Topic: Professional Task: A Case History With Guided Questions

Home » Topic: Professional Task: A Case History With Guided Questions

Weight: 30% Type of CollaborationSubmission: online Format: All assignments must be typed Required format as follows: Double spaced 3cm left and right margins Font: Arial or Times New Roman Font size: 12pt

All sourced materials must be properly referenced and a reference list must be included at the end.

Length: 1,000 words Curriculum Mode: Case Study

Case Study with four (4) guided questions Case Study:

 Jordan James is a 25-year-old male. Jordan has been admitted to hospital with a five day history of right lower abdominal cramping pain, a feeling of abdominal bloating, nausea and bilious vomiting, and an increased amount of abdominal gurgling and rumbling. Jordan stated that over recent weeks, he has experienced persistent diarrhoea, lower right abdominal pain and tenderness, fatigue and malaise. Jordan stated he has not been able to keep up with his work demands and is not getting quality rest and sleep. Due to his diarrhoea and current vomiting Jordan states that he has been reluctant to eat or drink much during the past five (5) days. He reported that he has lost seven kilograms in the last three weeks. Jordan was diagnosed with Crohn’s disease when he was 17 years old. His Crohn’s disease was diagnosed after Jordan presented to his general practitioner (GP) with a perianal abscess. Since his diagnosis and surgical management of his perianal abscess, Jordan’s Crohn’s disease has been managed with pharmacological (infliximab) and dietary strategies, and medical monitoring. During this time, Jordan has had a number of exacerbations of Crohn’s disease. Jordan’s observations on admission were: – Blood pressure: 92/52 mm/Hg – Pulse rate: 112 beats/minute – Weak peripheral pulses – Respiratory rate: 24 breaths/minute – Temperature: 38.3C – Sa02: 97% in room air – Weight: 75 kilograms – Height: 188 cm – Urinalysis: specific gravity: 1035; dark coloured urine; no other abnormalities noted On examination, Jordan had a distended abdomen, a tender mass in his right lower abdominal quadrant and audible bowel sounds. His skin was pale and dry with poor turgor. His extremities were cool to touch. The medical officer (MO) noted that Jordan had poor capillary refill and flat neck veins. The MO ordered some preliminary blood tests and abdominal CT Scan

Initial pathology result

 – Haemoglobin: 109 g/L (120-180g/L). 7

– Haematocrit: 51% (35 – 47%) – WBC: 13.9 X 109/L (4.3 – 10.8 X 109/L)

– Erythrocyte sedimentation rate (ESR): 26.5mm/hour (0 – 13 mm/hour)

 – C-reactive protein (CRP): 30.7mg/dl (20 mg/dl) – Albumin: 30.5g/L (35 – 50 g/L)

 The MO returns to discuss the results of the CT scan with Jordan. Jordan has developed a stricture causing a bowel obstruction in his terminal ileum. Jordan is referred to a gastroenterological surgeon. The surgeon explains to Jordan that he will require a surgical resection of the affected ileum and an end-to-end anastomosis of the ends of the ileum. The surgeon also tells Jordan that he has numerous large patches of inflamed mucosa and submucosa throughogh his small bowel and colon.

The MO orders the following – Morphine 15mg intamuscularly (IM) QID PRN – metoclopramide (’Maxolon’) 10mg IMI TDS – 1000mL Hartman’s solution over 6 hours via IVI – methylprednisolone 20mg IVI TDS – nil by mouth.

Guided QUESTIONS

Guided questions (Question 1. 10 marks). Suggested word limit 400 words)

 1. Explain the structural and functional changes in the disease process that led to Jordan’s weight loss. Student answers must be supported by relevant academic references. References are not included in the word limit.

 (Question 2. 5 marks. (Suggested word limit 200 words)

 2. Explain the pain pathway and how Morphine alters the conscious perception of pain. Students answers must be supported by relevant academic references. References are not included in the word limit.

(Question 3. 2.5 marks. Suggested word limit 200 words)

 3. Explain the clinical manifestations that may indicate the deterioration of Jordan’s Crohn’s condition and explain why they occur. Students answers must be supported by relevant academic references. References are not included in the word limit.

(Question 4. 2.5 marks. Suggested word limit 200 words)

 4. Explain the characteristics of the intravenous fluid that was ordered for Jordan and explain the rationale for the administration of the IV fluid relating to Jordan’s specific fluid balance. Students answers must be supported by relevant academic references.

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