Nursing Case Study Examples

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

  1. 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

  1. 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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