CASE STUDY

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CHIEF COMPLAINT: “I have been having dark stool and stomach pain for 3 days.”

HISTORY OF PRESENT ILLNESS: Mr. Marsh is a 32 year old who has been recently promoted to junior partner at a prestigious law firm. He is proud of his accomplishments at such a young age, and after being with the firm for a short time. He admits to feeling pressure and stress due to this new stage. He’s been having stomach pain for about a month, but it has worsened over the past few days. He reports that his stool has a dark, black appearance as well. Because of his hectic schedule, he does not really eat much, but when he does eat, he has a burning pain after meals. He takes medications for pain relief.

Prior to this visit, Mr. Marsh is healthy. His past medical history was for a tonsillectomy & adenoidectomy at age 10. Denies smoking, drinking or recreational drug use. He has annual check-ups as scheduled.

PHYSICAL EXAMINATION: AAOx 3. Well groomed, well nourished white male. Vital signs: BP 110/80 mmHg, HR 100/bpm right arm sitting, RR-18/bpm, T 98.6

HEENT/SKIN: Head is normocephalic. PERRLA. Tympanic membrane pearly gray. Patent nares. No bulging turbinates. Neck supple, trachea midline. Pallor of face. Mucous membranes moist, intact.

CARDIOVASCULAR: Lungs are clear to auscultation and percussion. S1, S2. No murmurs, bruit or thrills. Peripheral pulses are present but are rapid and weak.

ABDOMEN/RECTUM: To be completed by the nurse.

Rectal examination revealed black, tarry stool.

LABORATORY TESTS: Hemoglobin 9gm/dL, Hematocrit 27%, MCV 90. WBC 13,000/mm. PT/PTT – normal. BUN 12 mg/dL, Creatinine 0. 8 mg/dL. EKG-normal sinus rhythm, Chest x-ray -normal. X-ray of abdomen (kidney, ureter, bladder-KUB) is unremarkable.

1. What are signs and symptoms of anemia?
2. What is rebound tenderness? Guarding?
3. What do the vital signs reveal?
4. What would your abdominal assessment reveal? (Think IAPP)

a.Inspection-

b. Auscultation-

c. Percussion-

d. Palpation-

5.What medication could have contributed to his symptoms?

6. What is the diagnosis?

7. What medication regimen would be ordered for treatment?

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DISCUSSION

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Please write 1 paragraph for each of the following (total 3 paragraphs) and each paragraph shall be no more than 6 sentences.

*** Minus 1 point for extra long paragraphs or over 9 sentences.

(Make sure to post in the assignment & discussion tabs)

1. What is the difference between osteoporosis, osteopenia & osteomalacia?

2. Name 3 treatments for osteoporosis.

3. For what reason would a wrench need to be readily accesible for a patient on an orthopedic unit?

4. What is the proper order/sequence to assess the GI system?

5. Name one medication that affects the oral cavity (i.e. gums).

Comment 1

Imago dei means the image of God. It is a Christian concept of how man or human being was created in the image of God, and it bestows honor and dignity of each person irrespective of their social, mental and physical status (Shelly, 2006). Imago dei or the image of God is a theological term, and it applies to a human being only. The concept has its roots in Genesis. The concept of imago dei does not imply that we reflect the image of God in the real or literal sense but His intellectual, spiritual and moral nature.

Mother Teresa was driven by the concept of imago dei to care for the poor, the sick and also dying in Calcutta. This concept has motivated many Christians to care for the sick, the poor and the disenfranchised. Having an understanding that other human beings are created in the image of God is an important aspect that drives healthcare employees to care for a sick patient and also give those who are about to die a comforting and peaceful death (Shelly, 2006). The concept also help people in the societies to help each other in times of need. There is a saying in the healthcare sector that for the caregiver (nurse, physician, psychologist, social worker, etc.) the client or patient no longer remain a fellow human being in distress but the likeliness of eternal God. This awareness transform relationship between patients and caregivers to the recognition of the sanctity of other (Grove, 2015). The concept of imago dei is important in healthcare because it is the basis of the Western society’s comprehension of human rights as well as undergirds of the legal system. It also helps them understand the social service and healthcare agencies.

Comment 2

The readings from Meilaender made an interesting distinction between procreation and reproduction as well as between that of being begotten and being made. Procreation refers to the world as designed or given by the Creator, whereas Meilaender defines reproduction as the work of humans to, “master and reshape our world” (2013, p.10) or, stated another way, by conceiving through man-made technologies (2013). 

The term “begotten” goes along with procreation. If one is begotten, they have been naturally conceived. The child who is begotten is the union of his father and mother in physical, bodily form. This child has not been reproduced by human means. Their parents’ act of love has resulted in life being given to the child. Our text describes the begotten child as being different but equal to his parents because he is created of their flesh. To quote Meilaender, “The Father gives all that he is and has to the son. He begets him” (2013, p.15).

Conversely, “made” refers to a child who is conceived through human means, such as in vitro fertilization, surrogacy, artificial insemination, or some other technology developed by humans. This child is described as being created through our own reason and will, as opposed to God’s reason and will. The “made” child is not conceived through the human act of love, and thus, the most foundational component of human equality is absent (Meilaender, 2013).

I had not considered the difference between either procreation and reproduction or begotten and made, and I can very much see the validity in the argument put forth my Meilaender. However, I do not know that I completely agree or disagree. Like so many topics in ethics, I see a grey area. I do not think it’s as simple as agreeing or disagreeing. I feel that if I agree, I’m saying that the parents who love and cherish their children who were conceived through technological means were “wrong” in doing so, but the parents who had children through naturally conception but do not love and care for their children are “right.” To me that doesn’t seem right. At the same time, I also understand that, if this is truly God’s plan, I need not completely understand it in order to have faith in it. 

Guidelines in Writing the Paper:

1.         The paper will be three pages in APA format, not including the cover page, the APA title page, and  

the reference page. See page 54 for the cover page format.  

2.         The paper will contain an introduction, body, and conclusion.

3.  The introduction explicitly identifies the concept “self-help group” and the purpose(s) of the paper.

4.  The body will include:

· The date, time, location of the meeting

· A description of the atmosphere of the meeting place (approximate number of people, environment, attitude of different people, etc.)

· Explain the step(s) that was (were) discussed in the AA/CA/NA meeting. If the step(s) were not discussed, then explain what was discussed. OR Explain what was discussed in the Al-Anon/Alateenmeeting. Provide examples.

· A description of some of the interpersonal relationships you observed

· How you think a “newcomer” with a substance-related problem or mental illness disorder may feel attending the meeting for the first time.

· How you felt as an individual attending the meeting 

· A description of how AA/CA/NA or Al-Anon/Alateenis a therapeutic intervention for persons living with a substance-related or mental illness disorder.

5.  The conclusion is based on your experience of observing the (AA/CA/NA or Al-Anon/Alateen) meeting. In addition, describe the significance to mental health nursing/nurses of the information presented in the paper.

6.  Please take the utmost care in writing this paper to ensure that you do not reveal 

anyone’s identity.  Confidentiality!

Let’s look over the current draft of your paper, and then, answer the following questions:

• 1)First, looking over each section of the draft, in what area do you feel you did particularly well? What made it so strong, and how will you use these strengths in other sections of the draft that may need additional work?
• 2)Second, which sections of your draft do you feel need further improvement? Why do you feel these sections need to be revised? Which peer or instructor feedback will you use during the revision process?