Posted: May 6th, 2015

Clinical Medicine Case Studies

Paper, Order, or Assignment Requirements

 

 

4 case studies. The requirements are included on the case studies document that I will send. Any number of sources/references may be used that you deem to be appropriate.

The prescribed text book: Craft, J., Gordon, C. & Tiziani, A. (2011). Understanding
Pathophysiology (4th ed). Chatswood, NSW: Elsevier Australia.
? Recommended text book: Bryant, B. & Knights, K. (2011). Pharmacology for
Health Professionals (3rd ed). Chatswood, NSW: Elsevier Australia.

 

Case study 1

Louise is 39 years old and has visited you for a consultation because she feels tired, lethargic and generally lacks energy to perform normal daily tasks. She works full time, has three children (aged 15, 12 and 10) and is the primary carer for her children. Her job involves long hours, so she is constantly juggling her work requirements with her parenting requirements. About five months ago, she visited her medical doctor for a general check-up. Her doctor told her that her blood pressure was elevated, possibly due to stress, and that she should have it rechecked in six months time. Her doctor told her that she also needed to lose about 15 kilograms of body fat to improve her general health. Louise began an exercise routine but couldn’t maintain it, so she decided to lose weight by adopting a vegetarian diet as she felt this would decrease her fat intake. When you asked her about her diet, she tells you that she didn’t seek any advice from a professional before changing her diet and that, apart from the occasional piece of chicken breast, she removed of meat products from her diet and the diets of her children.

 

1. What underlying medical condition would you suspect Louise has given her age, her dietary changes and her complaints of fatigue, lethargy and general lack of energy? Include a brief justification as to why you have selected this medical condition.

I suspect Louise has iron deficient anaemia. I believe this to be due to her diet change (removal of meat). She is also presenting with classic signs and symptoms – fatigue, lethargy and lack of energy.

1. In addition to the client’s complaints listed above, what other signs and symptoms would you expect Louise to present with if she did have the condition that you identified in Part A? Provide at least five (5) signs and five (5) symptoms and ensure that you clearly distinguish which factors are signs of the medical condition and which factors are symptoms of the medical condition.

Signs	Symptoms
Pallor of skin	Headaches
Angular stomatitis (corners of mouth look sore and dry),	Faintness
Glossitis (tongue redness, soreness and atrophy of the papillae)	Dizziness
Koilonychia (spoon shaped nails)	Dyspnoea
Stomatitis (inflammation of the mouth)	Dysphagia

 

1. Explain the physiologic link between the condition that you have identified and Louise’s complaints of tiredness, lethargy and lack of energy.

Iron is important in manufacturing haemoglobin, therefore if there is a reduction of haemoglobin in the blood, a reduced oxygen carrying ability to the cells occur.  Louise’s lack of energy, lethargy and tiredness can be associated with the decreased amount of oxygen available for energy production in the tissues.

1. What potential effects could Louise’s decision to change her children’s diet have on their development and health? Include a brief description of how the dietary change affects each factor you have identified.

 

Case study 2

Tony is a 47 year old male that works as a brick layer. When he was in his mid-20s, he suffered acute kidney failure due to dehydration that left him with a small degree of nephron damage. During a recent full medical review, Tony’s doctor commented that Tony’s blood pressure had increased. Subsequent pathology tests showed that Tony’s LDL -cholesterol levels had increased, his HDL cholesterol levels had decreased and that his kidney function had deteriorated. As a result, Tony’s doctor diagnosed him with Stage 3 chronic kidney disease.

 

1. How does dehydration affect kidney function? In your response, include an explanation of how dehydration can result in acute kidney injury and permanent nephron damage.

Dehydration affects kidney function as a decreased amount of water excreted by the kidneys causes urine to become more concentrated, and there is not enough fluid present to allow substances to dissolve properly.

1. Why did Tony’s doctor examine Tony’s cholesterol level and blood pressure when diagnosing him with chronic kidney disease? Explain the physiological relationships between hypercholesterolaemia, hypertension and chronic kidney disease.

 

1. In addition to his altered blood lipid profile and raised blood pressure, what other signs and symptoms could Tony have that would indicate chronic kidney disease? Outline at least three signs and three symptoms and make sure that you clearly identify which are signs and which are symptoms.

 

1. If Tony’s condition continues to worsen, how would his chronic kidney disease affect his integumentary and immune systems? Include an explanation of the physiological mechanisms responsible for these factors in your response.

 

1. Tony’s doctor recommended that he decrease his protein intake and monitor his salt intake. He was also prescribed ACE inhibitors. Briefly explain how each of these intervention strategies could assist with the maintenance of Tony’s chronic kidney disease

 

 

Case study 3

Jane is a 48 year old woman that suffers from asthma that is triggered primarily by dust and pollens. She has been prescribed two medications to help her control her asthma, a PulmicortTurbuhaler (200ug) and a BricanylTurbuhaler (500ug). When she was 41, Jane underwent a hysterectomy and consequently experienced early menopause. During a recent coughing fit, she fractured a rib.

 

1. Which of Jane’s medications are for short term control of her asthma, and which is for long term control? Describe the mechanism of action for each medication.

 

1. Explain the inflammatory cascade that would occur if Jane was exposed to a known irritant for her asthma.

 

1. What underlying condition do you suspect was responsible for Jane’s fractured rib? Briefly explain your answer.

 

1. How did Jane’s early menopause and use of PulmicortTurbohaler contribute to the medical condition responsible for her fractured rib? Explain the physiologic link  between each factor and the medical condition you identified in Part C above.

 

1. How can a weight bearing exercise program assist in the management of Jane’s condition?

 

Case study 4

John is 64 years old and has recently retired. He worked for 36 years in a coal miner and was involved in processing mined coal in preparation for transporting it to export terminals. The work environment was hot and dusty, and even though personal protection equipment was available, John found it cumbersome and often elected not to use it.

John has been a cigarette smoker since he was 17 years old. Although he has cut down on his cigarette smoking, he still smokes 10 to 12 cigarettes a day on average. About seven years ago, John was diagnosed with mild hypertension and his blood work showed elevated LDL cholesterol and triglyceride levels. John was advised to change his diet and begin an exercise routine in order to control his blood pressure and blood lipid profile, but he didn’t follow any of this advice and is now taking medication to manage these aspects of his health.

At his last doctor’s appointment, John’s doctor had requested a series of chest diagnostic images and sputum pathology tests to investigate the source of a cough that John had had for at least four months. Following these tests, John’s doctor diagnosed John with chronic obstructive pulmonary disease (COPD) and placed John on additional medication.

John is currently taking the following medications:

• Captopril Sandoz – 50mg tablet – 1 tablet twice a day
• Betaloc – 100mg tablet – 1 tablet twice a day
• Lipitor – 20mg tablet – taken once a  day
• Combivent MDA – 2 inhalations taken 4  times each day

 

1. For each of the medications that John has  been prescribed, develop a table that:
2. Identifies which of John’s conditions the medication has been prescribed for

Il. Briefly describes the mode of action of the medication.

 

1. What role would John’s work history play in his development of COPD? Explain the physiological mechanisms behind the link between his work history and his COPD.

 

1. John’s doctor has explained to him that he is at risk of myocardial infarction. Explain how progressions of his current conditions could result in myocardial infarction.
2. John’s doctor has been working with him to help him quit smoking. Why is the cessation of smoking expected to have a positive impact on John’s blood pressure, lipid profile and COPD? Ensure that you explain the important physiological mechanisms in your answer.
3. Other than the cessation of smoking, identify two (2) non pharmacological strategies that you could us to manage John’s current health. Include a physiological explanation of how each intervention strategy will affect his current medical conditions.