Each Following Cases Question & Answer Guide (With Explanation)

This question focuses on applying theory to practical scenarios.

What This Question Is About

This question relates to each following cases and requires a structured academic response.

How to Approach This Question

Focus on explaining concepts clearly and supporting them with examples.

Key Explanation

This topic involves each following cases. A strong answer should include explanation, application, and examples.

Original Question

For each of the following cases, identify one or two likely conditions based on the data. Most importantly, include your rationales as to why you chose that disorder. Lastly, discuss any additional interventions needed to confirm the diagnosis. There is no need to use artificial intelligence (AI) tools for these discussions. Please refer to the College Catalog for a full review of ICHS Academic Integrity policies. Case #1: D.B., a 59-year-old attorney, presents to the clinic with abdominal pain. His vital signs are BP 170/98, HR 108, RR 25, and temp 100.4° F (38° C). Abdomen is obese and soft. He has direct and rebound tenderness, predominantly in the left lower quadrant. He reports a history of periodic constipation with previous episodes of mild abdominal cramping. He has a “high-stress job”, 30-pack-year smoking history, and drinks “a few beers most evenings”. He says he doesn’t have any time to exercise, and his diet consists mostly of “eggs, bread, meat, potatoes, cookies, and ice cream.” He denies cardiac or breathing problems and no personal history of cancer, although his father and brother died of colorectal cancer and his mother died of breast cancer. He denies the use of any medications, drugs, or herbal products except for a “multivitamin when I remember to take it.” Last bowel movement was yesterday, and it was “brown with streaks of blood.” Case #2: A.D. is a 63-year-old admitted to the medical-surgical unit from the ED. Assessment findings reveal the client is alert and oriented x3 and muscle strength is 5/5 bilaterally in upper and lower extremities. PERRLA. Breath sounds are clear in all fields. S1/S2 heart sounds are present, no murmur or rub. Client reports mild nausea and 9/10 right upper quadrant pain. Abdomen is rounded and tender to palpation. Bowel sounds normoactive in all quadrants. The client admits to having had several similar bouts of abdominal pain in the last few weeks, but “not as bad as this.” Reports “light brown” stools 3 times/day and darker urine in the past week. Mild scleral icterus noted. Vital signs are BP 164/90, pulse 118, respirations 26 breaths/min, temperature of 100° F (37.8° C), SpO2 96% on room air. Case #3: P.H. is a 52-year-old construction worker admitted to the telemetry unit with a diagnosis of chest pain. A comprehensive pain assessment reveals severe epigastric pain radiating to the back. This pain has been occurring for “about a month” although “this time is much worse.” The pain tends to be worse in the middle of the night and after skipping meals. He also reports a history of “heartburn” for which he takes a couple of Rolaids or Tums. Vital signs are T 98.6° F (37° C), Pulse 102 and regular, Respirations 20 and unlabored, BP 130/90, SpO2 95% on room air. A 12-lead ECG shows normal sinus rhythm. Client reports a 35-pack-year smoking history, moderate alcohol use, obstructive sleep apnea, and a recent back injury for which he takes ibuprofen 800 mg TID. Last bowel movement was yesterday and it was “brown and soft.” An emesis basin in the room reveals brown emesis with specks of bright red. Case #4: P.P. is an 85-year-old retired teacher presenting with abdominal pain and nausea and vomiting for the past 12 hours. Medical history information is obtained through her grandson as P.P. speaks very little English and a translator is unavailable. P.P. has a history of osteoarthritis, colon cancer, colectomy, and ventral hernia repair. No known allergies. She takes an acetaminophen or ibuprofen rarely for arthritis pain. Vital signs are 99.0F-92-20-132/88-97% on room air. D5½NS with 20 mEq KCl is infusing at 100 mL/hr through a 20-gauge PIV in her left forearm. Pulmonary, neurological, and cardiovascular assessment findings are expected. Her upper abdomen is distended with frequent, loud, high-pitched bowel sounds. Last bowel movement was 2 days ago, and it was “normal”.

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