DIAGNOSIS: ASTHMA STUDENT NURSE: ROSELYN DEDUQUE

GENDER Female AGE 38 SETTING ■ Walk-in health care center

ETHNICITY ■ White American PREEXISTING CONDITION ■ Mild persistent asthma
SOCIOECONOMIC ■ Husband employed in asbestos PHARMACOLOGIC ■ Albuterol (Proventil,
Ventolin); beclomethasone dipropionate (Vanceril)

PRIORITIZATION ■ Ensuring a patent airway; monitoring for status asthmaticus

Mrs. Hogan is a 38-year-old woman brought to a walk-in health care center by her neighbor. Mrs. Hogan
is in obvious respiratory distress. She is having difficulty breathing with audible high-pitched wheezing
and is having difficulty speaking. Pausing after every few words to catch her breath, she tells the nurse,
“I am having a really bad asthma attack. My chest feels very tight and I cannot catch my breath. I took
my albuterol and Vanceril, but they are not helping.” Mrs. Hogan hands her neighbor her cell phone and
asks the neighbor to dial a telephone number. “That number is my husband’s boss. My husband just
started working for an asbestos removal company about a month ago. He is usually on the road
somewhere. Can you ask his boss to get a message to him that I am here?”

While auscultating Mrs. Hogan’s lung sounds, the nurse hears expiratory wheezes and scattered rhonchi
throughout. Mrs. Hogan is afebrile. Her vital signs are blood pressure 142/96, pulse 88, and respiratory
rate 34. Her oxygen saturation on room air is 86%. Arterial blood gases (ABGs) are drawn. Mrs. Hogan is
placed on 2 liters of humidified oxygen via nasal cannula. She is started on intravenous (IV) fluids and
receives an albuterol nebulizer treatment
DIAGNOSIS: ACUTE DIVERTICULITIS STUDENT NURSE: MARIEFLOR LUGO

GENDER Female AGE 46 SETTING ■ Hospital ETHNICITY ■ White American COEXISTING CONDITION ■
Urinary tract infection (UTI) SOCIOECONOMIC ■ Married; no children PHARMACOLOGIC ■ Cefoxitin
sodium (Mefoxin); metronidazole (Flagyl); morphine sulfate; diphenoxylate hydrochloride with atropine
sulfate (Lomotil); propantheline bromide (Pro-Banthine); acetaminophen (Tylenol)

Client Profile Mrs. Dolan is a 46-year-old female who presented to the emergency department with
complaints of episodic abdominal pain, a low-grade fever, and diarrhea for almost two weeks. Mrs.
Dolan was on vacation in another country when she developed pain in the left lower quadrant of her
abdomen. Mrs. Dolan delayed seeking health care because of fear of the country’s unfamiliar medical
system and the assumption that bad water or food she had while on vacation must have given her a
stomach “bug.” Mrs. Dolan also reports a recent onset of painful urination.

Case Study Upon examination in the emergency room, Mrs. Dolan is found to be dehydrated with a
fever of 102.58F (39.2 8C). Vital signs are blood pressure (BP) 106/58, pulse 88, and respiratory rate of
22. Her potassium (K1) level is 2.8 mEq/L, erythrocyte sedimentation rate (ESR) is 37 mm/hr, and white
blood cell (WBC) count is 16,000 cells/ mm3. A urinalysis showed a positive urinary tract infection (UTI)
and an abdominal/pelvic computed tomography (CT) scan revealed diverticulitis with a question of an
ileus. Mrs. Dolan is admitted and started on intravenous (IV) fluid of D51/2 normal saline (NS) with 20
mEq of potassium chloride (KCl) at 50 mL per hour. Two IV antibiotics (cefoxitin sodium and
metronidazole) are prescribed. Her admitting orders include nothing by mouth (NPO), bed rest, IV
morphine sulfate for pain management, stools to be checked for occult blood, strict intake and output (I
& O), and repeat blood work in the morning to monitor her K+. Her height and weight on admission are
5 feet 7 inches and 170 lbs (77.3 kg). She is prescribed diphenoxylate hydrochloride with atropine
sulfate, propantheline bromide, and acetaminophen as “as needed” pro re nata (prn) medication

CASE PROGRESSION…..

After three days of IV fluids, antibiotics, and bowel rest, Mrs. Dolan’s K1 level is 3.7 mEq/L, ESR is 30
mm/hr, and WBC count is 15,000 cells/mm3. Her vital signs are blood pressure (BP) 114/68, radial
pulse/heart rate (HR) 102, respiratory rate (RR) 18, and temperature of 1038F (39.48C). Mrs. Dolan has a
follow-up abdominal/ pelvic CT scan. The CT scan reveals that Mrs. Dolan’s diverticulitis has not
responded to conservative medical management and an abscess has developed. Surgical intervention is
necessary and she is scheduled for surgery the next morning
DIAGNOSIS: ACUTE PANCREATITIS STUDENT NURSE: BIANCA CARNATE

GENDER Female AGE 88 SETTING ■ Hospital ETHNICITY ■ White American

PREEXISTING CONDITIONS ■ Heart failure (HF); hypothyroidism; gastroesophageal reflux disease
(GERD); allergy to penicillin (PCN)

PHARMACOLOGIC ■ Potassium chloride (KCl); pantoprazole sodium (Protonix); levothyroxine sodium

(Synthroid); spironolactone (Aldactone); metoclopramide (Reglan); morphine sulfate (MS Contin)

Client Profile Mrs. Miller is an 88-year-old woman who presented with complaints of nausea, vomiting,
and abdominal pain. Her vital signs on admission are temperature 99.6°F (37.6°C), blood pressure
113/82, pulse 84, and respiratory rate 20. Her laboratory tests reveal white blood cell count (WBC)
13,000/mm3, potassium (K+) 3.2 mEq/L, lipase 449 units/L, amylase 306 units/L, total bilirubin 3.4
mg/dL, direct bilirubin 2.2 mg/dL, aspartate aminotransferase (AST) 142 U/L, and alanine
aminotransferase (ALT) 390 U/L. Physical examination reveals a distended abdomen that is very tender
on palpation. Bowel sounds are present in all four quadrants, but hypoactive. Mrs. Miller is admitted
with a diagnosis of acute pancreatitis. She will be kept nothing by mouth (NPO). Intravenous (IV) fluid of
D51/2 NS with 40 mEq of potassium chloride (KCl) per liter at 100 mL per hour is prescribed. The health
care provider prescribes continued administration of her preadmission medications, that is,
pantoprazole sodium and levothyroxine sodium (in IV form because the client is NPO) and
spironolactone (available in oral form), and adds the prescription of IV metoclopramide and morphine
sulfate. A nasogastric (NG) tube is inserted and attached to low wall suction.

Case Study Mrs. Miller’s NG tube is draining yellow-brown drainage. Her pain is being managed
effectively with IV morphine 4 mg every four hours. Mrs. Miller is anxious and has many questions for
the nurse: “What is the test I am having done today? What is pancreatitis? Will I need to have surgery?
Why did they put this tube in my nose? When will I be able to eat real food?
DIAGNOSIS: BREAST CANCER STUDENT NURSE: ELINNE BALLON

GENDER Female AGE 45 SETTING ■ Hospital ETHNICITY ■ Black American

PREEXISTING CONDITION ■ Gravida 2, Para 2 SOCIOECONOMIC ■ Married; mother of two children
(ages 12 and 10 years old) PHARMACOLOGIC ■ Tamoxifen citrate PRIORITIZATION ■ Emotional
support and patient advocacy DELEGATION ■ Collaboration and referral to comprehensive breast
center and Reach for Recovery

Client Profile Mrs. Whitney is a 45-year-old woman who noticed a lump in her left breast during her
monthly breast self-exam two weeks ago. She made an appointment with her gynecologist who
documents “a fixed round lump with irregular borders palpated in the upper outer quadrant of left
breast at 2:00. Left axillary edema noted. There is symmetry of the breasts with no puckering or nipple
discharge. The client denies pain.” Mrs. Whitney began having her menstrual period at 10 years of age.
She has two children, both of whom she breastfed for approximately twelve months. Mrs. Whitney’s
oldest sister died of breast cancer. Mrs. Whitney has a diagnostic mammogram and a fine-needle
aspiration biopsy. It is determined that she has stage II breast cancer.

Case Study Mrs. Whitney will have a lumpectomy with lymph node dissection (partial mastectomy). A
Jackson-Pratt (JP) drain will be in place postoperatively. Following surgery, tamoxifen is prescribed.