Case Study Putting It All Together
Order ID 53563633773 Type Essay Writer Level Masters Style APA Sources/References 4 Perfect Number of Pages To Order 5-10 Pages Description/Paper Instructions
Instructions
After having read Chapters 1-3 and reviewed the learning materials for this week, please complete the following case study. Remember that your answers may be combined with medical terminology, but they must be defined and explained in physiological terminology.
Mrs. K.B. is age 64 and has been a patient of yours for many years. You are calling her today to tell her the results of her Pap test which was done last week during her routine annual checkup in your office. The test showed marked dysplasia of cervical cells but no sign of infection. Unfortunately, when you call, there is no answer.
Since you saw Mrs. K.B. last week she has had gastritis with severe vomiting for 3 days. She has a history of heart problems and is presently feeling dizzy and lethargic. Her eyes appear sunken, her mouth is dry, she walks unsteadily, and she complains of muscle aching, particularly in the abdomen, and she is concerned about her chronic back pain as well and how she is going to handle her pain if she can’t keep her medication down. She is thirsty but is unable to retain food or fluid. A neighbor has brought Mrs. K.B. to the hospital, where examination shows that her blood pressure is low, and her pulse and respirations are rapid. Laboratory tests demonstrate elevated hematocrit, hypernatremia, decreased serum bicarbonate, serum pH 7.35, and urine of high specific gravity. This case study illustrates a combination of fluid, electrolyte, and acid-base imbalances. Specific laboratory values are not given to focus on the basic concepts. For clarity, this case study is discussed in multiple parts. Further information about the specific problems involved is given in each part and is followed by a series of questions.
Part 1
Later in the afternoon, you receive a phone call from Mrs. K.B.’s daughter Sara who tells you that she has been admitted to the hospital with vomiting. Sara is asking about her mother’s test results. Please answer the following questions regarding your conversation with Sara.
Sara is requesting her Mother’s test results and she seems to know that her Mom had a Pap test last week. Sara is really concerned because her Mom had an abnormal Pap test a few years ago and her sister also has a history of Ovarian Cancer. How do you handle this conversation with Sara?
In thinking about how you might discuss these results with Mrs. K.B. or Sara, explain how each of these terms might apply to this scenario: prognosis, latent stage, remission, exacerbations, and predisposing factors.
Explain cellular adaptations and in particular, dysplasia and how testing and or additional testing is done regarding this condition.
Part 2: Day 1
Initially, Mrs. K.B. lost water, sodium in the mucus content, and hydrogen and chloride ions in the hydrochloric acid portion of the gastric secretions.
Alkalosis develops for two reasons, the first being the direct loss of _______________ ions, and the second being the effects of chloride ion loss. When chloride ions are lost in the gastric secretions, it is replaced by chloride from the serum (See Fig. 2.9 in Chapter 2 of your Gould text). To maintain equal numbers of cations and ____________ in the serum, chloride ions, and bicarbonate ions can exchange places when needed. Therefore, more bicarbonate ions shift into the serum from storages sites in the _______________ to replace the lost chloride ions. More bicarbonate ions in the serum raise serum pH, and the result is hypochloremic alkalosis.
Which compartments are likely to be affected in this case by early fluid-loss?
Explain how a loss of sodium ions contributes to dehydration.
Describe the early signs of dehydration in Mrs. K.B.
Describe the compensations for the losses of fluid and electrolytes that should be occurring in Mrs. K.B.
Explain why Mrs. K.B. may not be able to compensate for losses as well as a younger adult.
Part 3: Days 2-3
As Mrs. K.B. continues to vomit and is still unable to eat or drink any significant amounts, loss of the duodenal contents, which include intestinal, pancreatic, and biliary secretions, occurs. No digestion and absorption of any nutrients occurs.
Losses at this stage include water, sodium ions, potassium ions, and bicarbonate ions. Also, intake of glucose and other nutrients is minimal. Mrs. K.B. shows elevated serum sodium levels.
Sara has been at the hospital all morning waiting for the provider to come by with an update. Sara is rubbing her Mom’s back and she continues to complain back pain.
Explain why serum sodium levels appear to be in high in this case
Explain how high serum sodium levels might affect the intracellular fluid
Using your knowledge of normal physiology, explain how continued fluid loss is likely to affect the following:
Blood volume
Cell function
Kidney function
Given Mrs. K.B.’s history, why might a potassium imbalance have more serious effects on her?
As the provider, when you enter the room, you find Sara rubbing her Mom’s back – you introduce yourself and what is the first thing that you would then need to do?
In regard to Mrs. K.B.’s back pain, what type of questions or history would you like to obtain?
Mrs. K.B. reports using herbal compresses at home to help her back pain and that she usually takes two “extra-strong” Acetaminophen tablets every 4 hours and a Tylenol #3 whenever the pain is severe. Sara states that she has tried to get her Mom to use “more natural” treatments for her back but she “loves her Tylenol.”
When considering sources for Herbal and Natural Remedies there are many to choose from but not all are FDA approved, and who has time to vet every website. Take a look at Natural Medicines, which is in the Research Guides at the Regis Library. What type of Natural Medicine treatment would you recommend for Mrs. K.B. knowing that her back pain is due to arthritis that was diagnosed 10 years prior, that could offer her relief from her back pain?
What should Mrs. K.B. and Sara understand about the dosage of acetaminophen that she is taking?
Finally, Sara commented that her Mom seems to be suffering more frequently from insomnia but claims that her medication controls her back pain. Could the Tylenol #3 tablets be interring with her sleep and if so how is this occurring?
Part 4: Day 3
Mrs. K.B. has spent the night in the ED due to a bed shortage and she is finally admitted to Med-Surg.
After a prolonged period of vomiting, metabolic acidosis develops. This change results from several factors.
Loss of bicarbonate ions in duodenal secretions
Lack of nutrients leading to ______________ of stored fats and protein with production of excessive amounts of ketoacids
Dehydration and decreased blood volume leading to decreased excretion of acids by the __________________
Decreased blood volume leading to decreased tissue perfusion, less oxygen to cells, and increased _________________ metabolism with increased lactic acid.
Increased muscle activity and stress leading to increased metabolic acid production.
These factors lead to an increased amount of acids in the blood, which bind with bicarbonate buffer and result in decreased serum bicarbonate and decreased serum pH or metabolic _________________.
List several reasons why Mrs. K.B. is lethargic and weak.
Predict the serum level of carbon dioxide, lactic acid, pH, pO2, K+, Na+, LFTs—note you should indicate low, normal or high and explain why in a brief sentence to indicate you understand the pathophysiology of the process.
If Mrs. K.B. continues to lose body fluid, why might serum pH decrease below 7.35?
If serum pH drops below 7.35 what signs would be observed in Mrs. K.B.
Describe the effect of acidosis on serum potassium levels.
Mrs. K.B. will be given replacement fluid therapy. Why is it important that sodium and potassium be given as well as water?
Case Study Rubric
Note: Scholarly resources are defined as evidence-based practice, peer-reviewed journals; textbook (do not rely solely on your textbook as a reference); and National Standard Guidelines. Review assignment instructions, as this will provide any additional requirements that are not specifically listed on the rubric.
Case Study Rubric – 100 Points Criteria Exemplary
Exceeds Expectations Advanced
Meets Expectations Intermediate
Needs Improvement Novice
Inadequate Total Points Content of Case StudyThe writer demonstrates a well-articulated understanding of the case study subject matter in a clear, complex, and informative manner. The case study content and theories are well developed and linked to the course content, assignment requirements, and practical experience. The case study includes relevant material that fulfills all objectives of the assignment.
Cites three or more references, using at least one new scholarly resource that was not provided in the course materials.
30 points The writer demonstrates an understanding of the subject matter, and the components of the case study are accurately represented with evidence-based practice, ethics, theory, and/or role content. Course materials and scholarly resources are present to support required concepts. The paper includes relevant material that fulfills all objectives of the case study.
Cites two references.
26 points The writer demonstrates a moderate understanding of the subject matter, as evidenced by components of the case study and use of evidence-based practice, theory, or role-development. Course content is present but missing depth and/or development.
Cites only one reference.
23 points Absent application to evidence-based practice, theory, or role development.
Demonstrates incomplete understanding of content and/or inadequate preparation.
Significant content of case study is vague, inaccurately portrayed, or missing.
No references cited.
Submits assignment late.
20 points30Analysis and Synthesis of Case Study Content and Meaning Through critical analysis, the submitted case study provides an accurate, clear, concise, and complete summary of the scenario.
Information from scholarly resources is synthesized, providing new information or insight related to the context of the assignment by providing both supportive and alternative information or viewpoints.
All instruction requirements noted.
30 points Case study is complete, providing evidence of further synthesis of course content via scholarly resources.
Information is synthesized to help fulfill the case study requirements. The content supports at least one viewpoint.
Submission provides clarification of the assignment by correctly answering all posed questions within the instructions.
All instruction requirements noted.
26 points Lacks clarification or new information. Scholarly reference supports the content without adding any new information or insight. Case study content may be confusing or unclear, and the summary may be incomplete.
Most instruction requirements are noted.
23 points Submission is primarily a summation of the assignment without further synthesis of course content or analysis of the scenario.
Demonstrates incomplete understanding of content and/or inadequate preparation.
Missing some instruction requirements.
Submits assignment late.
20 points30Application of Knowledge The summary of the case study provides information validated via scholarly resources that offer a multidisciplinary approach to the scenario provided.
The student’s application in practice is accurate and plausible, and additional scholarly resource(s) supporting the application are provided.
All questions posed within the assignment are answered correctly in a well-developed manner, applying knowledge with citations for validation.
All instruction requirements noted.
30 points summary of the study, findings, and knowledge gained from the assignment is presented.
Student indicates how the information will be used within their professional practice.
All questions posed within the assignment are answered within the case study. The answer to one question may be vague and/or limited in development, but as a whole all answers are correct.
All instruction requirements noted.
26 points Objective criteria are not clearly used, allowing for a more superficial application of knowledge between the assignment and the broader course content.
One question is answered incorrectly and/or two case study answers are vague or limited in development but remain correct.
Student’s indication of how they will apply this new knowledge to their clinical practice is vague.
Most instruction requirements are noted.
23 points The application of knowledge is significantly lacking.
Demonstrates incomplete understanding of content and/or inadequate preparation.
Student’s indication of how they will apply this new knowledge to their clinical practice is not practical or feasible.
Application of knowledge is incorrect and/or student fails to explain how the information will be used within their personal practice.
Multiple questions are not answered or are answered incorrectly (e.g., two questions answered incorrectly, or three case study answers are vague or limited in development but remain correct).
Missing some instruction requirements.
Submits assignment late.
20 points30OrganizationWell-organized content with a clear and complex purpose statement and content argument. Writing is concise with a logical flow of ideas.
5 points Organized content with an informative purpose statement, supportive content, and summary statement. Argument content is developed with minimal issues in content flow.
4 points Poor organization and flow of ideas distract from content. Narrative is difficult to follow and frequently causes reader to reread work. Purpose statement is noted.
3 points Illogical flow of ideas. Prose rambles. Purpose statement is unclear or missing.
Demonstrates incomplete understanding of content and/or inadequate preparation.
No purpose statement.
Submits assignment late.
2 points5APA, Grammar, and Spelling Correct APA formatting with no errors.
The writer correctly identifies reading audience, as demonstrated by appropriate language (avoids jargon and simplifies complex concepts appropriately).
Writing is concise, in active voice, and avoids awkward transitions and overuse of conjunctions.
There are no spelling, punctuation, or word-usage errors.
5 points Correct and consistent APA formatting of references, and cites all references used. No more than two unique APA errors.
The writer demonstrates correct usage of formal English language in sentence construction. Variation in sentence structure and word usage promotes readability.
There are minimal to no grammar, punctuation, or word-usage errors.
4 points Three to four unique APA formatting errors.
The writer occasionally uses awkward sentence construction or overuses/inappropriately uses complex sentence structure. Problems with word usage (evidence of incorrect use of thesaurus) and punctuation persist, often causing some difficulties with grammar. Some words, transitional phrases, and conjunctions are overused.
Multiple grammar, punctuation, or word usage errors.
3 points Five or more unique formatting errors, or no attempt to format in APA.
The writer demonstrates limited understanding of formal written language use; writing is colloquial (conforms to spoken language).
The writer struggles with limited vocabulary and has difficulty conveying meaning such that only the broadest, most general messages are presented.
Grammar and punctuation are consistently incorrect. Spelling errors are numerous.
Submits assignment late
2 points 5 Total Points 100
RUBRIC
QUALITY OF RESPONSE NO RESPONSE POOR / UNSATISFACTORY SATISFACTORY GOOD EXCELLENT Content (worth a maximum of 50% of the total points) Zero points: Student failed to submit the final paper. 20 points out of 50: The essay illustrates poor understanding of the relevant material by failing to address or incorrectly addressing the relevant content; failing to identify or inaccurately explaining/defining key concepts/ideas; ignoring or incorrectly explaining key points/claims and the reasoning behind them; and/or incorrectly or inappropriately using terminology; and elements of the response are lacking. 30 points out of 50: The essay illustrates a rudimentary understanding of the relevant material by mentioning but not full explaining the relevant content; identifying some of the key concepts/ideas though failing to fully or accurately explain many of them; using terminology, though sometimes inaccurately or inappropriately; and/or incorporating some key claims/points but failing to explain the reasoning behind them or doing so inaccurately. Elements of the required response may also be lacking. 40 points out of 50: The essay illustrates solid understanding of the relevant material by correctly addressing most of the relevant content; identifying and explaining most of the key concepts/ideas; using correct terminology; explaining the reasoning behind most of the key points/claims; and/or where necessary or useful, substantiating some points with accurate examples. The answer is complete. 50 points: The essay illustrates exemplary understanding of the relevant material by thoroughly and correctly addressing the relevant content; identifying and explaining all of the key concepts/ideas; using correct terminology explaining the reasoning behind key points/claims and substantiating, as necessary/useful, points with several accurate and illuminating examples. No aspects of the required answer are missing. Use of Sources (worth a maximum of 20% of the total points). Zero points: Student failed to include citations and/or references. Or the student failed to submit a final paper. 5 out 20 points: Sources are seldom cited to support statements and/or format of citations are not recognizable as APA 6th Edition format. There are major errors in the formation of the references and citations. And/or there is a major reliance on highly questionable. The Student fails to provide an adequate synthesis of research collected for the paper. 10 out 20 points: References to scholarly sources are occasionally given; many statements seem unsubstantiated. Frequent errors in APA 6th Edition format, leaving the reader confused about the source of the information. There are significant errors of the formation in the references and citations. And/or there is a significant use of highly questionable sources. 15 out 20 points: Credible Scholarly sources are used effectively support claims and are, for the most part, clear and fairly represented. APA 6th Edition is used with only a few minor errors. There are minor errors in reference and/or citations. And/or there is some use of questionable sources. 20 points: Credible scholarly sources are used to give compelling evidence to support claims and are clearly and fairly represented. APA 6th Edition format is used accurately and consistently. The student uses above the maximum required references in the development of the assignment. Grammar (worth maximum of 20% of total points) Zero points: Student failed to submit the final paper. 5 points out of 20: The paper does not communicate ideas/points clearly due to inappropriate use of terminology and vague language; thoughts and sentences are disjointed or incomprehensible; organization lacking; and/or numerous grammatical, spelling/punctuation errors 10 points out 20: The paper is often unclear and difficult to follow due to some inappropriate terminology and/or vague language; ideas may be fragmented, wandering and/or repetitive; poor organization; and/or some grammatical, spelling, punctuation errors 15 points out of 20: The paper is mostly clear as a result of appropriate use of terminology and minimal vagueness; no tangents and no repetition; fairly good organization; almost perfect grammar, spelling, punctuation, and word usage. 20 points: The paper is clear, concise, and a pleasure to read as a result of appropriate and precise use of terminology; total coherence of thoughts and presentation and logical organization; and the essay is error free. Structure of the Paper (worth 10% of total points) Zero points: Student failed to submit the final paper. 3 points out of 10: Student needs to develop better formatting skills. The paper omits significant structural elements required for and APA 6th edition paper. Formatting of the paper has major flaws. The paper does not conform to APA 6th edition requirements whatsoever. 5 points out of 10: Appearance of final paper demonstrates the student’s limited ability to format the paper. There are significant errors in formatting and/or the total omission of major components of an APA 6th edition paper. The can include the omission of the cover page, abstract, and page numbers. Additionally the page has major formatting issues with spacing or paragraph formation. Font size might not conform to size requirements. The student also significantly writes too large or too short of and paper 7 points out of 10: Research paper presents an above-average use of formatting skills. The paper has slight errors within the paper. This can include small errors or omissions with the cover page, abstract, page number, and headers. There could be also slight formatting issues with the document spacing or the font Additionally the paper might slightly exceed or undershoot the specific number of required written pages for the assignment. 10 points: Student provides a high-caliber, formatted paper. This includes an APA 6th edition cover page, abstract, page number, headers and is double spaced in 12’ Times Roman Font. Additionally the paper conforms to the specific number of required written pages and neither goes over or under the specified length of the paper. GET THIS PROJECT NOW BY CLICKING ON THIS LINK TO PLACE THE ORDER
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