Case Studies Activity Instructions

Case studies are stories. They present realistic, complex, and contextually rich situations and involve problems to solve and/or questions to answer. Thoroughly read the case studies below and answer the questions presented in each. Your responses to the questions must be detailed and include information supported by academic sources (textbook, .gov, and .edu webistes). Do not use .com, .net, .org, or blog websites. All sources must have been published within the last 5 years.

Please complete all 3 case studies. Your case study responses must follow current APA format and include in-text citations for any resources you use to support your answers. You must also include a separate reference page. The Case Studies Activity must be submitted as a Microsoft Word document.

This assignment is due by 11:59 p.m. (ET) on Monday of Module/Week 2.

Case Study 1

Mrs. Jones, who is 80 years old, presents to ABC Medical Associates today for her annual wellness visit. She was last seen 6 months ago by a doctor in the practice for a bout with influenza.

In today’s visit, the patient will receive her annual gynecological evaluation in addition to a general maintenance examination. She will also have blood work done to evaluate her hypertension, hypothyroid, and type II diabetes.

Mrs. Jones is covered by Medicare and AARP Medigap insurance.

Based on the information in this case study, determine if this is a new or established patient. Then, describe what information you will need to collect from the patient and what steps you must take to ensure the services being rendered will be covered by insurance. Determine which insurance policy is primary.

Case Study 2

Mr. Jones is seen in the ER at Grand Valley Hospital for chest pain. He is from another state and is visiting family. He has never been to Grand Valley Hospital previously.

While in the ER, it is determined that the patient needs a cardiac catheterization done before discharge. This procedure is performed by Dr. Lindsay.

Mr. Jones serves in the National Guard and has been covered by TRICARE since 1989. He is also covered by his employer’s health plan, Blue Cross Blue Shield, and has been covered by this health plan for the past 2 years.

Based on the information in this case study, determine if this is a new or established patient. Then, describe what information you will need to collect from the patient and what steps you must take to ensure the services being rendered will be covered by insurance. Determine which insurance policy is primary.

  

Case Study 3

Jack Minnow, a 4-year-old boy, presents to Valley Allergy practice because of a recent allergic reaction to a bee sting. He has never had a reaction previously. Jack’s primary care physician Dr. Zane is referring him to Dr. Shelby, an allergist, for a consultation. Jack is accompanied by his mother who is the custodial parent.

During the visit, Dr. Shelby performs a series of allergy tests that identify not only an allergy to bees, but also to animal dander and grass.

Jack is covered by both his mother’s and his father’s employers’ health plans. His parents are divorced. His mother went back to work after the divorce 1 year ago and enrolled Jack under her health plan due to some concerns about whether Jack’s father would keep his job. However, his father is still employed with the same company and has worked there for the past 3 years.

Based upon the information in this case study, determine if this is a new or established patient. Then, describe what information you will need to collect from the patient/guarantor and what steps you must take to ensure the services being rendered will be covered by insurance. Determine which insurance policy is primary.

Chief complaint:  “ My right great toe has been hurting for about 2 months and now it’s itchy, swollen and yellow. I can’t wear closed shoes and I was fine until I started going to the gym”.

HPI: E.D a 38 -year-old Caucasian female presents to the clinic with complaint of pain, itching, inflammation, and “yellow” right great toe. She noticed that the toe was moderately itching after she took a shower at the gym. She did not pay much attention. About two weeks after the itching became intense and she applied Benadryl cream with only some relief.  She continued going to the gym and noticed that the itching got worse and her toe nail started to change color. She also indicated that the toe got swollen, painful and turned completely yellow 2 weeks ago. She applied lotrimin  AF cream and it did not help relief her symptoms. She has not tried other remedies. Denies associated symptoms of fever and chills. 

PMH:

Diabetes Mellitus, type 2.

Surgeries: None

Allergies: Augmentin

Medication: Metformin 500mg PO BID.

Vaccination History:  Immunization is up to date and she received her flu shot this year.

Social history:

College graduate married and no children. She drinks 1 glass of red wine every night with dinner. She is a former smoker and quit 6 years ago.

Family history:

Both parents are alive. Father has history of DM type 2, Tinea Pedis. mother alive and has history of atopic dermatitis, HTN.

ROS:

Constitutional: Negative for fever. Negative for chills.

Respiratory: No Shortness of breath. No Orthopnea

Cardiovascular: Regular rhythm.

Skin: Right great toe swollen, itchy, painful and discolored.

Psychiatric: No anxiety. No depression.

Physical examination:

Vital Signs

Height: 5 feet 5 inches Weight: 140 pounds BMI: 31 obesity, BP 130/70 T 98.0, P 88 R 22, non-labored

HEENT: Normocephalic/Atraumatic, Bilateral cataracts; PERRL, EOMI; No teeth loss seen. Gums no redness.

NECK: Neck supple, no palpable masses, no lymphadenopathy, no thyroid enlargement.

LUNGS: No Crackles. Lungs clear bilaterally. Equal breath sounds. Symmetrical respiration. No respiratory distress.

HEART: Normal S1 with S2 during expiration. Pulses are 2+ in upper extremities. 1+ pitting edema ankle bilaterally.

ABDOMEN: No abdominal distention. Nontender. Bowel sounds + x 4 quadrants. No organomegaly. Normal contour; No palpable masses.

GENITOURINARY: No CVA tenderness bilaterally. GU exam deferred.

MUSCULOSKELETAL: Slow gait but steady. No Kyphosis.

SKIN: Right great toe with yellow-brown discoloration in the proximal nail plate. Marked periungual inflammation. + dryness. No pus. No neuro deficit.

PSYCH: Normal affect. Cooperative.

Labs: Hgb 13.2, Hct 38%, K+ 4.2, Na+138, Cholesterol 225, Triglycerides 187, HDL 37, LDL 190, TSH 3.7, glucose 98.

A:

Primary Diagnosis: Proximal subungual onychomycosis

Differential Diagnosis:  Irritant Contact Dermatitis, Lichen Planus, Nail Psoriasis

Special Lab: Fungal culture confirms fungal infection.

   Treatment: terbinafine 250 mg daily x 12 weeks or Itraconazole 200 mg daily x 12 weeks

 For follow up and baseline therapy the labs ordered were:   liver blood test and blood count to determine the ALT and the AST levels  

 

 Please address the following:

1. Specify when to refer the patient after therapy and why? Provide rationale.
2. According to the recommended guidelines, what are the non-pharmacological approaches to Onychomycosis?
3. Provide patient education. Keep in mind the past medical history of this patient.

Use APA 6th format

No Plagiarism please.

Will need minimum of 300 words, APA Style, double spaced, times new roman, font 12, and and Include: 3 references (2015-2018) with intext citations. 

Topic: Psychosocial Disorders (Substance abuse, dependence, and addictions)

For your assigned topic (Substance abuse, dependence, and addictions)

Discuss the incidence and prevalence of the disorder,

pathophysiology from an advanced practice perspective,

physical assessment and examination, 

evidence-based treatment plan and patient education, 

Follow up and evaluation to assess the efficacy and outcomes of the evidence-based treatment plan for management of an episodic, acute, and chronic case involving the pathology(s) you are sharing.

 

Instructions

you will discuss the steps of the research process. Specifically, you’ll be sharing how your process went as you established a topic and then completed the research for your annotated bibliography. 

Provide a detailed initial post that responds to at least two of the four prompts noted below:

1. Considering the rhetorical situation: Describe your audience and your purpose. What was the “setting”? What did you need to consider at the very start of the process?
2. Identifying Research questions: Explain how you arrived at your thesis statement by creating initial questions on a topic. How did these musings – thoughts or reflections – and fuzzy questions develop into a viable research path? What makes an effective research question? How can a solid research question be transformed into a thesis?
3. Using strategic searches to conduct academic research: Explain to the reader what one must do to establish productive online searches using academic databases in the Herzing library. What is a Boolean operator? How can we use limiters to yield better results? What is a database? Which search terms and Herzing Library databases did you use for your search? In your post, provide the steps of your process.
4. Critically evaluate sources: How do we determine if a source is suitable? What is CRAAP? As you sort through your sources, what did you do to determine if they were credible or not? What did you look for?

Finally, address the following: What challenges have you overcome? What resources are available to you or what habits can you adopt to help you overcome these hurdles? What advice would you give other students? 

Please be sure to validate your opinions and ideas with citations and references in APA format.

This topic is valued at 40 points. Please review post and response expectations. Please review the rubric to ensure that your response meets criteria (Read Me First Section of the Course).

Peer Response: Unit 6, Due Sunday by 11:59 pm 

Instructions

Respond meaningfully to at least one of your peers.

• Ask a probing or clarifying question.
• Share an insight from having read your colleague’s posting.
• Offer, support, or challenge a position
• Validate an idea with your own experience.

Please be sure to validate your opinions and ideas with citations and references in APA format.