Chat with us, powered by LiveChat M.G. is an 8-year-old boy who has been brought to the emergency department by his parents with a fever of 104º F, lethargy, headache, and stiff neck. | WriteDen

M.G. is an 8-year-old boy who has been brought to the emergency department by his parents with a fever of 104º F, lethargy, headache, and stiff neck.

Case 1

M.G. is an 8-year-old boy who has been brought to the emergency department by his parents with a fever of 104º F, lethargy, headache, and stiff neck. Laboratory analysis of a spinal tap demonstrates increased white blood cells in the cerebrospinal fluid (CSF).


 Discussion Questions


1.            What is the most likely cause of M.G.’s signs and symptoms? What is the origin and pathogenesis? What other laboratory findings would be consistent with this etiology?


  2. What are common complications of this disorder, and how would one assess for their occurrence?


  3. What is the usual treatment for this disorder?




 Case 2


 J.S. is a 72-year-old woman with a long history of atherosclerosis. One afternoon, her grandson found her sitting in a chair staring blankly into space. She was leaning to the right, drooling, and had been incontinent of urine. She was able to focus her eyes on him when he spoke to her, but she was unable to verbalize a response. She was transported to the local hospital and diagnosed with a stroke.


 Discussion Questions


1.            What questions could be asked of J. S.’s family to help determine the cause of her stroke as thrombotic, embolic, or hemorrhagic (i.e., questions to assess risk factors for each type of stroke)?


   2. Based on the scenario described above, which brain hemisphere (left or right) suffered the ischemic damage? What other manifestations of this stroke location would likely be apparent?


   3. What medical therapies might be used to manage this current stroke and/or to prevent another one?


  4. What information might be appropriate to give J.S.’s family about the expected recovery process after stroke?




 Case 3


F.P. is a 66-year-old man hospitalized for surgical management of an enlarged prostate. His chart indicates that he has had Parkinson disease for 5 years prior to admission, and has been managed with a dopamine precursor (levodopa/carbidopa). He also has a seizure history, having experienced a seizure about 20 years ago as a complication of a motor vehicle accident. He took an anticonvulsant medication for many years but stopped taking it about 3 years ago because he was “tired of taking it” and hadn’t had a seizure since the accident.


 Discussion Questions


1.            What types of motor difficulties would F.P. be expected to exhibit related to his Parkinson disease?


  2. What is the rationale for managing Parkinson disease with a dopamine precursor?


   3. What safety and activities-of-daily-living problems might F.P. have encountered while hospitalized?


   4. If F.P. experiences seizure activity while in the hospital, what should be assessed during the seizure episode? How would his seizure be managed?


  Case 4S.Y. is a 90-year-old woman who is a resident of a long-term care facility. She was alert and mentally quite capable until about a year ago when she began to manifest signs and symptoms of dementia. A review of her medical records failed to document a thorough analysis of her dementia, but a diagnosis of “probable Alzheimer disease” was recorded.


Discussion Questions


1.            What are the manifestations of dementia?


  2. What other potentially treatable factors might have led to S.Y.’s deteriorating mental function?


   3. What are the organic brain alterations that are typical of Alzheimer disease?


4. How will her dementia be managed pharmaceutically? What strategies can be implemented by the staff to prevent exacerbations of dementia behaviors?


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