NR 325 Week 3 Case Study

Name

Chamberlain University

NR-325 Adult Health II

Prof. Name

Date

NR 325 Adult Health II – Case Study #1

Patient Profile

P.J., a 74-year-old female, presents with a complex medical history. She was recently discharged following a 14-day hospitalization for a gangrenous open cholecystectomy in which her gallbladder was removed. Postoperatively, P.J. experienced a bile leak due to gangrene that extended into the common bile duct. She has a history of diabetes and now reports diminished vision in her left eye, persisting for the last seven days. Her current medications include valsartan 160 mg/25 mg daily (ARB for hypertension), amitriptyline 25 mg daily (antidepressant), aspirin 81 mg daily (NSAID), and alprazolam 0.25 mg as needed every six hours for anxiety (benzodiazepine).

Subjective Data

P.J. describes her vision in the left eye as “fuzzy and distorted.” She states, “I survived that horrid ordeal with my gallbladder, and now I have trouble with my vision.” She is unmarried but has a supportive network of friends and caretakers.

Objective Data

Physical Examination: Blood pressure 119/79 mmHg, pulse 82 beats/min, temperature 97.7°F, respirations 16 breaths/min.
Mental Status: Alert and oriented to person, place, and time.
Respiratory Examination: Diminished breath sounds in the bilateral lower lobes posteriorly, likely due to postoperative atelectasis. Potential early signs of pneumonia warrant further assessment for adequate oxygenation. Oxygen saturation is 96% on room air.

NR 325 Week 3 Case Study

Table of Potential Causes of Blurry Vision, Focused Assessment, and Diagnostic and Dietary Interventions

Cause	Focused Assessment	Tests/Interventions
Potential Causes of Blurry Vision	Include in Focused Assessment	Testing and Dietary Recommendations
– Age-related macular degeneration	– Family history	– Ophthalmoscopy
– Hypertension-related retinopathy	– Past medical history	– Visual acuity tests
– Diabetes	– Extraocular muscle (EOM) testing	– Nutritional counseling (high in antioxidants, carotene, vitamin E, and B12)
– Medications (amitriptyline, alprazolam)	– Visual acuity check	– Photodynamic therapy for AMD if diagnosed
– Possible tumor or detached retina	– History of smoking and dry eyes	– Wear sunglasses to prevent sun damage
– Glaucoma (open or closed)	– Recent eye doctor visits

Case Study Progress

Following an ophthalmologist consult, P.J.’s initial eye exam reveals a scar in the central macular area, indicating age-related macular degeneration (AMD). The ophthalmologist recommends preventing further vision loss with photodynamic therapy.

Early signs of AMD include blurry or distorted central vision, difficulty in recognizing faces, and the need for brighter light when reading.

2. Risk Factors for Macular Degeneration

Known risk factors include smoking, hypertension, female gender, short body stature, family history, a diet deficient in carotene and vitamin E, and prolonged sun exposure.

P.J. should consume foods rich in antioxidants, carotene, vitamin E, vitamin C, and vitamin B12, such as leafy greens, eggs, nuts, whole grains, fruits, and vegetables.

NR 325 Week 3 Case Study

NR 325 Adult Health II – Case Study #2

Patient Profile

S.H. is a 25-year-old male presenting to the emergency department with severe vertigo and vomiting lasting for one day. He reports recurrent vertigo spells accompanied by right-sided tinnitus for the past month. He becomes nauseous upon attempting to sit up, experiences worsened vertigo with head movement, and has been crawling out of bed to avoid falls. S.H. currently complains of nausea.

Subjective Data

Reports that vertigo is exacerbated with head movement, accompanied by nausea.
S.H. has a history of tinnitus on the right side with increased severity of vertigo symptoms.

Objective Data

Physical Examination: Blood pressure 139/72 mmHg, pulse 90 beats/min, temperature 97.7°F, respirations 22 breaths/min.
Neurological Findings: Spontaneous nystagmus in the right eye.
Vomiting and Diaphoresis: Two episodes of vomiting within the last 30 minutes, intermittent diaphoresis.

Diagnostic Studies

Audiogram: Severe sensorineural hearing loss at 35.0 dB, with low-frequency impairment in the right ear.
Weber Test: Right-sided sensorineural hearing loss.

Discussion Questions

1. Definition of Vertigo vs. Dizziness

Vertigo refers to a sensation of spinning, where the patient feels as if the room is moving around them. Dizziness, by contrast, is a feeling of unsteadiness without the sensation of movement.

2. Potential Diagnosis for S.H.

Based on the symptoms, including vertigo, tinnitus, and sensorineural hearing loss, S.H. likely has Ménière’s disease.

3. Additional Diagnostic Tests for Vertigo

Additional tests may include the Romberg test, MRI, CT scan, and vestibular function testing.

4. Causes and Risk Factors of Ménière’s Disease

Causes include trauma, viral infections, and potential genetic predisposition.

5. Priority Nursing Diagnoses for S.H.

The primary concern is safety, as S.H. is at high risk of falling due to severe vertigo and associated symptoms.

6. Discharge Teaching for S.H.

S.H. should be cautioned about the sedative effects of prochlorperazine and diazepam and advised to avoid activities requiring alertness, such as operating heavy machinery, until his symptoms stabilize.

NR 325 Week 3 Case Study