Nursing Case Study Examples
Nursing case studies are clinical scenarios that nursing students use to develop critical thinking. They involve a detailed study of an individual patient to help nurses gain more information about the symptoms and the medical history of a patient. They also allow them to provide the proper diagnoses of the patient’s illness based on the symptoms they have experienced and other affecting factors. Because nursing students apply the lessons they have learned from school to treat patients, nursing case study examples are a sure way to help their learning process. This article explores some examples of nursing case studies.
Example 1
Tom was traveling to an area with poor sanitation. He went to a petting zoo where there were pigs. Before eating, he did not wash his hands, he never had any symptoms, but there was a cyst feeding on his bacteria within his small intestine. the cyst underwent excitation in the small intestine lumen (now trophozoite)
What is the genus/species of this organism?
What is special about it?
What is the hallmark?
Balantidium coli
the only ciliate
pigs
in rare cases, balantidium coli can cause?
ulceration in the colon due to trophozoite burrowing and causing inflammation
How is Balantidium coli diagnosed?
Wet mount, PCR
organism which the human is the accidental host?
balantidium coli
, where is excystation for B.coli?
Small intestine
what is special about the nuclei of B. coli?
Macro and micro
, what disease does B. coli cause?
None feeds off of host
ulceration in the colon is associated with what organism?
Trophozoites of B. coli , this is very rare
preferred diagnostic for B. coli?
PCR
the adult forms of this phylum are nonmotile?
Apicomplexa
most commonly confused with E. histolytica?
Entamoeba dispar
Example 2
Tom traveled to a country with poor sanitation and accidentally drank from a fountain that was not purified. After about 2-4 weeks, he started to develop amebic dysentery. It was found that he had small amoeba(trophozoites) within the lumen of his large intestine, which was feeding on him, invading the tissue, and causing colitis. These trophozoites under the microscope, you could see that they had ingested RBCs. Later he began to develop amebic liver abscesses.
What are the genus and species?
What is special about it?
What is the hallmark?
entamoeba histolytica
invade and cause flask-shaped ulcers
trophozoites have ingested RBCs
___% of those with E.histolytica are asymptomatic?
90
Three stages of E.histolytica life cycle?
trophozoite, precyst, cyst
The only stage of E. histolytica that is found in humans?
Trophozoite
how long can the trophozoite of E.histolytica survive outside of the human?
5 hours
- histolytica undergoes ____ in feces?
Encystment
, the precyst of E.histolytica, is found?
The lumen of the gut or outside of the host
hallmark of the precyst of E. histolytica?
Large glycogen vacuole and two chromatid bars
life cycle of E. histolytica, which has a single nucleus, NO glycogen vacuole, four nuclei, and one chromatid body? this stage is resistant to pH, temperature, and environmental conditions
Cyst
the infective stage of E. histolytica?
mature cyst stage
how many amoeba (trophozoites) are made from one cyst of E. histyoltica within the small intestine lumen before being brought to the large intestine?
8
how does the normal human immune system protect us from E. histolytica?
secretory IgA antibodies against lectin
- histolytica attaches to the human small intestine by?
lectin, glucose/galactose interactions
Two enzymes which E. histolytica secretes to degrade tissues and cause ulcers in the colon?
phospholipase A, neuraminidase
nibbling on cells associated with E. histolytica?
Trgocytosis
symptoms of E. histolytica may develop for how long after infection?
2-4 weeks
with an amebic liver abscess, what stage of the life cycle is present?
Trophozoites
with amebic liver abscesses, what should be a doctor’s number one organism of concern?
E-hystolica
How is E. histolytica diagnosed?
Trophozoites of cysts in feces
EIA kits for antibody detection two weeks after infection
PCR (method of choice)
what drugs are used to treat E. histolytica when cysts are present?
Paromomycin or iodoquinol
, what drugs are used to treat E. histolytica when invasive trophozoites are present?
Metronidazole
Example 3
Tom went for a swim in a nearby lake in Baton Rouge. While doing so, he got water up to his nose. this water contained the biflagellated trophozoite stage of an organism. At first, he presented with fever, headache, nausea, vomiting, stiff neck, and then he began to be dazed and confused; he lost his balance and began to have hallucinations. Finally, the doctors diagnosed him with PAM, a 94% mortality rate.
What are the genus and species?
Upon looking at his CSF the doctors found?
What is the treatment?
What is the hallmark?
naegleria Fowleri
cloudy with trophozoites
amphotericin B
PAM
experimental treatment for naegleria Fowleri?
therapeutic hypothermia and miltefosine
Example 4
Tom has a terrible eye site and requires contacts/glasses to see. he never takes these contacts out and even sleeps with them. He eventually developed an infection that caused tearing redness and blurred vision, and eventually he lost much of his sight, but he was lucky not to be blind. Upon looking at his corneal scrapping, cysts were found.
What is the genus and species of this organism?
What is the disease that tom has?
acanthamoeba spp
keratitis
Example 5
Tom was working on an old house and happened to breathe in lots of dust. A few days later, he developed an onset of symptoms ranging from seizures, paresis, and mental deterioration. After going to the hospital multiple times, he had trophozoites within his brain biopsy.
What is the genus and species of this organism?
What disease does tom have?
What other route could have caused the same disease with the same pathogen?
acanthamoeba spp
GAE
Broken skin
how is GAE diagnosed?
brain biopsy with trophozoites
Culture with monoclonal antibodies
what will be different about the CSF with GAE?
Increased lymphocytes and protein levels
how can keratitis be treated?
miltefosine
Topical biguanide or chlorhexidine
general niche for flagellates?
the lumen of the large intestine or blood
Example 6
Tom drank contaminated water again, but he developed symptoms two weeks after exposure. He started with abdominal pain, bloating, belching, flatulence, foul-smelling watery/fatty diarrhea in a large volume. After doing a stool antigen test, it came back positive.
Tom has to type A blood. What does this have to do with anything?
What are the organism’s genus and species?
What form is infective?
What disease does tom have?
he is more susceptible
Giardia lamblia
cyst
giardiasis
pear-shaped, owl face trophozoite with four pairs of flagella, sucking discs for attachment ventrally is associated with?
Giardia lamblia
, the infective form of giardia lamblia?
Cyst stage
what is the hallmark that giaria lamblia cysts present?
Oval with four nuclei at one end
, why can you find giardia lamblia even places with chlorinated water?
Why can you find giardia lamblia even in places with chlorinated water?
Resistant to chlorine, pH, and temperature,
what is the host defense system against giardia lamblia?
IgA, normal microbiotia, peristalsis
, how does giardia lamblia invade the host?
antigenic variation, alteration of microbiota, apoptosis of brush border cells
Thirty minutes after ingestion of giardia lamblia, what happens?
excystation of 1 cyst releases two trophozoites into the small intestine
where do the trophozoites of giardia lamblia multiply?
The lumen of the small intestine
, how does giardia lamblia feed?
Pinocytosis
where are cysts of giardia lamblia found, and what is special about them?
non diarrheal feces remain viable for weeks or months in the cold water
life cycle stage that induces apoptosis of enterocytes leading to short and flat villi, increases lymphocyte infiltration within giardia lamblia life cycle
Trophozoites
what disease is associated with the symptoms: malabsorption, weight loss, developmental delay, and growth retardation
chronic giardiasis
what stage of giardia lamblia life cycle is found in stool test microcopy?
Cysts and trophozoites
, what is a non-common way of diagnosing giardia lamblia mostly seen in underdeveloped countries?
String test
how do you treat giardiasis?
metronidazole or, if pregnant paromomycin
Example 7
sue went to a party about 20 days ago. She presents with itching, burning, redness, soreness of her vagina, and discomfort upon urination. She has a purulent discharge which is green and has a nasty odor. It is important to note that she had intercourse with a boy at the party and didn’t use protection.
What is the genus and species of this organism?
What stage of this organism is found within the genital tract?
what pH is optimal?
trichomonas vaginalis
trophozoites
4.5
the trophozoite of this organism is pear-shaped with a hydrosome. It has a SHORT undulating membrane (distinguishing), with four anterior flagella and a 5th which runs along the undulating membrane
trichomonas vaginalis
how does trichomonas vaginalis move?
A jerky twitching movement
where are trichomonas vaginitis trophozoites found in males?
Urethra and prostate
, how does trichomonas vaginalis reproduce?
Binary fission
how does trichomonas vaginalis cause disease?
Secretion of cysteine proteases, adhesions, lactic and acetic acids.
What does trichomonas vaginalis disrupt, helping it get its optimal conditions?
glycogen levels and increases pH
hallmark condition of trichomonas vaginalis?
Petechial hemorrhage because of blood vessel dilation causes a strawberry mucosa
how trichomonas vaginitis is diagnosed?
Trophozoites in discharge with lots of leukocytes, neutrophils,
PCR
how is trichomonas vaginitis treated?
flagyl, metronidazole
Two organisms associated with the oral cavity?
trichomonas tenax and entamoeba gingivalis
harmless commensal within the Cecum
trichomonas hominins
protozoan with a vacuolated, ameboid, and granular form
blastocystis hominis
Example of Lab experiments
Mayo Western Electric company – focused on a group of workers and studied their productivity, changed variables to see how it affected their work
Their productivity didn’t change
Concluded that due to him telling them they were being studied, it created a ‘Hawthorne effect,’ and it didn’t impact their work
Evaluation of lab experiments
A – high Reliability
– easily quantifiable
D- Costly – need resources
– Skills of the researcher may have to be high, costly
– low Validity
– Hawthorne effect
– possible deception as the researcher tends to keep the real aim of the experiment quite
Who prefers lab experiments?
Positivists, as it produces quantifiable data and allows them to conclude their cause and effect statements
Example of Field experiment
Rosehan 1973 – Psuedopatient experiment
Went to a mental hospital acting like a person with a mental health condition to see how patients were treated.
Concluded that once the label ‘schizophrenic’ has been placed on them, it was hard to remove it and became their master status
Evaluation field experiments
A – High validity asset in real situations
– high artificiality
D- lack informed consent
– deception
– Vulnerable groups May not be able to corporate accordingly
– less control over variables
Who prefers field experiments? Why?
Interpretivists, prefer more valid methods. Field experiments avoid being objective as it creates a genuine picture rather than looking for patterns in behavior
Example of the comparative method
Durkheim study into suicide and compared the suicide rates of Protestants and Catholics
Concluded that Protestants were more likely to commit suicide due to lack of social integration
Evaluation of Comparative method
A – easy and produce quick data
It- Cheap to research
– can be used to study past events
D- Reliability May not be replicable depending on whether they’re hard or soft stats
– Cannot be certain it has discovered the true cause of something
Example of Questionnaires
Hite 1991 – questionnaires aimed to investigate people’s sexual behaviors and whether they were satisfied within their marriage
Sent out 100,000, and only around 5,000 were returned (4.5%)
This means that it isn’t representative
Evaluation of questionnaires
A- cheap to produce and not time-consuming to answer
– respects privacy and confidentiality
– don’t need high skilled researchers, cheap
– informed consent, people don’t have to answer
– Reliable
D- lack validity, can’t get a more in-depth answer
– lack representativeness, some people may not send them back
– Detached and objective
Who prefers questionnaires? Why?
Positivists, as they prefer Quantitative data
Example of structured interviews
Young and Willmott – study on symmetrical family and whether the responsibilities are equally divided between parents
993 people, had to employ more interviewers to help
Formal and standardized answers were based on codes
Each interview was between 10-30 mins
Evaluation of structured interviews
A- large scale, potentially produce more representative data
– High reliability as asking the same questions
– practical, don’t need high skills or to teach high skills
D – High cost – have to pay exterior interviewers
– Time – a lot of people to get through
– sensitive questions
– Validity may be distorted due to the structured questions, can’t build rapport
Who prefers structured interviews? Why?
Positivists because they produce quantifiable data
Example of unstructured interview
Dobash and Dobash – Violence against wives
Studying domestic violence, spent many months in contact with women refugees, and formed unstructured interviews to be more sensitive
Two female researchers
But the women were happy to talk about the issues
Evaluation of unstructured interview
A – female researchers may create a more valid picture as they can console females
– Helps with sensitive issues to not harm the subject nor damage the Validity of the results
– Spending many months with them increased the representative data
D – time and money- cost researchers to research, as its a sensitive issue, May not want to talk about it
– Skills – needed to be careful and will be costly to train
– Privacy and confidentiality crucial
– vulnerable groups, crucial to keep them anonymous
Who prefers unstructured interviews?
Interpretivists- because it creates a more genuine picture, High Validity
People can openly talk about things with no restraints on how they answer the questions
Example of semi-structured interviews
Cicourel – studied the impact of setting on WC pupils and asked a follow-up question ‘what do you mean by that.’
Evaluation of Semi-structured interviews
A- Informed consent
It- maybe less costly due to them having a format to follow
– Doesn’t need loads of skills
– Validity, closer to the genuine picture
D – Skills, May need to be trained to ask diverted questions
– Reliability may be affected due to the diversion
What did Rich find?
Found that when adults interview children, they feel that they need to impress the adult
Example of Group interviews
Willis and his boys
Studied 12 working-class boys and why they get working-class jobs. Study the lads counter culture and how they interrupt classes and see how they would normally behave if he wasn’t there.
Evaluation of group interviews
A- puts them more at ease due to being together, making them more likely to behave as they would usually
– cuts the cost of interviewing them separately
– Doesn’t speculate deception issue as they are aware they’re being interviewed
D- May reduce the Validity due to them not wanting to answer certain questions in front of their friends
– well being – if certain questions are asked, maybe too embarrassing to answer
– skills of the researcher will need to be efficient, especially if they’re talking to troubled boys
Example of Covert Participant observation
Howard Griffin – ‘Black like me.’
A middle-aged white man committed to the cause of racial justice and underwent medical treatment to change the color of his skin and temporarily become a black man to see how he was treated
Found the conditions of black people were appalling, communities were run down.
Evaluation of Covert participant observation
A- high Validity, genuine picture of the racial injustice
– Research opportunity, was able to collate knowledge and change his appearance to study this fully
– high representativeness, due to him going into different communities and studying different people and their reactions, big sample size
D- Cost and time, costly due to medical treatment, time-consuming as had to gather lots of info over a long period
– Deception, people were unaware that he was studying as well as his appearance not being his own
– Informed consent, people weren’t informed that they were being studied
Example of Overt Participant observation
Whyte – street corner society
The 1930s – Studied a gang in Chicago that was poor and in the city. He was much older than the boys, so he got the gang leader’s approval to do so, and the boys were aware they were being studied.
Evaluation of Overt participant observation
A – Informed consent
– no deception
D- Costly, May have had to pay to gain access
– well being May damage the well being of both the researcher and the participants
– The Hawthorne effect affect the Validity
– low representativeness due to this being one gang
Who prefers Participant observation?
Interpretivism- because they seek to discover the meanings behind our actions, it can produce valid, qualitative data. Helps gain a clear understanding of their worldview
Example of Covert non-participant observation
– Humphreys – tea rooms
studied men having gay sex in bathrooms, homosexuality was illegal at the time and became a ‘watch queen’ keeping a lookout for people while men had sex
Evaluation of non-participant observation
A- Objective
– High Validity
– High reliability
D- Privacy and confidentiality will be crucial to keep safe
– No informed consent
– Deception (arguably justified due to at the time it was illegal)
– arguably low representativeness due to a small sample size
Who prefers non-participant observation?
Interpretivists
Examples of official statistics
– Census
– Crime survey England and Wales
– League tables
Evaluation of official statistics
A – Easily accessible
– High representativeness
– Don’t need highly skilled people to analyze data
D- Lack Validity due to potential of being socially constructed
– reliability, may be low due to errors
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