NR 325 Week 3 Case Study

Student Name

Chamberlain University

NR-325 Adult Health II

Prof. Name:

Date

NR 325 Adult Health II – Case Study #1: Patient Profile of P.J.

P.J. is a 74-year-old female with a complex medical history who recently recovered from a gangrenous open cholecystectomy involving the removal of her gallbladder. Her condition was further complicated by gangrene extending into the common bile duct and a bile leak postoperatively. She also has diabetes, which heightens her risks of complications. Today, she presents to the emergency department with a seven-day history of diminished vision in her left eye. Her current medications include valsartan 160 mg/25 mg daily for hypertension, amitriptyline 25 mg daily as an antidepressant, aspirin 81 mg daily as an NSAID, and alprazolam 0.25 mg PRN for anxiety. She reports experiencing “fuzzy and distorted” vision and expresses frustration about the new issue following her gallbladder ordeal. P.J. is alert, oriented, and shows stable vital signs, with blood pressure at 119/79 and oxygen saturation of 96% on room air. However, diminished bilateral lower lobe breath sounds are noted, potentially indicating atelectasis or early pneumonia.

Potential Causes of Blurry Vision and Focused Assessment

Blurry vision in P.J.’s case could stem from several factors, including age-related macular degeneration (AMD), hypertension-induced retinopathy, diabetes, medication side effects (e.g., amitriptyline, alprazolam), acute inflammation, open or narrow-angle glaucoma, a tumor, or a detached retina. A focused assessment should encompass her family and medical history, extraocular muscle strength (EOMs), visual acuity testing, a comprehensive ophthalmic exam, smoking history, and an evaluation of her ocular dryness or tear production.

Diagnosis and Management

An ophthalmologist’s consultation revealed a scar on P.J.’s macula, indicative of AMD. Early symptoms of AMD include difficulty recognizing faces, needing brighter light for reading, and distorted vision. Diagnostic tests, such as ophthalmoscopy and visual acuity tests, are vital for confirming AMD. Risk factors include smoking, hypertension, female gender, short stature, family history, and a diet deficient in carotene and vitamin E. Dietary recommendations for P.J. should emphasize consuming foods rich in antioxidants, carotene, vitamin E (e.g., spinach, eggs, nuts, and whole grains), vitamin C (fruits and vegetables), and vitamin B12 (shellfish and meats).

Case Study #2: Patient Profile of S.H.

Patient Presentation and Assessment

S.H., a 25-year-old male, presents with a one-day history of severe vertigo accompanied by vomiting. He reports recent vertigo episodes associated with right-sided tinnitus and worsened symptoms upon head movement. Due to his fear of falling, S.H. has resorted to crawling out of bed. Physical examination reveals spontaneous nystagmus in the right eye and severe sensorineural hearing loss predominantly at low frequencies in the right ear, confirmed by an audiogram. The Weber test indicates right-sided sensorineural hearing loss.

Diagnosis and Management

Vertigo differs from general dizziness in that it involves the perception of the environment spinning around the patient. Based on his symptoms and diagnostic findings, S.H. is diagnosed with Ménière’s disease, a disorder often linked to trauma, viral infections, or other inner ear disturbances. Diagnostic tests such as Romberg testing, MRI, CT scans, and vestibular testing may help confirm the diagnosis.

Discharge Teaching and Follow-Up

S.H. is prescribed prochlorperazine and diazepam for symptom management and advised to follow up with his primary care physician in 3–4 days. Discharge instructions should emphasize safety precautions to prevent falls, avoiding operating heavy machinery due to sedative medication effects, and seeking assistance when moving around.

Table Format

Section	Case Study #1: P.J.	Case Study #2: S.H.
Patient Profile	74-year-old female with diabetes and recent gallbladder surgery, presenting with blurry vision.	25-year-old male presenting with vertigo, tinnitus, and vomiting.
Diagnosis	Likely age-related macular degeneration (AMD).	Ménière’s disease.
Management	Ophthalmology consultation, photodynamic therapy, and dietary modifications.	Prescriptions for prochlorperazine and diazepam; safety precautions.

References

American Nurses Association. (2021). Nursing: Scope and standards of practice. 4th edition.

Hinkle, J. L., & Cheever, K. H. (2022). Brunner & Suddarth’s textbook of medical-surgical nursing. 15th edition.