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2 case studies; one discusses a patient with HIV, Mr. Hernanadez, and the other is about Ms. Sampson, a patient diagnosed with gout. You will need to answer the questions in the case studies, provide at least 2 evidenced-based references in APA format and develop a nursing care plan for any of the case studies providing three NANDA-approved nursing diagnoses. 

 

GUIDED CASE STUDY-1

GUIDED CASE STUDY- 3

Mr. Sampson is a 62 year old male who presents to the Emergency Department (ED) complaining of severe right knee pain x 3 days. His gait is unsteady as he is limping and guarding that right leg.

 

Patient reports a medical history:

Hepatitis C
HIV

What initial nursing assessment should be performed at this time?

 

 

 

 

 

 

 

 

 

 

Upon further assessment, Mr. Sampson’s right knee is very swollen, reddened, and warm and tender to the touch. Mr. Sampson reports that his joints swell up like this all the time, and proceeds to show the nurse his hands, where she notes a swollen nodule on the left wrist, and two swollen nodules on the proximal knuckles of the right hand.

What are the possible diagnosis that should be explored for Mr. Sampson at this time?

 

 

 

 

 

 

 

 

What laboratory or diagnostic tests should be performed for Mr. Sampson?

 

 

 

 

 

 

 

 

 

 

 

 

 

The provider orders X-rays of the right knee and bilateral hands, as well as some basic laboratory tests, including an ESR and CRP. 

 

When the nurse goes to draw blood, she notes another swollen nodule over the patients left elbow that is shiny and has two white spots on it. She now knows that she needs to recommend one more test for the provider to order.

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Figure 1:
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What is the significance of the finding on the patient’s elbow?

 

 

 

 

 

 

What other lab test should be added to confirm this diagnosis?

 

 

The joint x-rays show crystal deposits around the swollen joints

 

 

 

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50

 

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R MR

 

Lab Results-   
Explain what is going on with Mr. Sampson physiologically.

 

 

 

 

 

 

 

 

 

What medications would you anticipate for Mr. Jones?

 

You will administer the first dose of the medications.

 

 

After 2 days of anti-inflammatory treatments and physical therapy assistance, Mr. Sampson’s joint swelling has decreased and he is able to walk easily without pain and will be discharged home today. 

 

The nurse is concerned that he may not understand what triggers his gout flare ups, considering how frequently he reports that they happen.

 

What discharge teaching should be included for Mr. Sampson to help him reduce the frequency of his flare-ups?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 Mr. Hernandez is a 33 year old male with a history of IV Drug Use, Hepatitis C, and HIV. He has previously been managed on HAART therapy, but has been having recurrent bouts of pneumonia in the last 6 months.

He presents to the Free Clinic today complaining of weakness and fatigue, shortness of breath, and a persistent cough. 

He reports a 10 lb weight loss over the last 3 weeks, and night sweats. He says “I think I have pneumonia again”. 

 

  

 

What further history questions and assessment data would you obtain at this time?

 

 

Lung sounds- right upper and middle lobes

 
What laboratory or diagnostic tests do you anticipate the provider ordering?

 

 

 

 

 

 

 

 

Upon further questioning, the patient reports fever, chills, and night sweats for the last few days. His coughing has been nonproductive.  A Chest x-ray shows a nodular consolidation on the right side and diffuse infiltrates. The provider orders a CBC with Diff and a CD4 cell count.

 

Vital signs show the following:

 HR 100

 RR 20

 BP 108/67

 SpO2 90%

 Temp 101.6°F

 

CBC, CMP, Lactic acid

PT, INR, PTT

U/A, Blood Cultures 

What respiratory disease has Mr. Hernandez contracted?

 

 

What should your first nursing action be?

 

The results show the following abnormal values:

WBC 7,000

RBC  3.9

Hgb   8.1

Hct     24.3

Plt    104,000

            CD4 <10 / mm3     What is going on physiologically with Mr. Hernandez? How do you know?                   Mr. Hernandez is sent straight to the hospital to be admitted. The provider increases his HAART therapy dosages.  Additionally, the provider has written orders.      He continues to be weak and has fevers and night sweats. He is flushed and his skin is warm.   His vital signs in the morning are: HR 110 RR 22 BP 88/47 SpO2 92% on 4L nasal cannula Temp 101.8°F           What is the current MAP?   You will need to calculate this.   Obtain Blood cultures x2 sets   Azithromycin 500 mg IV infusion   Acetaminophen 1000 mg PO Q 4-6 hrs as needed for temperature > 100.5

 

Atripla (Sustiva 600mg-Viread 300mg-Emtriva 200mg)

 

Type and Cross-match 2 units PRBCs

 

Lactate Ringers IV infusion 30 mL/kg

 

 

 

 

Set up your IV infusion on the IV pump

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ALARM
INFUSE
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What condition is Mr. Hernandez developing because of his infection?

 

 
What are signs of end-organ damage?

 

 

 

 

 

 

 

What medications or treatments might he require to maintain his hemodynamics?

 

 

 

 

 

 

After 2 weeks of treatment and severe sepsis, Mr. Hernandez elects to stop all treatments. 

 

He decides to enter an inpatient hospice program to manage his pain and keep him comfortable. He passes away peacefully 5 days later.

 

 
Could anything have been done differently for Mr. Hernandez?

 

 

 

 

 

 

 

 

 

 

 

SCIENCE
HEALTH SCIENCE
NURSING
NUR 257

 

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