Clinical Case Study for Nursing Students

Imagine you are following the doctor as part of your nursing training. Before you enter the examining room the physician 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 question is worth 3pts.

Clinical Case 1

The throat is red, raw, and has a “beefy” look; lymph nodes are swollen, patient is feverish and fever is high: blood samples reveal bacteria in a chain.

ANSWER: streptococcal pharyngitis

Clinical Case 2

A 22 year old college student was presented at the health clinic with a fever, sore throat and enlarged lymph nodes. A blood test reveals an elevated number of damaged B-lymphocytes. The patient has a disease caused by a virus that causes

ANSWER: Infectious mononucleosis

Clinical Case 3

A young male, 17 years of age presented at the emergency room with a severe headache, vomiting, and a stiff neck with pain running up his back. On admission, his temperature was 101F. The young man appeared to have trouble hearing during the nurse’s interview and also seemed to have trouble concentrating. The history revealed that the young man is a wrestler for the local high school team. He had felt as though he were getting a cold the past few days, since his last meet in Hicksville.

He did not smoke or drink, but he had attended a party two days earlier thrown by his girlfriend and the other cheerleaders to celebrate his victory in the sectionals. He had been holding his weight at 162 for the season, so he ate little and did not drink on the day of meets (today is a day of the meet). On physical exam, the physician noticed several areas of small purplish spots on the skin of the back, thigh and arm. The boy thought those were from wrestling. Which of the following is the most likely diagnosis?

a.  Neisseria gonorrhoae induced meningitis

b.  E. coli induced meningitis

c.  Neisseria meningitidis induced meningitis

d.  Streptococcus pneumonae induced meningitis

e.  LaCrosse encephalitis

ANSWER: Meningitis due to Neisseria Meningitidis

Clinical Case 4

Acid-fast bacilli appear in the patient’s sputum; cough is deep and occasionally contains blood; patient lives in a ghetto area and is malnourished.

ANSWER: Pulmonary Tuberculosis

Clinical Case 5

The skin over the salivary glands is taut and shiny, and the area is painful when touched; swelling is obvious in the salivary gland area on both sides of the face.

ANSWER: Mumps (Viral parotitis)

Clinical Case 6

A lethargic 22-month old female was presented by her mother to the emergency room at 2:15am on a Sunday. The child had a history of a runny nose, hoarse cough and low-grade fever (~99F) for the past 48 hours. The mother was concerned about the forced and noisy breathing of the child. The pediatrician examined the child and found cloudy eyes and mild inflammation of the ears, but no overt signs of bacterial infection (no significant changes in the eardrums). The throat of the child was red and coated with mucus. The larynx was swollen and raw.

The physician performed a rapid Strep test and found it was negative. Throat swabs were taken for culture. The physician placed the child in a room with a warm vaporizer for about 30 minutes. This dramatically improved the breathing of the child. Do you believe that this is a bacterial or viral disease (Viral Laryngitis)? Circle the correct answer – Viral Laryngitis

Clinical Case 7

A 68-year old patient with Alzheimer disease was brought to the emergency room by the staff of a local nursing home. He presented as lethargic with a sallow complexion. He had an admission temperature of 102.4F and a respiratory rate of 33/minute. During respiration, the right side of his chest moved better than the left. He showed dense consolidation of the lower lobe of the left lung on physical exam. A sputum sample revealed blood and a greenish color.

A chest x-ray showed tight consolidation of the left lung with evidence of formation of cavities in the lung tissue from cytotoxic damage. The patient complained of chills in the exam room, combined with his fever. A smear of his sputum demonstrated no acid-fast bacteria. What is your presumptive diagnosis for this case?

ANSWER: Aspiration pneumonia

Clinical Case 8

A 26 year old female comes to her physician with genital itching, redness and severe pain on the labia. On examination, the physician observes a cluster of small red blisters. The blisters crust over and sores disappear within 3 weeks. The woman states that she has had 5 sexual partners over the past year and that her episodes have become progressively more severe. Given this person’s history, what is a serious heath risk associated with this disease?

ANSWER: Herpes simplex 2 virus genital infection

Clinical Case 9

A 5 year old male child has a fever, headache, and malaise followed by small, teardrop shaped fluid-filled vesicles; the vesicles appear in successions of clusters; eventually the vesicles crust and fall off without leaving scars.

ANSWER: chicken pox

Clinical Case 10

The patient has a cough, running nose, watery red eyes and a characteristic pink-red rash that breaks out at the hairline which then covers the face and spreads to the body trunk. The rash is said to “stain”, changing color from red to dark brown, before disappearing.

ANSWER: Measles (caused by Morbillivirus)

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