Case Study BSN Pathophysiology

Case study

• Cassie Felton is a 30-year old, African American female admitted to the hospital due to concerns of

gradually worsening dyspnea, abdominal distention, and occasional palpitations for the past 2 weeks.

• She reports a 4-year history of fatigue, generalized weakness, and joint aches that first appeared after

giving birth to her first child. Her issues were attributed to stress and lack of rest. After many months

of working to reduce stress and obtaining help with child care, the complaints resolved.

• After the birth of her second child one year ago, the complaints returned with increased severity. In

addition to a 35-pound unintentional weight loss, she has experienced worsening fatigue, generalized

weakness, pain, and morning stiffness in her knees and elbows. She has been unable to play in the

yard with her children or do yard work due to joint pain. She is now unable to sit and type for long

periods of time and had to take time off work.

• She has no known allergies. She denies ever smoking, drug use, and alcohol use. She has a personal

history of Reynaud phenomenon; and had only been hospitalized twice for vaginal childbirths

without any obstetrical complications. She has a family history of rheumatoid arthritis on her

maternal side.

Physical examination and diagnostic test results

• General, neuromuscular: Alert, oriented, cooperative, no acute distress. In bilateral elbows and knees

there is limited range of motion; crepitus and pain with motion; weakness (elbows 4/5, knees 3/5);

edema; erythema; and warmth. No obvious joint deformity noted.

• Vital signs: Temperature = 98.4 degrees Fahrenheit (oral); respiration rate = 24 breaths/min,

unlabored; heart rate = 88 beats/min, sinus rhythm; blood pressure = 102/66 mmHg (sitting); oxygen

saturation = 90% on room air; pain = 5/10 in elbows and knees.

• Skin, mucous membranes: Oral mucosal pallor, malar rash, and bilateral palpable axillary

lymphadenopathy.

• Cardiopulmonary: S1 and S2, no abnormal heart sounds. Decreased breath sounds and dullness to

percussion were noted at the left base. No signs of cyanosis or clubbing.

• Abdomen: Palpation and percussion revealed a distended, but soft and non-tender abdomen.

Normoactive bowel sounds in all quadrants

Diagnostic Test Results (objective data)

• Abnormal serum results: Red blood cell count = 3.2 million cells/mcL (normal 4.2–5.4 million

cells/mcL), hemoglobin = 9.5 g/dL (normal 12–16 g/dL), hematocrit = 31% (normal 37-47%),

platelets = 138,000/mcL (normal 150,000–400,000/mcL), blood urea nitrogen = 28 mg/dL (normal

6-20 mg/dL), creatinine = 150 mg/dL (normal 88-128 mg/dL), antinuclear antibody (ANA) test

positive at 1:640 (normal is low/none), anti-DNA antibody test elevated (normal is low/none)

• Urinalysis: Trace proteinuria

Spring

To answer questions 1-3, use the scenario above

1. Identify the likely disorder, the underlying pathophysiology (i.e., cellular and tissue changes),

and relate the changes to abnormal findings to support your interpretation. (20 points) Hint: We

are in the immune system ☺ !

2. Identify all nursing diagnoses labels (just the label!) that apply to this patient (e.g., impaired

swallowing). Identify the priority (#1) nursing diagnosis label; and for the (#1) nursing diagnosis

label, explain the nursing interventions to address the identified problem. Provide evidence-

based rationale to explain the need and/or benefit of each intervention. For interventions, include

what the nurse should “monitor/assess”, “do”, and “teach” to the client. (20 points)

3. Describe 2 medical therapies used to treat the disorder and explain their specific mechanism of

action and intended impact at the cellular and/or tissue level. (15 points)

To answer questions 4-5, choose ONE disorder from this week’s reading

4. For the chosen disorder, identify the disorder and describe the impact on the population in the

United States including incidence, prevalence, costs, morbidity, mortality, and/or other

appropriate issues. Be sure to identify the disorder, the population associated with the data, and

the year(s) of data. (15 points)

5. For the chosen disorder, locate recommendations in a nursing journal article or professional

nursing organization. Provide a brief summary of the information and specific recommendations

for nursing actions to improve care for patients. (15 points) Hint: To increase the likelihood of

locating a nursing journal or organization, look for some form of the word “nurse” in the

journal or organizational name!

Scholarly Writing: Use correct spelling, grammar, sentence structure, formatting, professional terms,

title page, paraphrasing, citations, and references. Sources current (<5 years old) and professional (15

points)