Week 2 In Class Assignment
A.S. was recently diagnosed with Hodgkin disease and scheduled for a staging procedure. His previous axillary lymph node biopsy result was positive for Reed-Sternberg cells. The surgeon charted results of the staging procedure as stage I.
What is the purpose of the staging procedure for A.S.?
How does Hodgkin lymphoma spread in the body, and what does stage Isignify for A.S.?
What is the difference between Hodgkin disease and non-Hodgkin lymphoma?
What is the prognosis and predicted therapy for A.S. now that he has been diagnosed with stage I Hodgkin disease?
What side effects might A.S. expect from this therapy?
Case 2 E.O. is an 8-year-old girl with a history of asthma and allergy to bee stings. She has been brought to the clinic complaining of a throat infection. Her health care provider prescribes a course of penicillin to manage her current infection and cautions her parents to watch her closely for a reaction.
What type of reaction is the health care provider concerned about and why?
Explain the role of IgE and mast cells in type I hypersensitivity reactions. Why might E.O. react adversely to the antibiotic with the first use?
What would you tell E.O.s parents to look for when they are assessing for a reaction?
What would you suggest the parents do if a reaction does occur?
Week 3 In Class Assignment
What risk factors for primary hypertension are evident from K.H.s history and physical data?
What is the rationale for treating K.H. with an ACE inhibitor? What is the mechanism of action? What part of the blood pressure formula do they affect?
K.H.s hypertension is not adequately controlled. What other intervention might be considered?
What tips can you give K.H.s wife to improve the accuracy of her blood pressure measurement technique?
Which type of heart failure (left or right sided) is usually associated with dyspnea? What other clinical findings are likely to be present with left-sided heart failure
What compensatory mechanisms are likely to be operative in A.O. to enhance cardiac output?
What is the most likely cause of A.O.s pedal edema?
What is the cause of A.O.s exertional chest pain? What laboratory tests would be useful to confirm this diagnosis?
What is the rationale for the use of each of A.O.s medications in managing her heart disease?
Based on his case history and responsiveness to fluid therapy, what type of shock was C.C. experiencing?
What other clinical findings would be helpful in confirming the type of shock? Why?
Because of his many open wounds and invasive lines, C.C. is at risk for sepsis and septic shock. What clinical findings would suggest that this complication has developed?
Week 4 In Class Assignment
Case 1What clinical findings are likely in R.S. as a consequence of his COPD? How would these differ from those of emphysematous COPD?
Interpret R.S.s laboratory results. How would his acid-base disorder be classified? What is the most likely cause of his polycythemia?
What is the rationale for treating R.S. with theophylline and a 2 agonist?
What effects would his respiratory disease have on his cardiovascular function?
Considering both his COPD and pneumonia, in what position would R.S. have the worst ventilation-perfusion matching?
Case 2 What is the most likely cause of her respiratory distress? Why?
What diagnostic findings would help confirm this diagnosis?
What is the pathogenesis of hypoxemia in this disorder?
How will R.S.s respiratory disorder likely be treated?
Case 3 What is the underlying mechanism of R.J.s asthma? What are the three airway responses that occur during an asthma episode?
In addition to bronchodilator therapy with intermittent albuterol, what other pharmacotherapy is important in the management of asthma?
What is the significance of a PEFR at 60% predicted? If spirometry were performed at this time, what would be the likely findings?
How to monitor response to therapy?
In addition to reviewing appropriate drug therapy, what other preventive and treatment measures should be included in R.J.s discharge teaching?
Week 5 In Class Assignment
Case 1How would a pneumococcal infection lead to glomerulonephritis? How can glomerulonephritis result in nephrosis?
Use J.H.s laboratory values to determine if he is still experiencing nephrosis or his condition is progressing to renal failure.
What additional physical or laboratory findings would help determine J.H.’s degree of renal impairment?
How will J.H.’s therapy change if his condition has progressed from nephrosis to uremia?
Case 2 What type of renal failure is P.W. likely developing? What data support this conclusion?
Without adequate therapy, what may develop? Why? What is the best therapy for preventing this from occurring?
In addition to urine output, what laboratory data should be monitored to assess changes in P.W.s renal function?
If P.W.’s renal function does not return to normal but continues to be diminished, what are the subsequent stages of his renal disorder and what clinical problems do they present?
Week 6 In Class Assignment
Case study 1 What risk factors does L.B. have that predispose her to development of gallstones?
Why are fatty foods often associated with an exacerbation of symptoms?
What is the relationship between gallstones and cholecystitis?
What options are there for the surgical removal of the gallbladder? What other options are available for the treatment of cholecystitis?
Laparoscopic cholecystectomy is selected. Will L.B. continue to secrete bile after her surgery? How?
Case study 2 What are the common manifestations of alcoholic cirrhosis? Which of these are secondary to hepatocellular failure? Which are secondary to portal hypertension?
Why is F.C. at particular risk for GI bleeding?
What is the probable cause of F.C.s progressive mental deterioration? How might his mental deterioration be medically managed?
What problems might be precipitated by F.C.s abrupt cessation of alcohol intake while hospitalized?
Case study 3 What is the likely cause of the dysphagia?
What advice should he be given regarding his OTC medication at this time?
What are the usual signs and symptoms of GERD? How will it be managed?
Week 7 In Class Assignment
1. What is the most likely cause of M.G.’s signs and symptoms? What is the origin and pathogenesis? What other laboratory findings would be consistent with this etiology?
2. What are common complications of this disorder, and how would one assess for their occurrence?
3. What is the usual treatment for this disorder?
Case 2 Discussion Questions
What questions could be asked of J. S.’s family to help determine the cause of her stroke as thrombotic, embolic, or hemorrhagic (i.e., questions to assess risk factors for each type of stroke)?
Based on the scenario described above, which brain hemisphere (left or right) suffered the ischemic damage? What other manifestations of this stroke location would likely be apparent?
What medical therapies might be used to manage this current stroke and/or to prevent another one?
What information might be appropriate to give J.S.’s family about the expected recovery process after stroke?
Case 3 Discussion Questions
1. What types of motor difficulties would F.P. be expected to exhibit related to his Parkinson disease?
2. What is the rationale for managing Parkinson disease with a dopamine precursor?
3. What safety and activities-of-daily-living problems might F.P. have encountered while hospitalized?
4. If F.P. experiences seizure activity while in the hospital, what should be assessed during the seizure episode? How would his seizure be managed?