NR511 Case Studies (Week 3 & 6) |Guide to NR 511 Case Studies (Week 3 & 6)

Guide to NR511 Case Studies (Week 3 & 6) Part 1 In Part 1, you are given a patient scenario. Using the information given, answer the following questions: 1. Briefly and concisely summarize the H&P findings as if you were presenting it to your preceptor using the pertinent facts from the case. Use shorthand where possible and approved medical abbreviations. Avoid redundancy and irrelevant information. Do NOT simply rewrite the information as is it is presented in the case. This is NOT a SOAP note. The information that you present to your preceptor should include only what is needed. State the chief complaint (CC), HPI, and relevant history and physical findings. You can use shorthand and medical abbreviations. Don’t be redundant. Example: “J.S. is a 34yo male with a CC of acute onset ST x 3 days” [provide additional information from the history that is relevant]. “Physical exam is significant for” [provide relevant physical exam findings]. 2. Provide a differential diagnosis (minimum of 3) which might explain the patient’s chief complaint along with a brief statement of pathophysiology for each. The pathophysiology statement does not need to be extensive but it should not be vague either. Just list the diagnosis and follow with a pathophysiology statement for each diagnosis. Example: Diagnosis #1 -Pathophysiology statement 3. Analyze the differential by using the pertinent findings from the history and physical to argue for or against a diagnosis. Rank the differential in order of most likely to least likely. (This is where you present your argument for EACH DIAGNOSIS in your differential using the patient’s subjective and objective information that was given). This is where you present your argument for EACH DIAGNOSIS individually using the patient’s pertinent subjective and objective information from the scenario. Example: Diagnosis # 1-Streptococcal pharyngitis Strep pharyngitis is at the top of my differential. A streptococcal bacterial infection should be ruled out in a patient presenting with pharyngitis to prevent serious complications such as rheumatic fever. • Pertinent positive findings: ST, fever, nausea, lymph node swelling, bad breath {subjective findings}; posterior pharynx erythema, 3+ tonsillar edema, tonsillar exudate, halitosis, anterior cervical chain lymphadenopathy and tenderness, T 101.5 {objective findings} • Pertinent negative findings: No known recent exposure to person with strep, no rash, no cough 4. Identify any additional tests and/or procedures that you feel is necessary or needed to help you narrow your differential. All testing decisions must be supported with an EBM argument as to why it is necessary or pertinent in this case. If no testing is indicated or needed, you must also support this decision with EBM evidence. This is where you identify, based on what you know thus far, test or test(s) that you would perform TODAY which would help you narrow your differential diagnosis. *Do not list all of the possible tests that can be done. You are being evaluated on your diagnostic reasoning skills as well your ability to make decisions that are in-line with current practice recommendations. Just because a test is available does not mean it needs to be done. Example: Let’s say my patient’s CC was cough and that my differential included bronchitis and pneumonia. In this case, a CXR might be useful in differentiating the 2 conditions-so I am going to state that I want to perform a CXR today. However, remember that you have to have an EBM argument for this decision. So make sure you are telling the reader why this is the best choice based on the literature (i.e., it is not enough to say the test and cite the author & date). In this instance, my argument might look like this: “According to the Infectious Disease Society of America (2012) a CXR is considered the gold standard for diagnosing pneumonia.” Keep in mind that you also need an EBM argument if you decide NOT to test too.