Medical Surgical Nursing Case Study: Gastrointestinal System 1

A 37-year-old executive returns to your clinic for follow-up of recurrent upper abdominal pain. He initially presented 3 weeks ago, complaining of an increase in frequency and severity of burning epigastric pain, which he has experienced occasionally for more than 2 years. Now the pain occurs three or four times per
week, usually when he has an empty stomach, and it often awakens him at night. The pain usually is relieved within minutes by food or over-the-counter antacids, but then recurs within 2 to 3 hours. He admitted that stress at work had recently increased and that because of long working hours, he was drinking more caffeine
and eating a lot of take-out foods. His medical history and review of systems were otherwise unremarkable, and, other than the antacids, he takes no medications. His physical examination was normal, including stool guaiac that was negative for occult blood. You advised a change in diet and started him on a proton-pump
inhibitor. His symptoms resolved completely with the diet changes and daily use of the medication. Results of laboratory tests performed at his first visit show no anemia, but his serum Helicobacter pylori antibody test was positive.

What is your diagnosis?

What is your next step

Medical Surgical Nursing Case Study: Cardiovascular System 1

A 72-year-old man presents to the clinic complaining of several weeks of worsening exertional dyspnea. Previously, he had been able to work in his garden and mow the lawn, but now he feels short of breath after walking 100 feet. He does not have chest pain when he walks, although in the past he has experienced episodes of retrosternal chest pressure with strenuous exertion. Once recently he had felt lightheaded, as if he were about to faint while climbing a flight of stairs, but the symptom passed after he sat down. He has been having some difficulty sleeping at night and has to prop himself up with two pillows. Occasionally, he wakes up at night feeling quite short of breath, which is relieved within minutes by sitting upright and dangling his legs over the bed. His feet have become swollen, especially by the end of the day. He denies any significant medical history, takes no medications, and prides himself on the fact that he has not seen a doctor in years. He does not smoke or drink alcohol.

On physical examination, he is afebrile, with a heart rate of 86 bpm, blood pressure of 115/92 mm Hg, and respiratory rate of 16 breaths per minute. Examination of the head and neck reveals pink mucosa without pallor, a normal thyroid gland, and distended neck veins. Bibasilar inspiratory crackles are heard on examination. On cardiac examination, his heart rhythm is regular with a normal S1 and a second heart sound that splits during expiration, an S4 at the apex, a nondisplaced apical impulse, and a late-peaking systolic murmur at the right-upper sternal border that radiates to his carotids. The carotid upstrokes have diminished amplitude.

What is the most likely diagnosis?

What test would confirm the diagnosis?

Case Study #0001: Orthostatic Hypotension

The Case Study Series of JQ Nursing Review presents a real life patient situation to encourage you to become an active learner as you read. This will also develop your critical thinking skills. Case Study Questions will challenge you to use your understanding of new concepts and help you integrate your knowledge to solve a clinical problem.

Case Study #0001: 

Orthostatic Hypotension

Scenario
As a nurse, you are assigned at the Emergency Room of the hospital to provide rapid assessment and intervention to various clients.

 In your shift a 72-year old woman was accompanied by her son presented herself at the emergency room. You asked what brings her to the hospital and you've found out that for 3 days, she have had  fever and chills and stayed mostly in bed. On rising to go to the bathroom, she felt dizzy, fainted, and fell to the floor. She regained consciousness immediately and called her son.

Upon further assessment and evaluation by the health team, a diagnosis of Orthostatic Hypotension was made.

Clinical Questions
a. Describe the normal response to a decrease in blood pressure on standing.
b. What happened to the client's heart rate just before she fainted? Why did the client faint?
c. How did the client's fainting and falling to the floor assist in establishing homeostasis (assuming she was not injured)?