MSN 572 Case Study

MSN 572 Case Study

Case Study Scenario

Scenario: GI is your body system, 42-years-old female with abdominal pain and constipation

Criteria Exceeds

Expectations

Meets Expectations

Below Expectations Far Below Standard

Group Identifies 3

Appropriate

Differentials

25%

Differentials are appropriate to

presenting symptoms, each

group member has identified a

differential, and differentials are

medical diagnoses.

25 points

Differentials are appropriate for entry- level providers and all group members

have unique differentials, but

differentials may not be medical diagnoses

20 points

All group members have unique

differentials, but differentials are not

applicable, or relevant, or are not medical diagnoses.

16 points

Not all group members have

unique differentials or differentials chosen are not

medical diagnoses/do not

relate to symptoms

10 points

Each Differential

Includes a

complete and

applicable lab and

radiology workup,

as appropriate 30%

Workup is specific to the chosen

differential and does not include

unnecessary testing.

Student considers insurance coverage

or costs.

30 points

Workup is specific to chosen differential, but may include too many or not enough

labs/testing.

May or may not consider insurance

or costs.

25 points

Workup is only generally applicable to differential, and does not narrow

objective findings.

No mention of insurance or cost.

20 points

Workup is not appropriate to the differential. This

would be labs/radiology that would not provide

needed information towards final

diagnosis.

No mention of insurance or cost.

15 points

Each workup

Includes complete

interpretation of lab

work/ radiology, as

necessary 30%

Interpretation includes high/low values, as well as

all/most clinical conditions

associated with high/low values.

30 points

Interpretation includes high/low values, but only includes several

conditions associated with high

or low values

25 points

Interpretation includes high/low values, but only

includes some/few associated conditions

20 points

Interpretation does not include high/low

values or misidentifies/

confuses associated conditions

15 points

Appropriate

attribution (at least

3 peer-reviewed,

recent references

to support each

differential/work-

up, in APA format)

5%

No errors in APA format. In-text

citations present, and 3 peer reviewed,

recent (less than 10 years old) references

included

5 points

Minimal errors in APA format or missing in-

text citations. 3 references included

4 points

Major errors in APA format or references are not scholarly or

recent.

2.5 points

Poor citations or references, poor paraphrasing or incorrect use of

quotations.

Plagiarized assignments may take a zero in all

categories.

0 points

Mechanics

(spelling, grammar,

format) 5%

Clear writing without errors. Perfect grammar and

engaging written voice.

5 points

Clear writing with minimal errors.

Some passive voice or other minimal

errors that could be improved but do not

detract from readability.

4 points

Writing is difficult to understand due to multiple errors in

spelling, grammar, composition.

2.5 points

Writing cannot be understood due to extensive errors.

1.5 point

Style &

Formatting

(weighted 5%)

The assignment is organized and easy to read. Fonts and text

formatting are consistent and

readable. There is some element or

originality and style. There is consistency and flow with how the

data is reported.

5 points

The assignment is organized and easy to read. Fonts and text

formatting are usually consistent and

readable. There is consistency and flow. Might be missing the element or originality

and style.

4 points

The assignment is somewhat organized

but not always easy to read. Fonts and text formatting are not

always consistent and readable. Missing the element or originality

and style.

2.5 points

The assignment is choppy with bad

editing. The style of the chart/outline or format is difficult to

read and inconsistent. Fonts and headings

are inconsistent.

1.5 points

TOTAL 100 82 63.5 43

Differential for Diverticulitis

Risk factors include:

● Overweight

● >40 Years of age

● Cigarette smoker

● Lack or little exercise

● Diet high in fat and red meat but deficient in fiber

● Taking medications such as steroids, opioids, and nonsteroidal anti-inflammatories(NSAIDS)

(mayo clinic, 2018)

Differential for Diverticulitis

Symptoms

Fever

Leukocytosis

Left lower quadrant pain

Constipation

Bloating

Pelvic tenderness on rectal exam

(When Constipation Becomes Chronic, n.d.)

Differential for Diverticulitis

Labs

CBC with differential $4.31 Stool culture $11.99

C-reactive protein $3.41 Amylase $3.24

Helicobacter Pylori $10.11 Lipase $3.44

IgE antibodies $3.48

Fecal Occult blood or fecal immunochemical test $4.38

Labs CBC with differential-measurement of the number of red blood cells, platelets, and different white blood cells. Those being neutrophils, lymphocytes, monocytes, basophils, and eosinophils.

WBC Normal values 4,500-11,000 cells/mcl

Abnormal low indicates bone marrow disorders, sepsis, autoimmune disorders, immune disorders, lymphoma and other cancers to name a few

Abnormal high indicates Infection, inflammation, leukemia, allergies, asthma, severe stress to name a few

Hemoglobin Men 14-17.5 gm/dL Women 12.3-15.3 gm/dL

Abnormal low indicates anemia, acute or chronic bleeding, Bone marrow disorder, chronic inflammatory disease,

Nutritional deficiencies, and chronic kidney disease

Abnormal high indicates dehydration, pulmonary disease, kidney disease, high altitude living, and polycythemia

Hematocrit Men 41.5-50.4 % Women 36.9-44.6%

Same as hemoglobin

(Connor, 2020)

CBC Continued RBC Men 4.5-5.9 million cells/ mcL Women 4.1-5.1 million cells/ mcL

Abnormal low indicates anemia, acute or chronic bleeding, Bone marrow disorder, chronic inflammatory disease,nutritional

deficiencies, chronic kidney disease

Abnormal high indicates dehydration, pulmonary disease, kidney disease, high altitude living, and polycythemia

MCV 80-96 fL

Abnormal low indicates Anemia (Iron deficiency), thalassemia

Abnormal high indicates Anemia (Vitamin deficiency) , hypothyroidism

RDW (Red Cell distribution width) 11.5-14.5 fL

Abnormal low indicates RBC size uniformity

Abnormal high indicates iron deficiency anemia

CBC and Differential

Platelets 150,000-450,000 platelets/mcL

Abnormal low indicates Thrombocytopenia, viral infection

Abnormal high indicates Cancer, Inflammatory bowel disease, Rheumatoid Arthritis

Neurtrophils 41.0-77.0%

Abnormal low indicate Sepsis, immunodeficiency, bone marrow damage, dietary restrictions

Abnormal high indicates inflammation, heart attack, acute bacterial infection, stress, Cushing syndrome

Lymphocytes 14.0-48.0%

Abnormal low indicates infection, bone marrow damage, autoimmune disorder

Abnormal high indicates acute viral infection, inflammatory disorders, toxoplamosis

CBC with differential

Monocytes 4.0-13.0%

Abnormal low indicates not medically significant

Abnormal high indicates asthma, parasitic infections, inflammatory disorders, some cancers

Eosinophil 0.0-8.0 %

Abnormal low indicates not medically significant

Abnormal high indicates inflammation, allergic reactions, leukemia

Basophil 0.0-1.5 %

Abnormal low indicates allergic reaction, overactive thyroid, infection

Abnormal high indicates chronic infammation

More lab studies

Amylase 50-123 U/L

Abnormal high indicates acute pancreatitis, cholecystitis, alcohol abuse

Lipase 10-50 UI/L

Abnormal high indicates cirrhosis, celiac disease, cholecystitis

CRP

Abnormal high indicates bacterial infections

2nd Differential for Gastrointestinal Disease

Gastrointestinal (GI) diseases most often present with one or more of four common classes of

Symptoms and Signs:

● (1) Abdominal or chest pain; ● (2) Altered ingestion of food (eg, resulting from nausea, vomiting, dysphagia, odynophagia, or anorexia ● (3) Altered bowel movements (ie, diarrhea or constipation); and ● (4) GI tract bleeding (Mills & Ciorba, 2019)

Labs

● Molecular diagnosis-primary immunodeficiency diseases (PIDDs)) with 344 distinct molecular etiologies reported according to the International Union of Immunological Sciences (IUIS) to detect Gastrointestinal Disease (Hartono et al., 2019).

● WBC-assess for infections

Test for Gastrointestinal Disease ● Barium swallow $300-$450 ● Computed tomography scan (CT or CAT scan). $350-$650 ● Fecal occult blood test. A fecal occult blood test checks for hidden (occult) blood in the stool. It

involves placing a very small amount of stool on a special card. The stool is then tested in the healthcare provider’s office or sent to a lab.

● Stool culture. A stool culture checks for the presence of abnormal bacteria in the digestive tract that may cause diarrhea and other problems. A small sample of stool is collected and sent to a lab by your healthcare provider’s office. In 2 or 3 days, the test will show whether abnormal bacteria are present.

● Magnetic resonance imaging (MRI) avg cost $1751 ● Magnetic resonance cholangiopancreatography (MRCP) (Dalwadi, Herman, Das, & Holliday, 2020)

Treatment for Gastrointestinal Disease

● Weight control-Diet high in fruits and vegetables

● Quit smoking

● Exercise

● Increase fiber

● Increase water intake ● Avoid medications such as steroids, opioids, and nonsteroidal anti-inflammatories(NSAIDS)

● Radiotherapy (Dalwadi, Herman, Das, & Holliday, 2020) ● Complementary therapy-acupuncture, diet, probiotics, and dietary supplements and herbs (Dossett, Cohen,

& Cohen, 2017).

References Complete Blood Count (CBC) – Understand the Test & Your Results. (2015, June 25).

Labtestsonline.org. https://labtestsonline.org/tests/complete-blood-count-cbc

Connor, G. J. (2020). Lab values interpretation : the ultimate laboratory tests manual of reference ranges and what they mean.

Dalwadi, S. M., Herman, J. M., Das, P., & Holliday, E. B. (2020). Novel Radiotherapy Technologies in the Treatment of Gastrointestinal Malignancies. Hematology/oncology clinics of North America, 34(1), 29–43. https://doi.org/10.1016/j.hoc.2019.08.016

Dossett, M. L., Cohen, E. M., & Cohen, J. (2017). Integrative Medicine for Gastrointestinal Disease. Primary care, 44(2), 265–280. https://doi.org/10.1016/j.pop.2017.02.002

Hartono, S., Ippoliti, M. R., Mastroianni, M., Torres, R., & Rider, N. L. (2019). Gastrointestinal Disorders Associated with Primary Immunodeficiency Diseases. Clinical reviews in allergy & immunology, 57(2), 145–165. https://doi.org/10.1007/s12016-018-8689-9

Mayo clinic. (2018). Diverticulitis – Symptoms and causes. Mayo Clinic; https://www.mayoclinic.org/diseases-conditions/diverticulitis/symptoms-causes/syc-20371758

Mills, J. C., & Ciorba, M. A. (2019). Chapter 13: Gastrointestinal Disease. Retrieved from https://accessmedicine.mhmedical.com/content.aspx?sectionid=198222337https://labtestsonline.org/tests/complete-blood-count-cbchttps://doi.org/10.1016/j.hoc.2019.08.016https://www.mayoclinic.org/diseases-conditions/diverticulitis/symptoms-causes/syc-20371758

References

When Constipation Becomes Chronic. (n.d.). GI Associates. Retrieved June 24, 2021, from https://gi.md/resources/articles/when-constipation-becomes-chronic

• Slide 1
• Case Study Scenario
• Slide 3
• Differential for Diverticulitis
• Differential for Diverticulitis
• Differential for Diverticulitis
• Labs
• CBC Continued
• CBC and Differential
• CBC with differential
• More lab studies
• 2nd Differential for Gastrointestinal Disease
• Labs
• Test for Gastrointestinal Disease
• Treatment for Gastrointestinal Disease
• References