I HUMAN CASE AMINA JOHNSON CASE STUDY., Exams of Nursing

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Exam I HUMAN CASE AMINA JOHNSON CASE STUDY

TESTED AND CONFIRMED A+ ANSWER

I HUMAN CASE AMINA JOHNSON 23 Y/O

5'7" (170 CM) 120.

IB (54.5 KG) REASON FOR ENCOUNTER

FEVER AND SORE

THROAT. LOCATION OUT PATIENT

CLINIC WITH X

RAY, ECG

AND LABORATORY CAPABILITIES

Case Summary: Amina

Fever and sore throat

Location: Outpatient clinic with x

ray, ECG, and laboratory capabilities Assessment and Evaluation

Initial Assessment:

Chief Complaint: Fever and sore throat

History of

Present Illness:

Onset, duration, and se verity of symptoms

Associated symptoms such as headache, body aches, cough, difficulty swallowing, or ear pain

Any recent contact with sick individuals or history of similar symptoms

Vital Signs:

Temperature: Measure to confirm fever

Nose, Throat):

Inspect throat for erythema, swelling, or exudates

Palpate lymph nodes for enlargement or tenderness

Examine ears for any signs of infection

Assess for nasal congestion or discharge

Cardiovascular:

Listen to heart sounds for any murmurs or irregularities

Respiratory:

Auscultate lungs for any abnormal breat h sounds

Abdomen:

Palpate for tenderness or organomegaly

RAY, ECG AND LABORATORY CAPABILITIES Differential Diagnosis

Streptococcal Pharyngitis (Strep Throat)

Viral Pharyngitis

Infectious

Blood Count (CBC):

To check for elevated white blood cell count, which may indicate infection

Monospot Test:

To rule out infectious mononucleosis

Chest X

ray:

If there are signs of respiratory involvement or to rule out pneumonia

ECG:

If there are any cardiac symptoms such as palpitations or chest pain Treatment Plan

For Streptococcal Pharyngitis:

Antibiotics: Prescribe antibiotics such as penicillin or amoxicillin

Supportive Care: Pain relievers (acetaminophen or ibuprofen), hydration, and rest

Symptom Management:

Fever: Acetaminophen or ibuprofen to reduce fever and manage pain

Sore Throat: Saltwater gargles, throat lozenges, and warm f luids Patient Education

Medication Adherence:

Importance of completing the full course of antibiotics if prescribed

Symptom Management:

Measures to relieve throat pain and fever Clues about the patient's stool for Ms. Schilling - ANS-If floating high fat content, if watery the colon is not able to absorb water, urgency also indicates more water in stool Role of the gallbladder for Ms. Schilling - ANS-Patient had gallstones, gallbladder is responsible for making bile so could be recurrence of gallstones. Gallstones can be stuck in gallbladder and often in the sphincter of Oddi area. This could be the reason for her pain.

5 complications specific to Celiac disease for Ms. Schilling

• ANS-1. Malnutrition: if left untreated, happens in spite of adequate diet, deficiency in vitamins/minerals, vitamin D, folate, iron, anemia, weight loss 2. Loss of calcium and bone density: loss of fat in stool causing calcium and vitamin D loss, may result in osteomalacia, osteoporosis

3. Lactose intolerance: damage to small intestine from gluten can cause sensitivities to other foods like dairy, may or may not resolve with gluten-free diet 4. Cancer: if gluten-free diet not maintained greater chance of cancers including intestinal lymphoma and bowel cancers
4. Neurological complications: Celiac disease associated with nervous system disorders including seizures and peripheral neuropathy Normal non-inflammatory response to foods Ms. Schilling case - ANS-M-cells sample protein digests and present antigens to immune system so that we do not react to these antigens in order to promote tolerance. Celiac disease immune response Ms. Schilling case - ANS- Not able to fully break down gluten, likely due to high proline content. If perforation in gut barrier then will

cause reaction. Antigen recognizing cells HLA-DQ2 HLA- DQ8 recognize gluten. Gluten doesn't quite fit in receptor so TTG needs to change conformation in order to fit. Antigen recognizing cells in Celiac disease Ms. Schilling case - ANS-HLA-DQ2 HLA-DQ What causes Celiac disease? Ms. Schilling case - ANS- Stress or infection and genetic susceptibility leads to a inflammatory milieu leading to increased antigen sampling. Higher levels of TNF and IL-15 (can turn into natural killer cells in high amounts). HLA positive is driving force then more non-HLA genes cause more or less vulnerability. Genes related to Celiac disease Ms Schilling case - ANS- HLA-DQ2 HLA-DQ8 on chromosome 6 but other factors important because 40% of population has these variants, not a great screening test. 64 other associated genes in Celiac. 40 of these genes interact with each other and influence TNF and IL- 15

4 groups of common deficiencies in Celiac disease Ms. Schilling - ANS-1. Macronutrients: carbs, fats, proteins 2. Essential fatty acids and amino acids 3. Minerals: iron, calcium, magnesium, copper, zinc 4. Vitamins: lipid soluble (A,E,D,K), B vitamins, C vitamins