Case Study 1 & 2 (10 Points)

Students must review the case study and answer all questions with a scholarly response using APA and include 2 scholarly references. Answer both case studies on the same document and upload 1 document to Moodle.

The answers must be in your own words with reference to the journal or book where you found the evidence to your answer. Do not copy-paste or use past students’ work as all files submitted in this course are registered and saved in turn it in the program.

Answers must be scholarly and be 3-4 sentences in length with rationale and explanation. No Straight forward / Simple answer will be accepted. 

Turn it in Score must be less than 25 % or will not be accepted for credit, must be your own work and in your own words. You can resubmit, Final submission will be accepted if less than 25 %. Copy paste from websites or textbooks will not be accepted or tolerated. Please see College Handbook with reference to Academic Misconduct Statement.

All answers to case studies must have reference cited in the text for each answer and a minimum of 2 Scholarly References (Journals, books) (No websites) per case Study

Case Study 1

Mr. JS presents today to your office for a follow up appointment after a BP reading at home of

166/95 last week. He is a 52 y/o male with a PMH of HTN and Angina secondary to CAD, which

is well controlled, experiencing less than 1 attack per month.

On today examination, MR JS’s vital signs are as follows:

Temperature: 96.8º

Heart Rate: 68 bpm

Blood Pressure: 168/92

Respiration: 14

Ox Sat: 95% at room air

Pain: denies pain.

Labs:

Last LDL on records (6 months ago): 189

Current Medications:

Atorvastatin 40 mg/day

Metoprolol tartrate 10 mg/twice/day

CASE STUDY QUESTIONS:

1) According to the recently released American Heart Association guidelines on hypertension,

what should be the BP goal for a patient with chronic stable angina and hypertension?

2) In addition to diet and lifestyle modifications, what is the medication of choice to control the

BP of a patient with chronic stable angina? Provide rationale

3) Provide at least 3 (questions) you would ask your patient RELATED to the case presented and

provide rationale.

4) Please explain whether you would request any laboratory or screening tests for this patient

and why (if any)

5) How would you achieve the B/P goal recommended for this patient according to the

guidelines provided above?

6) Provide References in APA style

……………………………………………………………………………………………………………………………………………………..

Case Study 2

Testicular Cancer

Case Studies

A 21-year-old male noted pain in his right testicle while studying hard for his midterm college

examinations. On self-examination, he noted a “grape sized” mass in the right testicle. This

finding was corroborated by his healthcare provider. This young man had a history of delayed

descent of his right testicle until the age of 1 year old.

Studies Results

Routine laboratory studies Within normal limits (WNL)

Ultrasound the testicle Solid mass, right testicle associated with calcifications

HCG (human chorionic gonadotropin) 550mIU/mL (normal: <5)

CT scan of the abdomen Enlarged retroperitoneal lymph nodes

CT scan of the chest Multiple pulmonary nodules

Diagnostic Analysis

At semester break, this young man underwent right orchiectomy. Pathology was compatible with

embryonal cell carcinoma. CT directed biopsy of the most prominent pulmonary nodule

indicated embryonal cell carcinoma, compatible with metastatic testicular carcinoma. During a

leave of absence from college, and after banking his sperm, this young man underwent

aggressive chemotherapy. Repeat testing 12 weeks after chemotherapy showed complete

resolution of the pulmonary nodules and enlarged retroperitoneal lymph nodes.

Critical Thinking Questions

1. What impact did an undescended testicle have on this young man’s risk for developing

testicular cancer?

2. What might be the side effects of cytotoxic chemotherapy?

3. What was the purpose of preserving his sperm before chemotherapy?

4. Is this young man’s age typical for the development of testicular carcinoma?

Week 4: Discussion on End-of-Life Decisions and Advanced Directives

Participation Requirement: You are required to post a minimum of three (3) times in each discussion. These three (3) posts must be on a minimum of two (2) separate days. You must respond to the initial discussion question by 11:59 p.m. on Wednesday.  On additional days, respond to your peers’ posts as well as additional faculty posts. Responses to peers must be posted by 11:59 p.m. on Sunday each week a discussion is due.

Step 1: Read attached article entitled, Advance Directives and Health Care Planning-Are all the pieces in place.pdf 

Step 2: Read the following article: Effect of Living wills on End of Life Care.pdf

Step 3: Watch the video, “Advanced Directives: Important Healthcare Tools for Supporting You and Your Family”https://www.youtube.com/watch?v=GOIrnjqP5_M (Links to an external site.)

Step 4: Watch the video, “How to Have an End of Life Discussion”https://www.youtube.com/watch?v=JtkgTzCSzqk (Links to an external site.)

An Advanced Directive is a document in which a client who is competent is able to express wishes regarding future acceptable health care. The document may include decisions including the desire for extraordinary lifesaving measures, such as resuscitation, intubation, and artificial hydration, and nutrition. The advanced directive may also be used to designate another person to make decisions when the client becomes physically or mentally unable to do so. The Patient-Determination Act requires all clients admitted to a health care facility be asked if they have advanced directives.

Planning guides for seriously ill clients includes:

1. Living will: Legal document that instructs health care providers and family members about what, if any, life-sustaining treatment an individual wants if at some time the individual is unable to make decisions.
2. Durable power of attorney for health care: Legal document that designates another person to make health care decisions for the client when the client becomes unable to make decisions independently.

Nursing intervention in these types of situations is to ensure to communicate to the interdisciplinary health care team that the client has provided and advanced directive and that it has been placed in the client’s medical record. Clients who do not have advanced directives must be given written information outlining rights related to health care decisions.

Initial Discussion scenario:

Mr. Gomez is a 73-year-old man who is estranged from his wife. Since he prefers that she doesn’t make any medical decisions for him should the need arise, he has filled out an advance directive naming his daughter Elena as his health care proxy. He has suffered from diabetes for many years and is adamant that he does not want dialysis, even if it would sustain his life. He does, however, wish to have tube feeding for however long it will sustain him.

One evening while at home with his daughter, Mr. Suarez has a seizure. He is taken to the hospital immediately, but never regains consciousness and doctors do not expect him to do so. Elena contacts her mother Mr. Gomez’s estranged wife and she quickly joins her daughter at the hospital. They want to put him on dialysis (as his diabetes is worsening) and a feeding tube (as there is no other way for him to receive nutrients). His daughter informs the doctors of her father’s end-of-life wishes. The doctors warn her that without dialysis her father will pass away more quickly, even with the feeding tube. Mr. Gomez’s estranged wife informs Elena that she needs to follow the advice received from the doctors in order to save her father’s life. Elena says that although she is aware of the consequences, she wants them to carry out her father’s wishes.

The clients estranged wife immediately has her attorney file an order to stop Elena from following her father’s wishes that are in his advanced directive. She feels that even though they are estranged, she still should have the right to make decisions regarding Mr. Gomez’s care. This action delays Elena’s ability to honor her father’s wishes and the doctors feel that it is necessary to inform the hospital’s ethics committee about the ongoing issue.

Assignment: Discuss the following questions

1. What is the role of the doctors in deciding whether or not to respect Mr. Gomez’s advanced directive?
2. Does Mr. Gomez’s estranged wife have the authority to step in and ignore Mr. Gomez’s advanced directive. Explain your reasoning while providing evidence-based solutions in your conclusion.
3. Gomez’s estranged wife has filed temporary order to ignore the advanced directive. If you were Elena, how would you handle this dilemma? What rights does Elena have that allow her to honor her father’s wishes?
4. What is the role of the ethics committee and how can they best support the client and his family?