made after Thursday, 11:59 p.m. MT

Partial posts may be considered to be an AI violation Submissions will not be accepted after Sunday 11:59 p.m. MT of the week they are due.

NOTE: To receive credit for a week’s discussion, students may begin posting no earlier than the Sunday immediately before each week opens. Unless otherwise specified, access to most weeks begins on Sunday at 12:01 a.m. MT, and that week’s assignments are due by the next Sunday, 11:59 p.m. MT. Week 8 opens at 12:01 a.m. MT Sunday and closes Saturday, 11:59 p.m. MT. Any assignments and all discussion requirements must be completed by 11:59 p.m. MT Saturday of the eighth week.

Guide to NR511 Case Studies (Week 3 & 6)

Part 1
In Part 1, you are given a patient scenario. Using the information given, answer the following questions:

1. Briefly and concisely summarize the H&P findings as if you were presenting it to your preceptor using the pertinent facts from the case. Use shorthand where possible and approved medical abbreviations. Avoid redundancy and irrelevant information.

Do NOT simply rewrite the information as is it is presented in the case. This is NOT a SOAP note. The information that you present to your preceptor should include only what is needed. State the chief complaint (CC), HPI, and relevant history and physical findings. You can use shorthand and medical abbreviations. Don’t be redundant.

Example:
“J.S. is a 34yo male with a CC of acute onset ST x 3 days” [provide additional information from the history that is relevant].

“Physical exam is significant for” [provide relevant physical exam findings].

2. Provide a differential diagnosis (minimum of 3) which might explain the patient’s chief complaint along with a brief statement of pathophysiology for each.

The pathophysiology statement does not need to be extensive but it should not be vague either.
Just list the diagnosis and follow with a pathophysiology statement for each diagnosis.

Example:
Diagnosis #1
-Pathophysiology statement

3. Analyze the differential by using the pertinent findings from the history and physical to argue for or against a diagnosis. Rank the differential in order of most likely to least likely. (This is where you present your argument for EACH DIAGNOSIS in your differential using the patient’s subjective and objective information that was given).

This is where you present your argument for EACH DIAGNOSIS individually using the patient’s pertinent subjective and objective information from the scenario.

Example:
Diagnosis # 1-Streptococcal pharyngitis

Strep pharyngitis is at the top of my differential. A streptococcal bacterial infection should be ruled out in a patient presenting with pharyngitis to prevent serious complications such as rheumatic fever.

• Pertinent positive findings:
ST, fever, nausea, lymph node swelling, bad breath {subjective findings};
posterior pharynx erythema, 3+ tonsillar edema, tonsillar exudate, halitosis, anterior cervical chain lymphadenopathy and tenderness, T 101.5 {objective findings}

• Pertinent negative findings:
No known recent exposure to person with strep, no rash, no cough

4. Identify any additional tests and/or procedures that you feel is necessary or needed to help you narrow your differential. All testing decisions must be supported with an EBM argument as to why it is necessary or pertinent in this case. If no testing is indicated or needed, you must also support this decision with EBM evidence.

This is where you identify, based on what you know thus far, test or test(s) that you would perform TODAY which would help you narrow your differential diagnosis. *Do not list all of the possible tests that can be done. You are being evaluated on your diagnostic reasoning skills as well your ability to make decisions that are in-line with current practice recommendations. Just because a test is available does not mean it needs to be done.

Example:
Let’s say my patient’s CC was cough and that my differential included bronchitis and pneumonia. In this case, a CXR might be useful in differentiating the 2 conditions-so I am going to state that I want to perform a CXR today.

However, remember that you have to have an EBM argument for this decision. So make sure you are telling the reader why this is the best choice based on the literature (i.e., it is not enough to say the test and cite the author & date). In this instance, my argument might look like this: “According to the Infectious Disease Society of America (2012) a CXR is considered the gold standard for diagnosing pneumonia.” Keep in mind that you also need an EBM argument if you decide NOT to test too.

Part 2
In Part 2 you will be given some additional history, exam and/or test findings. Using this information and the information in Part 1, answer the following questions:

1. What is your primary (one) diagnosis for this patient at this time? (support the decision for your diagnosis with pertinent positives and negatives from the case).

Tell the reader how you came to this conclusion using the information that you were given (i.e., CXR result, lab result). Interpret the results into your diagnosis decision (i.e., tell how this information helped you to narrow your differential to the one diagnosis that you chose).

Example:
Diagnosis: Pharyngitis, streptococcal

Rationale: The CBC results are normal which rules out infection and anemia. The RSA test was + which tells me that she has a very strong likelihood of streptococcal pharyngitis.

Pertinent Positives and Negatives: list all of the supporting history & physical findings from Part 1 & 2 to support your diagnosis.

In the case where a diagnosis was made based on clinical presentation and history, explain the criteria with an EBM argument to support.

2. Identify the corresponding ICD-10 Code.

You can find a link to an ICD-10 code finder by going to the Library homepage>Browse guides>Course directory tab>select NR511 from the drop down box>select Go. Otherwise, a google search will provide you with several free options you can use

Example:
J02.0

3. Provide a treatment plan for this patient’s primary diagnosis which includes:

If part of the plan does not warrant an action, you must explain why. ALL medication and testing decisions (or decisions not to treat with medication or additional testing) MUST be supported with an EBM argument as you did in Part 1.

• Medication
All prescriptions and OTC medications should be written in RX format AND include an EBM argument to support why this medication is the most appropriate:

• Any additional testing necessary for this particular diagnosis
This is typically done when you need more information to confirm a diagnosis or differentiate the diagnosis. This is not where you list any tests that were already done and reported to you in the case.

You need to be decisive and tell me what you are going to do for this patient, right here in your office, today. Don’t list all of the possibilities that are available or could be done down the road. I want to assess your diagnostic reasoning skills and ability to make a decision in the moment.

• Patient education
This is pretty self-explanatory. You do need to provide references.

• Referral
Also self-explanatory. Provide references.

Example:
• Penicillin VK 500mg, Disp #20, Sig: 1 tab twice daily x 10days; RF: 0

Rationale: Penicillin is the 1st line treatment recommendation for Group A Beta-hemolytic streptococcal pharyngitis, based on their narrow spectrum of activity, infrequency of adverse reactions, and modest cost. (Shulman, Bisno, Clegg, Gerber, Kaplan, Lee, Martin, & Van Beneden, 2012). My patient has no noted allergies, so PCN VK is appropriate.

• No additional testing will be performed today (Reference, date).

Rationale: Point of care, rapid strep antigen tests are highly specific (approximately 95%) when compared with throat cultures, so false-positive test results are highly unusual. Consequently, a therapeutic decision can be confidently made based on the positive result which was reported for this patient in the scenario (Shulman, Bisno, Clegg, Gerber, Kaplan, Lee, Martin, & Van Beneden, 2012).

• Patient instructions:
-take all medication as prescribed (Reference, date).
-Etc…

• No referral is necessary at this time (Reference, date).

4. Provide an active problem list for this patient based on the information given in the case.

This is where you list all of the known medical problems of the patient. This is different than a differential.

Example:
Hypertension-poorly controlled
Obesity
5. Are there any changed that you would also make to the patient’s overall treatment plan at this time? Must provide and EBM argument for each treatment or testing decision.

Other than what you have prescribed above in your plan for the primary diagnosis, this is where you address anything else regarding the patient’s care that you feel is necessary. Let’s say that our patient has a history of HTN and she is currently taking Lisinopril 5mg daily. Let’s also say that at today’s visit, her BP is 170/95.

Example:
Given that the patient has suboptimal control of her HTN, I also would like to increase her Lisinopril to 10mg daily. (Given EBM argument for your choice).

6. Provide an appropriate F/U plan

Example:
F/U in 10-14 days if symptoms are not resolved or sooner if they become worse, etc., (Reference, date). Otherwise, If her symptoms have resolved she should return to the clinic in 1 month to reevaluate her blood pressure after the medication change.

List your references that were cited above according to APA rules. Format is not graded (Canvas does a poor job in formatting the tabs and spaces) BUT all other APA elements are required.

Example:

References
Shulman, S., Bisno, A., Clegg, H., Gerber, M., Kaplan, E., Lee, G., Martin, J., & Van Beneden, C. (2012). Clinical Practice Guideline for the Diagnosis and Management of Group A Streptococcal Pharyngitis: A 2012 Update by Infectious Diseases Society of America. Clinical Infectious Disease, 55(10), e89. DOI: 10.1093/cid/cis629

Click to Download Solution

Purchase Solution $30

Loader Loading...
EAD Logo Taking too long?

Reload Reload document
| Open Open in new tab

Download [19.23 KB]

By | 2019-10-16T08:05:53+00:00 October 16th, 2019|Nursing|