For this Case Study Assignment, you will chose from four case studies to identify common health implications for women. You will then explore the chosen case study to determine the diagnosis, diagnostic tests, and treatment options for the patient.
NRNP6552 Week 8 Case studies
Case 1
A 48-year-old Asian American woman is concerned about thin bones. Her mother was diagnosed
with osteoporosis at the age of 50 and fell at the age of 68 and fractured her hip and spent months
in Rehab before being able to return home. The patient has no history of fractures.
The patient presents to the office to have her bones checked to see if she has “thin bones”
Patient has no history of previous fractures: Patient states she went through Menopause at the
age of 43-44 with no major problems. Patient was diagnosed with hypothyroid at at age 40.
Patient does not drink. Smokes 1ppd for 20 yrs. Husband has been out of work for 9 months due
to downsizing at his job. Pt works as an administrative assistant for a publisher but does not have
health insurance at this time.
Pt had a melanoma removed from her left cheek in 2018; No hospitalizations except for
childbirth x2
Family history: Paternal Grandmother died at age 78 due to heart disease. Paternal Grandfather
died at age 83 due to heart attack. Maternal Grandmother died at age 82 cause unknown;
Maternal Grandfather died from farm accident at age of 56. Mother is 75 alive with Osteoporosis
diagnosed at age 50 and HTN diagnosed at age 63. Father is 77 alive with HTN diagnosed at age
45. Pt has two daughters alive and well with no medical problems.
Objective Info
Height 5’2’ Wt 105 lbs; BMI 19.2; 128/78; HR-72/min
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•
•
•
•
•
•
•
HEENT: Normocephalic, no lumps/lesions
Neck: supple without adenopathy , no thyromegaly.
Lungs: Eupneic, CTA
CV: RRR, no murmurs, rubs or extra sounds noted; 2+ peripheral pulses, no edema noted
Breast: soft, fibrocystic changes bilaterally, without masses, dimpling or discharge
Abd: soft, +BS, no tenderness
MS: Full ROM in spine and shoulders. No tenderness, no spasms
T-Score is -1.2
Questions
1.
2.
3.
4.
5.
6.
What other information do you need
What other diagnostic tests would be appropriate for this pt?
Is this patient at high risk or low risk? What are her risk factors
What other screenings are appropriate for this patient?
What is the difference between a Z score and a T score?
What would you include in patient education to prevent further loss of bone? Be specific.
Case 2
A 46-year-old Caucasian woman presents to the clinic complaining of breast pain. The patient state the
pain is intermittent, in the right breast, the pain is sharp and has a burning sensation. She rates the pain
as 7/10 at it worst. The patient states the pain sometimes interferes with her sexual activity. She has
tried warm compresses, ibuprofen, and support bras with little improvement. Pt is on oral birth control
pills and takes a daily vitamin.
Soc hx: Pt reports she sometimes eats nutritious meals, but due to her job and family obligations she
does eat fast food frequently. Pt states she is an assistant accountant at a local accounting firm, which
adds to her stress especially at the end of each month and during tax season. She exercises 1-2
times/week by walking around the block. Sometimes the walking causes more pain in her breast. She
drinks socially once or twice a month and has 1-2 glasses of wine at that time. She smokes 2 packs/day
for last 22 yrs. She has tried to quit but has not been successful. Family history non-contributory.
Objective Info
Height 5’6” Wt 155 lbs; BMI 25; 140/78; HR-72/min
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•
•
•
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HEENT: Normocephalic, no lumps/lesions
Neck: supple without adenopathy , no thyromegaly.
Lungs: Eupneic, CTA-bilaterally
CV: RRR, no murmurs, rubs or extra sounds noted; 2+ peripheral pulses, no edema noted
Breast: Macromastia breasts are soft, fibrocystic changes bilaterally noted without masses,
dimpling or discharge, no redness or inflammation noted.
Questions
1.
2.
3.
4.
5.
What other information do you need?
Describe the most appropriate way to perform the breast exam on this patient.
What diagnostic tests would be appropriate for this pt?
What are the risk factors for this patient?
What other screenings are appropriate for this patient?
6. When would you refer to a breast specialist?
7. What pharmacological and nonpharmacological therapies would you consider for this patient?
Case 3
A 36-year-old Hispanic woman presents to the OB clinic for her Week 24 check-up, gravida 2
para 1. Patient is a full-time homemaker. Pt states she is doing well but is worried about her
weight gain. Obstetric history includes a normal spontaneous vaginal delivery (NSVD) 31/2 yrs
ago with a viable 9 lb male infant after a 10-hour labor. No complications during pregnancy,
delivery or postpartum period. She denies allergies to food, drugs or the environment. Current
meds include Prenatal vitamins 1/day and Fe 90 mg/day. Family history significant only for dietcontrolled DM in paternal grandfather and an aunt and obesity in both mother and father.
Objective Info
Height 5’2” Wt 170 lbs; BMI 31.1; 140/84 (sitting); HR-92/min
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•
•
•
•
•
HEENT: Normocephalic, no lumps/lesions
Neck: supple without adenopathy , no thyromegaly.
Lungs: Eupneic, CTA-bilaterally
CV: RRR, soft systolic murmur Grade II/VI, no rubs noted; 2+ peripheral pulses, no
edema noted
Breast: Soft, fibrocystic changes bilaterally noted without masses, dimpling or discharge,
no redness or inflammation noted. Breast self-exam reviewed
GU: Uterus at umbilicus-approximately 24 wks size and non-tender. FHT present with
Doppler
Questions
1.
2.
3.
4.
What other information do you need?
What diagnostic tests would be appropriate for this pt?
What are the risk factors for this patient?
What other screenings are appropriate for this patient?
5. What management treatment would be most effective for this patient?
6. What are the possible maternal and newborn complications with this health problem?
Case 4
A 32-year-old African American woman presents to the clinic for her 24-week check-up. Pt states
her morning sickness has resolved. However, she states she seems sad often and does not
understand why, as she is happy about the pregnancy.
HPI: Pt is 24 weeks gestation. The patient is having sad moods at least once a day. She also states
she is tired all the time, but figures that is just part of being pregnant, but has no energy and does
not feel like doing her usual daily chores. She finds it difficult to go to work every day. This
moodiness started about a week ago. She tried going to bed earlier but it did not seem to help.
Taking 1 prenatal vitamin every day, No known drug, food, or environmental allergies. Family
history is significant only for diet-controlled DM in paternal grandfather with onset in mid 40’s,
Mother 58 yrs old is healthy; Father 60 yrs old with hx of DM with onset at age 45 and chronic
depression which began in early 20s.
Objective Info
Height 5’4” Wt 147 lbs; BMI 25.2; 132/78 (sitting); HR-88/min
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•
•
General: Appears well nourished, hair is in disarray, with flat affect
HEENT: Normocephalic, no lumps/lesions
Neck: supple without adenopathy , no thyromegaly.
•
•
•
•
Lungs: Eupneic, CTA-bilaterally
CV: RRR, soft systolic murmur Grade II/VI, no rubs noted; 2+ peripheral pulses, no
edema noted
Breast: Soft, enlarged, fibrocystic changes bilaterally noted without masses, dimpling or
discharge, no redness or inflammation noted. Breast self-exam reviewed
GU: Uterus at umbilicus- approximately 24 wks size and non-tender. FHT present with
Doppler
Questions
1.
2.
3.
4.
What other information do you need?
What diagnostic would be appropriate for this pt?
What are the risk factors for this patient?
What other screenings are appropriate for this patient?
5. What management treatment would be most effective for this patient?
6. What are the possible maternal and newborn complications with this health problem?
Case # (1, 2, 3 or 4) and Description of the Case Chosen:
•
•
•
•
Case 1
Case 2
Case 3
Case 4
Outline
Subjective data.
Outline
Objective findings.
Identify data
provided in your
chosen case and
any additional
data needed.
Identify findings
provided in your
chosen case and
any additional
data needed.
Identify
diagnostic tests,
procedures,
laboratory work
indicated.
Describe the
rationale for each
test or
intervention with
supporting
references.
Distinguish at
least three
differential
diagnoses.
Describe the
rationales for
your choice of
each diagnosis
with supporting
references.
Identify
appropriate
medications,
treatments or
other
interventions
associated with
each differential
diagnosis.
Describe
rationales and
supporting
references for
each.
Explain key
Social
Determinants of
Heath (SDoH)
for your chosen
case.
Describe
collaborative
care referrals
and patient
education needs
for your chosen
case.
Describe
rationales and
supporting
references for
each.
Write the answers to questions posed for chosen case scenario
1.
2.
3.
4.
5.
6.
7.
NRNP_6552_Week8_Case_Study_Assignment_Rubric
NRNP_6552_Week8_Case_Study_Assignment_Rubric
Criteria
This criterion is
linked to a
Learning
Outcome
analyzes
subjective and
objective data
and outlines
applicable
diagnostic tests
related to case
studies.
This criterion is
linked to a
Learning
Outcome
Identifies
differential
diagnoses
related to case
studies.
Ratings
30 to >26.7 pts
Excellent
The response
provides clear,
complete, and
comprehensive
descriptions of
subjective and
objective case
data,
appropriately
outlining all
diagnostic tests,
clinical
procedures and
pharmacological
interventions.
26.7 to >23.7 pts
Good
The response
provides clear,
complete partial
descriptions of the
components of the
subjective and
objective case
data, appropriately
outlining most of
the diagnostic
tests, clinical
procedures and
pharmacological
interventions.
23.7 to >20.7 pts
Fair
The response
provides some
components of the
subjective and
objective case
data, but they are
incomplete, vague
or inaccurate,
outlining some of
the diagnostic
tests, clinical
procedures and
pharmacological
interventions.
30 to >26.76 pts
Excellent
The response
contains at least 3
differential
diagnoses
relevant and
applicable to the
case.
26.76 to
>23.7 pts
Good
The response
contains at least 2
differential
diagnoses
relevant and
applicable to the
case.
23.7 to >20.7 pts
Fair
The response
contains at least 1
differential
diagnosis relevant
and applicable to
the case.
Pts
20.7 to >0 pts
Poor
The response
provides unclear
or incomplete
components of
subjective and
objective case
data. The
diagnostic tests,
clinical
procedures and
pharmacological
interventions are
missing, incorrect,
or inappropriately
applied.
20.7 to >0 pts
Poor
The response
contains few or no
differential
diagnoses and/or
diagnoses are not
relevant and
applicable to the
case.
30 pts
30 pts
NRNP_6552_Week8_Case_Study_Assignment_Rubric
Criteria
This criterion is
linked to a
Learning
Outcome
formulates a
treatment plan
related to case
studies based on
scientific
rationale,
evidence- based
standards of
care, and
practice
guidelines.
Integrates
ethical,
psychological,
physical,
financial issues
and Social
Determinants of
Health in plan.
Ratings
30 to >26.76 pts
Excellent
Formulates a
thorough treatment
plan including
explanations of
appropriate
diagnostic tests and
treatment options.
Fully incorporates
syntheses
representative of
knowledge gained
from the resources
for the module and
current credible
sources, with no
less than 75% of
the treatment plan
having exceptional
depth and breadth.
Supported by at
least 3 current
peer- reviewed,
references or
professional
practice guidelines.
26.76 to >23.7 pts
Good
Formulates a
partially complete
treatment plan
including partial
explanations of
appropriate
diagnostic tests and
treatment options.
Somewhat
incorporates
syntheses
representative of
knowledge gained
from the resources
for the module and
current credible
sources with no
less than 50% of
the treatment plan
having exceptional
depth and breadth.
Supported by at
least 3 current
peer- reviewed,
references or
professional
practice guidelines.
23.7 to >20.7 pts
Fair
Formulates a
minimally
complete
treatment plan
including
incomplete or
vague
explanations of
appropriate
diagnostic tests
and treatment
options. Lacking
in synthesis of
knowledge
gained from the
resources for the
module and
current credible
sources.
Supported by at
least 2 current
peer- reviewed,
references or
professional
practice
guidelines.
Pts
20.7 to >0 pts
Poor
Formulates a
treatment plan
that contains
incomplete
explanations of
appropriate
diagnostic tests
and treatment
options and/ or
explanations are
missing. Lacks
synthesis gained
from the
resources for the
module and
current credible
sources.
Supported by 1
or no current
peer- reviewed,
references or
professional
practice
guidelines.
30 pts
NRNP_6552_Week8_Case_Study_Assignment_Rubric
Criteria
This criterion is
linked to a
Learning
Outcome
Written
Expression and
Formatting English writing
standards:
Correct
grammar,
mechanics, and
proper
punctuation
This criterion is
linked to a
Learning
Outcome
Written
Expression and
Formatting – The
paper follows
correct APA
format for title
page, headings,
font, spacing,
margins,
indentations,
page numbers,
parenthetical/intext citations,
and reference
list.
Total Points: 100
Ratings
5 to >4.45 pts
Excellent
Uses correct
grammar,
spelling, and
punctuation with
no errors.
4.45 to
>3.95 pts
Good
Contains a few
(1 or 2)
grammar,
spelling, and
punctuation
errors.
5 to >4.45 pts
Excellent
Uses correct APA
format with no
errors.
4.45 to >3.95 pts
Good
Contains a few (1
or 2) APA format
errors.
3.95 to
>3.45 pts
Fair
Contains several
(3 or 4)
grammar,
spelling, and
punctuation
errors.
Pts
3.45 to >0 pts
Poor
Contains many (? 5)
grammar, spelling, and
punctuation errors that
interfere with the
reader’s understanding.
3.95 to >3.45 pts
Fair
Contains several (3
or 4) APA format
errors.
3.45 to >0 pts
Poor
Contains many (?
5) APA format
errors.
5 pts
5 pts