CASE1

A10yearoldgirlwasreferredtopediatricdentistryclinicwithcomplaintof
toothache.Norelevantmedicalhistorywasreportedduringtheanamnesis.After
toothprophylaxis,theclinicalexaminationshowedthatshewasatmixeddentition
withcariescavitiesintheteeth#55and#65.Alargepitanddemineralizationin
theocclusalsurfacewasobservedinteeth#36and#46,althoughtheseteeth
appearedhealthy(figure1).Bitewingradiographrevealedrizolysisofteeth#55
and#65andalargeradiolucentareainthecoronaldentinofthetooth#36
affectingthepulptissue(figures2and3).
1. What are the risk factors in
the development of dental
caries? Including the
common pathogens for
tooth decay
2. Formulate the
pathophysiology related to
the case
3. 3 Nursing Diagnosis with
management

CASE 2
ChiefComplaint&ID:Mrs MS is a 56 y/o OFW having chest pains for the last
week.
HistoryofPresentIllness
One week prior to admission, she noticed the abrupt onset (over a few seconds
to a minute) of chest pain which she describes as dull and aching in character
about 8/10. Her discomfort was accompanied by shortness of breath, but no
sweating, nausea, or vomiting. The pain lasted approximately 5 to 10 minutes
and resolved spontaneously.
Shes a coffee drinker, About 4-5 cups a day. 20 pack years smoking history and
occasional alcoholic beverage drinker. Diabetic for 15 years and HPN for 10
years. BMI is 26. She been complaining of occasional epigastric pain especially
after eating for the past 6 months now. According to her the epigastric pain is
more prominent early in the morning.
Questions:
1. What are your possible diagnosis. State according to priority.
2. Create a pathophysiology discussion based on your #1 (primary)
diagnosis.
3. State 3 nursing diagnosis and interventions

Case 3
The patient 53 Y/o presented to the dentist due to very poor state of
dentition. After having performed initial examination and having taken
an dental x-ray (fig. 1), the dentist unequivocally detected numerous
roots with gangrenous pulp.
After diagnosis had been made, history was taken. The 53-year-old was
on his last dental check-up 20 years earlier. During this period he had
been abusing alcohol. In addition, he has been smoking one pack of
cigarettes daily on average since he was 20. He had never used
prostheses and taken care of oral hygiene, as he used to brush teeth
every two or three days. It was initially established that patients
sexual life had been very rich. It is worth noticing that frequency of
accidental contacts with women without protection was quite high.
Moreover, due to the fact that he had worked in the printing industry
for 30 years, he had been exposed to many quite strong substances
with carcinogenic properties.
After dental consultation and sanitation of oral cavity, the patient was
referred ENT specialist because of a nodule in the oropharynx (fig. 2)

fig 1

Fig 2.

Questions:
1. What is your diagnosis?
2. Identify the risk factors related to the diagnosis and mark those
present in the patient.
3. Create your pathophysiology on this case
4. Enumerate 3 Nursing Diagnosis with corresponding intervention

CASE 4
A 45 years old 78-kgs man was experiencing generalized body
weakness, brownish tint in the urine, and sudden weight gain of 8-kgs
within a period of three weeks. Blood pressure was100/60, pulse rate
found to be 116 beats/min, temperature 38 C, and enlarged abdomen.
He was a truck driver and used to live in environment with known
exposure to radiations, fumes, chemicals, and other environmental
allergens. He had a 7 year medical history of hepatitis C. Laboratory
tests including complete blood count, liver function tests; urea tests
came out to be significantly abnormal, complicating the case.
Laboratories include blood glucose 143gm/dl (normal range 80-140),
blood urea 90mg/dl (normal range 17-43), creatinine level
was2.4mg/dl, and bilirubin 2.2mg/dl, liver function tests revealed

alanine aminotransferase (ALT) 89u/l, aspartate amino transferase

78u/l, serum albumin 2.1g/dl(normal range3.5-5.2).Sodium level was
165(normal range 135-150) potassium 6.4 (normal range 3.5-6.0)
hematology tests revealed hgb level 6.2mg/dl neutrophills77%
lymphocytes 20% eosinophils0.2. reduced levels of serum albumin
and abnormal elevation of liver enzymes(ALT and AST)
1. What are the medical problem in the case?
2. What is the primary GI problem that will explain the
manifestation in the case.
3. Create your pathophysiology regarding the case.
4. Enumerate 3 nursing diagnosis with interventions