Case Study # 1

Mrs. S is a 74 year old, admitted with a pressure ulcer

over the coccyx that is 5 cm in diameter and
approximately 1 cm deep. The tissue surrounding the
ulcer is inflamed and tender to touch. VS 38.1c, 100,
18 164/78 Ht 5’8” WT. 115 lbs. Blood sugar 368,
WBC 18,000, H&H 6& 25.8. Mrs. S was transfer
from a nursing home where she had resided for 6
months after a massive stroke. According to the
nursing home Mrs. S has lost 30 lbs since her
admission, and her appetite is very poor. She is
unable to move independently in bed and does not
sense pressure or discomfort over her coccyx or hips.
Mrs. S has a foley and required max assist with
ADL's and meals. Past medical history is HTN, DM,
and hyperlipidemia.

1. Give three NSG dx for this patient

2. What are the defining etiologies to support your

dx?

3. List symptoms for three nursing diagnosis

4. List five interventions for one of the diagnoses

Case study #2
Ms. R is 38 year old admitted with a diagnosis of
Crohn’s disease, an inflammatory condition of the
bowel. Ms. R has had considerable abdominal pain,
accompanied by cramping and frequent diarrhea
stools. Her nursing history shows that she has lost 15
pounds over the last 2-month period. Her appetite has
been poor. VS; 36.5c-68-18 100/68 HT 5’8” 106lbs.
Ms. R rates her pain 9/10. She has no past medical
history besides two childbirths.

1. List three nursing diagnoses?

2. What are the defining etiologies to support your

dx?

3. What are the defining symptoms for each

diagnoses?

4. List five interventions

Case Study #3

You are assigned to Mr. C, who had abdominal

surgery for obstruction 48 hours ago. VS: 37.1 C- 82-
24 140/88. Mr. C weighs 270 pounds and is 6 feet
tall. He has a Morphine PCA system for pain control.
Mr. C rate his pain at 8/10. His intravenous (IV)
fluids are running at 100 ml/hr, and he has two IV
antibiotics scheduled to run every 6 hours. Mr. C
orders include NGT in right nare to LIWS, NPO,
foley, abd dressing changes wet to dry twice a day
and OOB to chair this am.

1. List three nursing dx?

2. List defining etiology to support each dx’s?

3. List symptoms to support your dx?

4. What questions do you need to ask before you

attempt to ambulate this client?

5. List five interventions

Case Study #4

Mr. J is a 48 year old, recently been diagnosed with

asthma and is to be discharged tomorrow. His
physician has ordered a metered-dose inhaler for Mr.
J to use daily. The client has not used an inhaler
before. He asks the nurse, “What do I do at home if I
have trouble using this thing?” Mr. J, is a 1/2ppd
smoker with history of SOB and difficulty breathing
this is his third admission in a month. He lives at
home with his wife, two dogs and one cat.
1. Develop three nursing diagnosis for Mr. J.

2. List the etiology associated with each dx’s?

3. List the symptoms?

4. List 5 interventions to help this patient meet his goal?

5. Any Teaching?
Case study # 5

Ms. S is a 72 year old, admitted with a high fever for

several days. Her lungs with coarse rhonchi, and is
producing thick yellow sputum. She is diaphoretic
and very fatigued. She has difficulty turning herself
in bed because she has little energy and she is
overweight. VS: 102.9 F- 118- 28 98/46 ht 5’1” wt.
260 lbs. She is on 4L O2 with a PO of 92%. She has
+ 3 pitting edema in her LE. The skin over her bony
prominences is intact at this time, with some redness
appearing over the coccyx area. Reddened area
blanches with fingertip pressure. Her past medical
history includes COPD, CHF, 1PPD smoker and DM
type II.

1. List three other potential nursing diagnoses?

2. List the etiology associated with each dx’s?

3. What are the defining symptoms for each dx’s?

4. What factors should you consider in selecting
interventions for Ms. R?

5. List five interventions

Case Study # 6

Mr. V is back for a F/U weekly visit to the clinic for care of
a chronic venous stasis ulcer of the left leg. The nurse’s
note at the time of his first visit 3 weeks ago contained the
following information: “Ulcer with irregular margins, 4 cm
wide by 5 cm long, approximately 0.5 cm deep, with foul-
smelling purulent yellowish drainage. Only subcutaneous
tissue visible. Skin around ulcer, brownish rust in color.
Zinc oxide and calamine gauze applied to ulcer; elastic
wrap bandage applied to gauze. Client instructed to return
weekly for dressing changes. Mr. V is 65 year old recent
widower living alone. He is 260lbs. 5'5''. VS 99.8-86-28
178/99. During this dressing change the wound is noted as
the following, Ulcer with irregular margins, 3cm wide x
4cm long, with foul smelling purulent drainage.
1. List three nursing dx for this patient

2. List the etiology associated with each dx’s?

3. What are the defining symptoms for each?

4. List 5 interventions for this patient

5. As the nurse who is caring for the client on the follow-

up visit, what expected outcomes would you anticipate for
the goal of “Wound will demonstrate healing within 4
weeks”? What evaluative measures would you use to
determine whether the wound was healing?
Case Study # 7

Mr. B is a 78-year-old man who has been diagnosed with terminal

lung cancer. He reports a loss of appetite and a 6-pound weight
loss over the last 1-month period (152 pounds to 146 pounds). He
is able to chew and swallow food without difficulty. Mr. B denies
feeling nauseated but states, “I just have no interest in food.” His
wife reports that he eats only a portion of what is served, “He gets
full so quickly.” Mrs. B also reports that her husband is less active
around the house, sleeps poorly, and is unable to talk about his
diagnosis.
1. List three nursing DX for this patient

2. List the etiology associated with this dx?

3. What are the defining symptoms?

4. List 5 interventions you can recommend to the patient

wife to help meet the goals set?

5. How would you evaluate if your goals are being met?