2026 inhuman case studies, Study Guides, Projects, Research of Nursing

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Inhuman case studies

Doyle, Janet Riley and Justin Johnson

Russe, Mabel Johnson, Patricia

Betty Burns, chana Kumar, Carlotta A.

1- Pyelonephritis: Causes right flank pain and CVA tenderness, it is often associated with fever, nausea,

and vomiting. Lower urinary symptoms may or may not be present (Cash & Glass, 2014).

2- Pancreatitis, acute: This should be considered in this multipara patient taking oral contraceptive pills

and presenting with abdominal/back pain associated with N/V, fever, and tachycardia.

3- Nephrolithiasis: This should be considered since it may be associated with severe flank pain, with

radiation towards the groin area, nausea, and vomiting.

4- Ectopic pregnancy: This should be considered when a sexually active, premenopausal woman

presents with acute abdominal pain. A negative (HCG) will ruled it out.

5- Appendicitis: This should be considered because of the patient's report of N/V, and fever.

What was your final diagnosis?

The Final diagnosis was: Pyelonephritis: This diagnosis was considered and confirmed by the patient's

past medical history, risk factors, signs, symptoms, and laboratory results.

Pyelonephritis Common Complaints include: Shaking, chills, and fever, flank pain or tenderness, urinary

frequency or urgency, CVA tenderness, and/or guarding (Cash & Glass, 2014).

This is a young sexually active female with a past history of three UTIs, the most recent one month

ago, presenting with worsening right flank pain for two days, fever, nausea and vomiting. Upon

physical exam there is a positive right CVA tenderness, fever of 101, and tachycardia (HR: 114).

Laboratory results showed bacteriuria and nitrite positive on urinalysis along with a positive urine

culture (I-Human, n.d.). 2- Pancreatitis: was ruled out by a normal limits serum lipase result (I-

Human, n.d.).

3- Nephrolithiasis was ruled out by a CT of the abdomen negative for evidence of renal obstruction, and

renal/paraphrenic abscess (I-Human, n.d.).

4- Ectopic pregnancy: was ruled out by a urine pregnancy (HCG) test negative (I-Human, n.d.).

5- Appendicitis: was ruled out by the CT of the abdomen that showed a normal appendix (I-Human, n.d.).

References:

Cash, J. C. & Glass, Ch. A. (2014). Family Practice Guidelines, 3rd Edition. [South University]

Anam Mardians 6152 B

Section 200

Mabel Johnson

pain, or gout.

negative findings

• Bony enlargement of her knees. There is evidence of a

small effusion (fluid) in the right knee. Both knees exhibit

crepitus, a grinding or crackling noise or sensation felt over

the joint.

• The medial joint line of both knees is tender upon palpation.
• Some distal interphalangeal of her finger joints joints) are

enlarged (both proximal and

• Shibe flexed has limited to 90 degrees. range of She motion

cannot in her completely knees, they straighten can only

her knees. Her ability to flex and extend at the hips is also diminished slightly.

BETTY BURNS I HUMAN CASE STUDY 6

• She has limited range of motion in her fingers.

Negative findings:

• She has normal musculoskeletal stability.

II. ASSESSMENT (Medical Diagnosis) – Your differential diagnoses List

of Differential Diagnoses

• Differential Diagnosis #1: Osteoarthritis:

Osteoarthritis is a degenerative joint disease in which there is a slow, progressive loss of joint

cartilage from mechanical stress. The joints that are affected in the disease can be the knees,

hips, hands, cervical and lumbar spine, and wrists.

The pain in osteoarthritis occurs in the morning lasting a brief amount of time. With the pain,

small joint effusions are present with bone enlargement. Risk factors in developing osteoarthritis

is obesity and genetic factors (Bickley & Silage, 2017, pp. 696-697). Diagnostic studies that

confirm the diagnosis of osteoarthritis are films that show “progressive changes, including

diminishing joint space, sclerosis, and osteophyte formation (Goolsby & Grubbs, 2019, p.443).”

Ms. Mable Johnson has many positive findings that indicates this disease. Ms. Johnson has had

pain in her knees for 5 years but has gotten worse over the years. The pain is in both knees

which occurs in the morning, and it last for about 15 to 20 minutes. Occasionally, Ms. Johnson

has pain in her hands along with the knee pain. Along with the pain, Ms. Johnson has swelling in

her knees and finger knuckles. Ms.

Johnson is also obese, and her mother had a history of arthritis. During her physical examination,

it was noted that Ms. Johnson has bony enlargement of her knees, and there is evidence of

small effusion

(fluid) in the right knees. Some of her finger’s joints are enlarged. To confirm the diagnosis, the left

and right knee x-ray shows significant narrowing of the medial joint space of left knee with

sclerosis and osteophytes.

• Differential Diagnosis #2: Gout - Significant positive & negative findings Gout is an

inflammatory reaction that results from microcrystals within a joint

of Gout, “films are generally negative unless the condition has persisted for

a long period. In this case, films may reveal “punched-out” lesions of the bone. The uric acid

level is elevated. Joint aspirate will reveal crystals. There may be a mild increase in white blood

cells, and

sedimentation rate is increased (Goolsby & Grubbs, 2019, p. 446).”

Ms. Mabel Johnson has many negative findings for the differential diagnosis of Gout. Ms.

Johnson describes her pain in her knees as stiff and achy, which occurs in the morning for a brief

amount of time. In gout, the pain is usually confined in one joint which occurs suddenly at night,

and there is no stiffness present. Ms. Johnson also does not complain of hot, red joints or

BETTY BURNS I HUMAN CASE STUDY 7

fever. The test shows a normal uric acid level, normal ESR, normal synovial fluid analysis,

and normal CBC.

• Differential findings Diagnosis #3: Rheumatoid Arthritis - Significant positive & negative

Rheumatoid Arthritis is a chronic inflammation of the synovial membranes. The common

location affected for rheumatoid arthritis are the hands and symmetrical in nature. The pain is

onset is usually fast. Along with the pain, swelling, warmth of the joints is present. Redness of

the joints is almost always present. Stiffness is usually present for an hour in the mornings. The

diagnostic studies that help to confirm the diagnosis are a positive antinuclear antibody (ANA)

and anticitrullinated protein (antiCP) autoantibodies. The scans show a loss of joint space and

An equipment ETTY that produces compressed air through with a mask even as you sleep can be used

to 2 treat sleep disorders.

Exercise. Aggressive workout treatments frequently worsen symptoms, but it is critical to maintain

exercises that are tolerated in order to avoid deconditioning. Exercise routines that begin at a low

intensity and gradually increase in intensity over time may be beneficial in improving long-term function.

Formulating Differential Diagnoses (4th Eds.). Philadelphia, PA: FA Davis

Step-by-step explanation

Reference:

Davis, K. M., Lai, J. S., Hahn, E. A., & Cellar, D. (2008). Conducting routine fatigue assessments for use

in clinical oncology practice: patient and provider perspectives. Supportive Care in Cancer , 16 (4), 379-

exertion and had an episode of increased shortness of breath with

with movement such as climbing stairs or turning a door knob. She becomes short of breath with

feels lik e it started with sun exposure. Her knee and hand pain are rated at a 3/10 and is worsened

and goes. Her rash started on her cheeks and nose and progressed to her forearms and chest. She

vacation to Florida. She states her fever has been elevated to a little over 100 degrees that comes

of breath and chest pain. She feels her symptoms began a pproximately 2 weeks ago after taking a

She also has associated symptoms of fatigue, pain and stiffness to her hands and knees, shortness

rife HPI: Patricia Doyle is a 21 y/o female who presents to the clinic today with complaints of fever and rash.

CITATION Per20\ l 1033]. This patient has 6 of 11 criteria of the 1997ACR.

biopsy proven nephritis compatible with SLE in the presence of ANA or anti- dsDNA antibodies [

patient fulfills 4 of 11 criteria in the 1997 AC R, have 4 of 17 criteria of the 2012 SLICC or has a

complex deposition tissue damage (Ferry, 2019). A patient can be diagnosed with SLE if that

characterized by autoantibody production responsible for antibody- mediated and immune

Primary Diagnosis: Systemic Lupus Erythematosus (SLE)- Chronic inflammatory disorder

Patricia Doyle IHUMAN CASE STUDY

BETTY BURNS I HUMAN CASE STUDY 2

BETTY BURNS I 1

AAFP American Academy of Family Physicians.

Joseph R. Yancey Sarah M. Thomas. (2012, October 15). Chronic fatigue syndrome: Diagnosis and treatment.

Clinic. https://www.mayoclinic.org/diseases-conditions/chronic-fatigue-syndrome/diagnosis- treatment/drc -

Chronic fatigue syndrome-Diagnosis and treatment-Mayo Clinic. (2020, September 24). Mayo Clinic- Mayo

and has some alleviation with sitting up. She has been taking Tylenol but has had

minimal relief of her symptoms.

BURNS I HUMAN 3

BETTY CASE STUDY

Medications:

• Tylenol 650 mg PO Q6H as needed for pain or fever.
• Hydroxychloroquine 200 mg PO daily. Antimalarials (hydroxychloroquine) may

be helpful in treating lupus rashes or joint symptoms and appear to reduce the

incidence of severe disease flares [ CITATION Bar15 \l 1033].

• Methyl prednisone 50mg IV daily. Prednisone 1mg/kg/day for serious

manifestations and during flare ups then taper to low doses during disease

inactivity [ CITATION Per

\l

CASE STUDY

• Repeat CXR – to watch for worsening / improving pleural effusion [ CITATION

Dav19 \l 1033]

Diagnostic testing: EKG – Patient c/o of chest pain [ CITATION Dav19 \l 1033] Kidney

ultrasound - given patient's proteinuria to check for ischemia / damage

Consults:

• Follow a healthy diet.