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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.

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].

*Do
not simply rewrite the information as it is presented in the case report. This
should mimic how you would present this patient to your preceptor.

2.
Provide
a differential diagnosis (plural) which might explain the patient’s chief
complaintalong
with a brief statement of pathophysiology for each.

Example:

Diagnosis
#1

-Pathophysiology
statement

Diagnosis
#2

-Pathophysiology
statement

Diagnosis
#3

-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).

Example:

Diagnosis
# 1, 2, & 3 (provide an analysis for each of the diagnoses listed above)

A
brief argumentas to why this condition should be considered plus:

-Pertinent
positive symptoms which support the diagnosis

-Pertinent
negative symptoms which support the diagnosis

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 differential included bronchitis and pneumonia. In this case, a CXR might be useful in
differentiating the 2 conditions.
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.

Part
2

In
Part 2 you might be given some additional history, exam or test findings. Using this information and the
information in Part 1, answer the following questions:

1.
What
is your primary diagnosis for this patient? Tell the reader how you came to this
conclusion using the information that you were given (i.e., CXR result, lab
result). Interpret the results into your
diagnosis decision (i.e., tell how this information helped you to narrow your
differential to the one diagnosis that you chose).

Example:

Diagnosis:
Pharyngitis, streptococcal

Rationale:
The CBC results are
normal which rules out infection and anemia. The RSA test was + which tells me
that she has a very strong likelihood of streptococcal pharyngitis.

In the case where a diagnosis was made
based on clinical presentation and history, explain the criteria with an EBM argument
to support.

2.
Identify
the corresponding ICD-10 Code for the diagnosis.

Example:

J02.0

You
can find a link to an ICD-10 code finder by going to the Library
homepage>Browse guides>Course directory tab>select NR511 from the drop
down box>select Go. Otherwise, a google search will provide you with several
free options you can use.

3.
Provide
a treatment plan
for this patient’s primary diagnosis which includes:

a) Medication–all
prescriptions and OTC medications should be written in RX format with an EBM to
support:

Medication Name & Medication Strength

Dispensing quantity:

Sig:

RF:

b) Any
additional testing necessary for this particular diagnosis-typically
done when you need more information to confirm a diagnosis or differentiate the
diagnosis. Do not state all of the
possibilities that are available. To assess your diagnostic reasoning skill,
you will need to be decisive.

c) Patient
education–self explanatory

d) Referral-self
explanatory

e) F/U plan-include if and when the
patient should follow-up

*If part of the plan
does not warrant an action, you must explain why. ALL medication and testing decisions
(or decisions not to treat with medication or additional testing) MUST be
supported with an EBM argument as you did in Part 1.

Example:

a. Penicillin
VK 500mg, Disp #20, Sig: 1 tab twice daily x 10days; RF: 0 (full RX required)

Rationale: Penicillin is
the 1^st line treatment recommendation for Group A Beta-hemolytic
streptococcal pharyngitis, based on their narrow spectrum of activity,
infrequency of adverse reactions, and modest cost. (Shulman, Bisno, Clegg, Gerber, Kaplan, Lee,
Martin, & Van Beneden, 2012). My
patient has no noted allergies, so PCN VK is appropriate.

b.
No additional testing will be performed
today.

Rationale: Point of care, rapid
strep antigen tests are highly specific (approximately 95%) when compared with
throat cultures, so false-positive test results are highly unusual. Consequently, a therapeutic decision can be
confidently made based on the positive result which was reported for this
patient in the scenario (Shulman, Bisno, Clegg, Gerber, Kaplan, Lee, Martin,
& Van Beneden, 2012).

c.
Patient instructions:

-take
all medication as prescribed (Reference, date)

-F/U
in 10-14 days if symptoms are not resolved or sooner if they become worse,
etc., (Reference, date)

-Etc..

4.
Provide
an active problem list
for this patient based on the information given in the case. This is where you list all of the known
medical problems of the patient. This is
different than a differential.

Example:

1. Streptococcal
Pharyngitis

2. Hypertension

3. Obesity

List
your references that were cited above according to APA rules. Format is not
graded (Canvas does a poor job in formatting the tabs and spaces) BUT all other
APA elements are required.

References

Shulman,
S., Bisno, A., Clegg, H., Gerber, M., Kaplan, E., Lee, G., Martin, J., &
Van Beneden, C. (2012). Clinical
Practice Guideline for the Diagnosis and Management of Group A Streptococcal
Pharyngitis: A 2012 Update by Infectious
Diseases Society of America. Clinical Infectious Disease, 55(10), e89. DOI: 10.1093/cid/cis629

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