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Clinical Case studies

Clinical Case studies - BIOL 230 SPRING 2011 CLINICAL CASE...

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BIOL 230 SPRING 2011 CLINICAL CASE STUDIES (50 POINTS) DR. TELLES Imagine you are following a Nurse Practitioner as part of your clinical experience in nursing school. Before you enter the examining room the Nurse Practitioner pulls the chart off the door and hands it to you. You enter the room and greet the patient. What is your tentative diagnosis? Each case study is worth 2 points. Use a scantron to answer the following questions. Clinical Case 1 A 62-year old diabetic man presents himself in the emergency room with a swollen left leg with areas of blanching and blue mottling. A "foul odor" is coming from a dressed wound. The physicians remove the dressing and a brownish fluid is seeping from a wounded area. The fluid contains what appear to be small bits of the tissue. No pus appears to be present. The wound has a strong "rotten" odor. Five days earlier, while at his work as a farmer, he caught the leg in his manure spreader, sustaining a deep, crushing, grossly dirty injury. His wife cleaned the wound as well as she could with soap and water, dressed it with clean gauze, and wrapped it tightly with an elastic bandage to stop the bleeding. The second day they redressed the wound and applied triple antibiotic ointment. The patient treated his pain with ibuprofen (Advil). He reported the pain was not very bad for the first 72 hours. In the past 24 hours, the leg swelled and the mottling began to appear. A foul odor and severe pain accompanied the swelling. His wife convinced him to come to the emergency room even though they did not have medical insurance. What organism is most likely to be responsible for these symptoms and findings? a. Clostridium tetani b. E.coli 0157:H7 c. Clostridium perfringens d. Bacillus anthracis Clinical case 2 A 3 month old baby, Jarret Fox, was admitted into the ER for dehydration. According to his mother, the baby had stopped eating four days ago. Jarret was about 5% dehydrated and was much floppier than usual. He seemed passive and expressionless and lay as limp as a rag doll in his hospital crib. An emergency electromyogram (a test of Jarret’s muscle and nerve function) revealed abnormal nerve responses. His breathing has become labored and when a blood-gas analysis revealed signs of respiratory failure, he was transferred to the ICU where he was placed on a ventilator. The mother assured the doctor that the baby was exclusively breast-fed. On further inquiry, the doctor finds out that his little sister had offered him a spoonful of oatmeal topped with natural honey straight from the hive on the day that he stopped eating. What was the diagnosis? Dr. C. Telles Page 1
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a. Tuberculosis b. Botulism c. Tetanus d. Scalet fever Clinical Case 3 A 58-year old lawyer is presented in the emergency room with a headache, irritability, generalized muscle pain and uncontrollable back spasms. He has become very restless and worried because he has had the back spasms all through his court case that afternoon and they became extremely painful.
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