NURS 530 Acute Bacterial Meningitis Case Study

Case studiesWeek 3 Case Study
The purpose of the case study is to have you expand on
the pathophysiological disease process by searching for evidence-based practice
treatment and advanced practice nursing role implications related to the disease.
Case Study Topic:
Select either a type of pain syndrome or a neurologic disease process
(headache, CVA, acute bacterial meningitis, Alzheimer’s, anxiety, depression,
chronic pain syndrome) and discuss the pathophysiologic process
involved.
Identify current evidence-based treatment modalities for the selected syndrome or
disease and discuss how the treatment impacts the disease process.
Conduct an evidence-based literature search to identify the most recent standards
of care/treatment modalities from peer-reviewed articles and professional
association guidelines (www.guideline.gov) (Links to an external site.). These
articles and guidelines can be referenced, but not directly copied into the clinical
case presentation. Cite a minimum of three resources.
Include the following in your clinical case presentation:
1. A discussion of the pathophysiology of the disease, including signs and
symptoms.
2. An explanation of diagnostic testing and rationales for each.
3. A review of different evidence-based treatment modalities for the
disorder obtained from guideline.gov or a professional organization.
Next, address the following questions:
1. How does the information in this case inform the practice of a master’s
prepared nurse?
2. How should the master’s prepared nurse use this information to design a
patient education session for someone with this condition?
3. What was the most important information presented in this case?
4. What was the most confusing or challenging information presented in
this case?
5. Discuss a patient safety issue that can be addressed for a patient with
the condition presented in this case.
The use of medical terminology and appropriate graduate level writing is expected.
Your paper should be 3–4 pages (excluding cover page and reference page).
Your resources must include research articles as well as reference to non-research
evidence-based guidelines.
Use APA format to style your paper and to cite your sources. Your source(s)
should be integrated into the paragraphs. Use internal citations pointing to
evidence in the literature and supporting your ideas. You will need to include a
reference page listing those sources. Cite a minimum of three resources.
Week 8 Extended Case Study
Maria is a 42-year-old single mother living in New York City with her three sons. She
immigrated to New York from Peru two years ago. About six months after she arrived, she
began developing night sweats and unexplained fevers. Most recently, she has developed a
persistent, worsening cough. Her illegal status has made her hesitant to seek medical
treatment, but a neighbor told her that the local community clinic would see her and would
not check her residency status.
Screening at the clinic included a questionnaire that addressed some of the problems she
was experiencing. The nurse explained to Maria that she might have TB. The physician
treating Maria performed a complete physical exam and discussed her questionnaire
responses with her, including her response that in Peru, she lived with her grandfather who
she believes may have died from TB.
Physical exam findings showed abnormal lung sounds in Maria’s upper lobes bilaterally.
The physician found cervical and axial lymphadenopathy. Maria was asked to leave sputum
samples to be tested for mycobacterium tuberculosis. A PPD was placed with instructions
for Maria to return in two days to have it read. When Maria returned two days later, the
result showed a 10 mm raised, red reactive site. Maria was also screened for HIV at the
time of initial exam because it is often found in patients with TB. In this case, she tested
negative for HIV. Her sputum culture tested positive for M. tuberculosis.
The physician explained that given the findings on the chest x-ray and the clinical findings
on exam, he believed that she had reactivation TB. The physician informed Maria that he
planned to start her on a four-drug regimen of isoniazid, rifampin, pyrazinamide, and
ethambutol (Myambutol) for two months. The physician then explained that a “continuation
phase” would follow, which would consist of isoniazid and a rifamycin (rifampin, rifabutin
[Mycobutin], or rifapentine [Priftin]) that is administered daily for four to seven months.
He also informed her that he would start her treatment at the hospital, where she would stay
for least two days because she was still considered contagious. Following the hospital stay,
Maria would need to come to the clinic for observed medication administration and to
assure compliance.
Two months passed and Maria continued about her day-to-day life including going to the
clinic for her medication. She attempted to work full time and to take care of her three sons.
She found that her night sweats had become a nightly occurrence, and her cough had
become productive with blood along with intense coughing spells. Maria was compliant
with the drug regimen but called the clinic because her symptoms were worsening. Maria
was scheduled for a visit the very next day.
The follow up chest x-ray showed no improvement, and it was determined that Maria was
exhibiting signs of multidrug-resistant TB. Because multidrug-resistant and extensively
drug-resistant tuberculosis requires at least 18 to 24 months of therapy, depending on the
patient’s response to treatment, the physician decided to extend her therapy to 18 months,
beyond the 4 to 7 month time period he had projected. He also stopped the ethambutol and
started moxifloxacin. Thoracic surgery for resection of lung lesions is often considered as
adjunctive therapy, and this was discussed with Maria at the time of the exam.
Maria was devastated to learn about her multidrug resistant TB because she needed to
work. Fortunately, the clinic was able to fund Maria’s drugs at a discounted rate.
Nonetheless, the entire situation has put Maria under stress to the point that it is unclear
how she will meet this challenge and adequately handle her health crisis.
Review the patient’s TB questionnaire. (Page 1)
(Page 2)
Conduct an evidence-based literature search to identify the most recent standards of
care/treatment modalities from peer-reviewed articles and professional association
guidelines (www.guideline.gov (Links to an external site.)). These articles and
guidelines can be referenced, but not directly copied into the clinical case presentation.
Cite a minimum of three resources.
Answer the following questions:
1. What is the transmission and pathophysiology of TB?
2. What are the clinical manifestations?
3. After considering this scenario, what are the primary identified medical concerns
for this patient?
4. What are the primary psychosocial concerns?
5. What are the implications of the treatment regimen, as far as likelihood of
compliance and outcomes? Search the Internet to research rates of patient
compliance in treatment of TB, as well as drug resistant TB.
6. Identify the role of the community clinic in assisting patients, particularly
undocumented patients, in covering the cost of TB treatment. What resources exist
for TB treatment in community health centers around the United States? Compare
the cost for treatment between, subsidized as it would be for a community health
center, and unsubsidized.
7. What are the implications of TB for critical care and advanced practice nurses?
The use of medical terminology and appropriate graduate level writing is expected.
Your paper should be 4–5 pages, (excluding cover page and reference page).
Your resources must include research articles as well as reference to non-research
evidence-based guidelines.
Use Current APA Style to format your paper and to cite your sources. Your source(s)
should be integrated into the paragraphs. Use internal citations pointing to evidence in
the literature and supporting your ideas. You will need to include a reference page
listing those sources. Cite a minimum of three resources.
Week 4 Video Presentation
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Due Apr 3 by 11:59pm
The purpose of this assignment is to demonstrate
understanding through teaching and explanation. Begin by choosing one of the topics
below, or propose a topic of your own interest from the assigned readings subject
to instructor approval. Post your choice to the discussion board thread “Video
Presentation Topics” as soon as you make your choice. You may not select a
topic that has already been chosen by a classmate. The sooner you choose,
the more options you will have.
For this assignment, you will produce a 4–7-minute audio–video presentation on
your chosen topic.
In your presentation, include the following:
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Include at least one type of visual aid in your presentation such
as PowerPoint slides, diagrams, white board use, etc.
You are expected to explain the processes or concepts in your own words
using references to support your explanations. Include a reference list at the
end and cite references verbally or with on screen citations.
Use appropriate master’s level terminology.
Include all necessary physiology and/or pathophysiology in your explanation.
Use detailed explanations to teach or explain. Your classmates and
professional colleagues are your audience.
Reference a minimum of two sources; you may cite your e-text as a
source. Use APA format to style your visual aids and cite your sources. Include
a reference page in your video.
Your presentation must include both audio and visual components and be
professional in nature.
Possible topics:
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Explain endocrine feedback in terms of short, long, and ultra-short feedback
loops
Explain the two general effects hormones have on cells: direct effects, or
obvious changes in cell function, and permissive effects, or less obvious
changes that facilitate cell function
Explain methods used to measure the levels of hormones in the plasma
Describe the causative factor and manifestations for
the hypersecretion of prolactin
Discuss the causes of hyperpituitarism and hypopituitarism with consideration
of the populations at highest risk for the development of the disorders
Characterize the manifestations of hypothyroidism and hyperthyroidism
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Explain the process of thermoregulation
Explain the process of glucose regulation
Discuss the similarities of breast cancer invasion and normal mammary gland
branching
Explain the role of myoepithelial cells in invasive breast cancer
Explain the causes of delayed or incomplete puberty
Relate luteinizing hormone (LH) and follicle-stimulating hormone (FSH) levels
to the stages of follicle development and to progesterone and estrogen
production
Describe the functions of the female breast, and discuss the cyclic, hormonemediated changes in the breast tissue during the reproductive years and with
pregnancy
Describe the conditions present and pathophysiology of polycystic ovarian
syndrome (PCOS)
Describe the clinical presentation and pathophysiology of gonorrhea
Describe the clinical presentation and pathophysiology of hepatitis B
Describe the clinical presentation and pathophysiology of acquired
immunodeficiency syndrome (AIDS)
Propose a topic of your own interest from the assigned readings; however, it
must be submitted to your instructor for approval
Week 7 Video Presentation
The purpose of this assignment is to demonstrate understanding through teaching
and explanation. Begin by choosing one of the topics below, or propose a topic of
your own interest from the assigned readings subject to instructor approval. Post
your choice to the discussion board thread “Video Presentation Topics” as
soon as you make your choice. You may not select a topic that has already
been chosen by a classmate. The sooner you choose, the more options you
will have.
For this assignment, you will produce a 4–7 minute audio-video presentation on
your chosen topic.
In your presentation, include the following:
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Include at least one type of visual aid in your presentation such as PowerPoint
slides, diagrams, white board use, etc.
You are expected to explain the processes or concepts in your own words using
references to support your explanations. Include a reference list at the end and cite
references verbally or with on screen citations.
Use appropriate master’s level terminology.
Include all necessary physiology and/or pathophysiology in your explanation.
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Use detailed explanations to teach or explain. Your audience is your classmates and
professional colleagues.
Reference a minimum of two sources; you may cite your etext as a source. Use APA
format to style your visual aids and cite your sources. Include a reference page in
your video.
Your presentation must include both audio and visual components and be
professional in nature.
Possible Topics:
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Describe the pathophysiology for
the vesiculobullous disorders, bullous pemphigoid, and pemphigus.
Describe the clinical manifestations and treatment options for psoriasis.
Distinguish between rubella and rubeola. What are the differences between
them in pathology, manifestation, and treatment?
Provide an overview of common insect bites and parasites affecting children.
Develop a treatment plan for a child diagnosed with head lice.
Describe the cellular alterations associated with shock.
Compare and contrast the different types of
shock: cardiogenic, hypovolemic, neurogenic (vasogenic), anaphylactic, and
septic.
Define multiple organ dysfunction syndrome (MODS), discuss risk factors
associated with MODS, explain the pathogenesis of MODS, and compare
primary and secondary MODS.
Identify the clinical manifestations of MODS by organ system.
Compare and contrast assessment techniques used to determine the amount
of burn injury.
Discuss burn shock and fluid resuscitation in burns and discuss common
treatment methods for burn injuries. Also explain the three essential elements
of survival of a major burn injury.
Compare compensated and uncompensated shock in children.
Describe the common causes of scald injuries and contact, flame, electrical,
and chemical burns in children and Identify factors contributing to the depth of
burn injuries in children.
Explain and characterize the changes in the standard rule-of-nines for burns
involving children.
Define and describe the pathophysiology of reperfusion injury.
Identify and discuss fluid resuscitation, wound management, pulmonary
support, nutritional support, comfort management, and community reintegration
of children with burns.
Propose a topic of your own interest from this week’s readings; however, it
must be submitted to your instructor for approval.