ST.

PAUL UNIVERSITY DUMAGUETE

COLLEGE OF NURSING

IN PARTIAL FULFILLMENT OF THE REQUIREMENTS IN

PAUL N 106 - PROBLEM BASED LEARNING

CASE ANALYSIS IN A PROBLEM-BASED LEARNING APPROACH

SUBMITTED TO

SUBMITTED BY

(DATE)

ACTIVITY #1: In the Emergency Department (ED) or Emergency Room (ER), patient usually seek medical intervention with
manifestations of Fever and Body Malaise. List down all diseases that will cause these symptoms. Please categorize according
to system.
System Illness/Disease Signs/Symptoms Diagnostics/ Medical Surgical Nursing
Labs Management Management Intervention
(at least 6
clinical features) (to confirm the
diagnosis)

Chest >Assess the

Respiratory Pneumonia Fever, Body X-Ray, Blood Antibiotics, O2 tube,thoracostom rate, rhythm,
System Malaise, chest Chemical Studies therapy y, lobectomy, and depth of
pain, productive (CBC), blood respiration,
coughing, deep culture, sputum chest
breathing, examination, movement,use
tachypnea, bronchoscopy, of accessory
bradycardia, pleural fluid muscles, and
sweating or chills, culture vital signs.
bluish skin, lips or >Auscultate
nails lung fields,
noting areas of
decreased or
absent airflow
and adventitious
breath sounds:
crackles,
wheezes.
>Suction as
indicated
>Elevate the
head of the bed
and change
position
frequently
>Teach and
 assist the
patient with
proper deep-
breathing
exercises.
>Maintain
adequate
hydration at
least 3000
mL/day warm
water, unless
contraindicated.
>Tell patient to
conserve
enerygy.

Respiratory COPD Frequent Spirometry, chest O2 therapy, Lung volume >assess for
System coughing/ x-ray, CT scan, Bronchodilators, reduction, lung respiratory rate,
wheezing, Arterial blood gas Corticosteroids, transplantation depth, and
shortness of analysis, postural drainage, characteristics,
breath, fatigue, Bronchogram, sputum amount
fever, body measuring force and type, and
malaise, vital capacity, anxiety level of
wheezing measure the the patient.
sound or expiratory volume. >Note use of
crackles in the accessory
lungs heard, muscle, and
increase pattern of
anteroposterior breathing.
to lateral ration >maintain
of chest. supplemental
oxygen therapy
>keep patient in
 semi-fowlers
position to
increase lung
expansion,,
>encourage
deep slow or
pursed lip
breathing as
individually
tolerated.
>administer
bronchodilators
as ordered.
>Advise client to
avoid
conditions that
increase oxygen
demand like
doing strenuous
activity.

Respiratory BRONCHITIS Coughing with or Chest X-ray, Antibiotics, Lung volume >Assess
system without mucus, Sputum tests, bronchodilators reduction respiratoryrate,
Soreness in the Spirometry, , O2 surgery, depth. Note
chest,body pulmonary therapy,Anti- useof accessory
malaise, fever, function test, inflammatory muscles,pursed
sore throat bronchoscopy medications, lip
Chest breathing,Inabilit
physiotherapy y to speak.
to mobilize >Elevate head
secretions, if of the bed,
indicated.Hydra assist
tion to liquefy patientassume
secretions position toease
work
ofbreathing.
>Encourage
deep slow or
pursed lip
breathing as
individually
tolerated or
indicated
>Encourage
mobilization of
secretion
through
ambulation,
coughing, and
deep breathing.
>Ensure
adequate fluid
intake to liquefy
secretions and
prevent
dehydration
caused by fever.
> Encourage
rest, avoidance
of bronchial
irritant, and a
good diet to
facilitate
recovery.
> Instruct the
patient to
complete the full
course of
prescribed
antibiotics and
explain the
effect of meals
on drug
absorption.
>Caution the
patient on using
over-the-counter
cough
suppressants,
antihistamines,
and
decongestants,
which may
cause drying
and retention of
secretions. .
>Advise the
patient that a
dry cough may
persist after
bronchitis
because of
irritation of
airways.
Hematologic MONONUCLEOS Fever, body Monospot test There's no Mononucleosis
System IS malaise, and EBV specific therapy may cause
● Obtain a
extreme antibody test. available to enlargement of
history of
fatigue, sore treat infectious the spleen. In
exposure
throat, head mononucleosis. extreme cases,
● Check
and body Antibiotics don't your spleen
vitals and
aches, swollen work against may rupture,
documen
lymph nodes in viral infections causing sharp,
t
the neck and such as mono. sudden pain in
presence
armpits, Treatment the left side of
of fever
swollen liver or mainly involves your upper
● Encourag
spleen or both taking care of abdomen, a
e not
and rash yourself, such splenectomy is
sharing
as getting needed.
food or
enough rest,
personal
eating a healthy
care
diet and
items
drinking plenty
● Encourag
of fluids.
e patient
not to
kiss
● Educate
patient
on
avoiding
sports for
at least 6
weeks
● Encourag
e
hydration
● Tell the
 patient
not to
take
penicillin-
like
antibiotic
s as it
may
result in a
rash
● Take
acetamin
ophen for
pain and
headach
e

ANEMIA Fatigue,
weakness, fever,
pale or yellowish
skin, irregular
heartbeats,
shortness of
breath, dizziness
or
lightheadedness,
chest pain, cold
hands and feet,
headaches
Respiratory INFLUENZA Fever, body Viral culture,
system malaise, sore serology, rapid People with the Administer
throat, antigen testing, flu are advised analgesics,
runny or stuffy reverse to get plenty of antipyretics,
nose, muscle or transcription rest, drink plenty and
body aches, polymerase
headaches, chain reaction
of liquids, avoid decongestant
and fatigue. (RT-PCR), using alcohol s, as ordered.
immunofluoresc and tobacco
ence assays, and, if
and rapid necessary, take
molecular Follow droplet
medications
assays. and standard
such as
precautions.
acetaminophen
(paracetamol)
to relieve the
fever and Provide cool,
muscle aches humidified air
associated with but change
the flu. the water daily
to prevent
pseudomonas
superinfection
Children and
.
teenagers with
flu symptoms
(particularly
fever) should Encourage the
avoid taking patient to rest
aspirin during in bed and
an influenza drink plenty of
infection fluids.
(especially
influenza type
B), because
Administer I.V.
doing so can
fluids as
lead to Reye’s
ordered.
syndrome, a
rare but
potentially fatal
disease of the Administer
liver. oxygen
therapy if
warranted.
Since influenza
is caused by a
virus, antibiotics Regularly
have no effect monitor the
on the infection; patient’s vital
unless signs,
prescribed for including his
secondary temperature.
infections such
as bacterial
pneumonia.
Monitor the
patient’s fluid
Antiviral intake and
medication may output for
be effective, but signs of
some strains of dehydration.
influenza can
show resistance
to the standard
Watch for
antiviral drugs
signs and
and there is
symptoms of
concern about
developing
the quality of
pneumonia.
the research.

Advise the
Phenylephrine
patient to use
and antitussive
mouthwash or
agents such as
warm saline
terpin hydrate
gargles to
with codeine are
ease sore
often prescribed
throat.
to relieve nasal
congestion and
coughing. In
patients with Teach the
influenza that is patient the
complicated by importance of
pneumonia, increasing
 antibiotics may fluid intake to
be administered prevent
to treat a dehydration.
bacterial
superinfection.
Suggest a
warm bath or
heating pad to
relieve
myalgia.

Review
prevention of
future
influenza
episodes with
patient and
the
community.

Cardio- CARDIOMYOPAT -Fatigue -Chest X-ray -Beta-blockers - Several types of

vascular HY -Breathlessness -Echocardiogram Angiotensin- devices can be
System with activity or - converting surgically
even at rest Electrocardiogra enzyme (ACE) implanted in the -Provide oxygen
-Swelling of the m (ECG) inhibitors - heart to improve at 2 to 4 L/min to
legs, ankles and -Treadmill stress Angiotensin II its function and
feet test receptor relieve symptoms,
-Bloating of the -Cardiac blockers (ARBs). including:
abdomen due to catheterization - -Sacubitril/valsar maintain or
fluid buildup, - Cardiac MRI tan (Entresto). Implantable improve
Heartbeats that -Cardiac CT scan cardioverter- oxygenation.
feel rapid, -Blood tests defibrillator -Minimize
pounding or -Genetic testing (ICD), Ventricular oxygen demand
fluttering or screening assist device by maintaining
-Chest discomfort (VAD), the patient at
or pressure, - Pacemaker bed rest.
dizziness -Provide liquid
-lightheadedness Septal diet on acute
fainting myectomy, Heart phase,
transplant -Administer
diuretic as
prescribed to
reduce preload
and afterload.
-Monitor serum
potassium
before and after
administration of
loop diuretics.
-Prophylactic
heparin may be
ordered to
prevent
thromboembolus
formation
secondary to
venous
poisoning
-Institute
pressure ulcer
prevention
strategies
secondary to
hypoperfusion or
vasoconstriction
agents.
Cardio- HEART FAILURE Fatigue and Blood tests, Angiotensin- Coronary bypass -Promoting
vascular weakness, fever, Chest X-ray, converting surgery, Heart activity
System chills, Swelling in Electrocardiogra enzyme (ACE) valve repair or tolerance
the legs, ankles m (ECG), inhibitors, replacement,
and feet, Rapid or Echocardiogram, Angiotensin II Implantable -Reducing
irregular Stress test, receptor cardioverter- fatigue.
heartbeat, Cardiac blockers, Beta defibrillators
Persistent cough computerized blockers, (ICDs), Cardiac -Relieving fluid
or wheezing with tomography (CT) Diuretics, resynchronizatio overload
white or pink scan, Magnetic Aldosterone n therapy (CRT), symptoms.
blood-tinged resonance antagonists, Ventricular
mucus, Swelling imaging (MRI), Positive assist devices -Controlling
of the belly area Coronary inotropes, (VADs), Heart anxiety
(abdomen), Very angiogram, Digoxin transplant
rapid weight gain Myocardial (Lanoxin), -Encouraging
from fluid buildup, biopsy Hydralazine and the patient to
Nausea and lack isosorbide verbalize his or
of appetite dinitrate (BiDil), her ability to
Vericiguat make
(Verquvo), decisions and
influence
Sodium outcome.
restriction,
Supplemental -Teaching the
Oxygen patient about
self-care
program.
Cardio- PERICARDITIS Cough, fatigue or Electrocardiogra Pain relievers Pericardiocentes Monitor patient
vascular general feeling of m (ECG), Chest (aspirin or is, pain level and
System weakness or X-ray, ibuprofen (Advil, pericardiectomy evaluate pain
being sick, leg Echocardiogram, Motrin IB, within 30
swelling, low- Cardiac others), minutes.
grade fever, heart computerized Colchicine
palpitations, tomography (CT) (Colcrys,
shortness of scan, Cardiac Mitigare),
breath when lying magnetic corticosteroid Administer
down, swelling of resonance (prednisone) prescribed pain
the belly imaging (MRI), C- medication
(abdomen) reactive protein such as
(CRP), Blood morphine to
Urea Nitrogen relieve pain.
(BUN), Troponin-
I, CK-MB,
Myoglobin, ESR Monitor the
patient pain
level and
effectiveness of
analgesics.

Provide a
comfortable
position (sit up
and lean
forward).

Check vital
signs and
record them
continuously.

Discuss
disease
process and
signs and
symptoms
expanding
aneurysm or
impending
aneurysm.

If surgical
intervention is
needed,
provide
psychological
support, and
prepare for
surgery.

For post-
surgical
patients,
discuss warning
signs of
postoperative
complications
such as fever,
inflammation in
the surgical
site, bleeding,
and swelling.

Daily check of
weight.

Closely monitor
and notify a
physician about
persistent
cough,
vomiting, or
systolic blood
pressure above
180mmhg
because of the
increased risk
for hemorrhage.

Ensure bed rest

until fever,
chest pain and
friction rub
disappear.

Administer O2
and keep SPO2
˃90%.

Administer
medication as
order-such as
NSAIDs and
steroids with
food.

Ensure
administer of
antibiotic timely.

Continue I.V
antihypertensiv
e medication if
persistent blood
pressure high.

Carefully
maintain fluid
intake and
output.

Reassure the
patient that
chest pain is
not a
Myocardial
Infarction.

Check signs
and symptoms
for cardiac
tamponade at
least 8 hourly
and PRN.

Assist the
patient with
bathing if
necessary.

Provide a
bedside
commode to
reduce stress
 on the heart.

Tell the patient

to resume his
daily activities
slowly.

Hepatic Hepatitis fever, fatigue, The hepatitis Surgery is not

System loss of appetite, virus panel used to treat
nausea, hepatitis. A liver
Hepatitis A- Vitamin K transplant may be Monitor
vomiting,
Hepatitis A injected needed if damage hydration
abdominal pain,
dark urine, light- immunoglobulin subcutaneously is severe enough through
M (IgM anti- (S.C.) if to keep the liver intake and
colored stools, from working as it
joint pain, and HAV) antibody prothrombin output.
time is should
jaundice test, Hepatitis A
immunoglobulin prolonged.
G (IgG anti- Monitor
HAV) antibody prothrombin
test, Total I.V. fluid and time and for
hepatitis A electrolyte signs of
antibody test, replacements
nucleic acid
amplification
testing (NAAT)

Hepatitis B- as indicated. bleeding.

Blood tests,
transient
elastography,
Liver biopsy Antiemetic for Encourage
nausea. the patient to
Hepatitis C- HCV
Ab test eat meals in a
sitting
Hepatitis D - high position to
levels of anti-
Long-term
interferon reduce
HDV
therapy in pressure on
immunoglobulin
G (IgG) and combination the liver.
immunoglobulin with oral
M (IgM), and ribavirin may
confirmed by produce Encourage
detection of HDV remission
RNA in serum pleasing
inHCV patients. meals in an
Hepatitis E - anti- Peginterferon environment
HEV alfa-2b is a with minimal
immunoglobulin long-acting noxious
M (IgM) preparation stimuli (odors,
given S.C., noise, and
once per week, interruptions).
and ribavirin is
taken twice
daily.
Teach self-
Antiviral administratio
treatment is n of
being antiemetics
investigated for as prescribed.
HBV.

Encourage
rest during
symptomatic
phase,
according to
level of
fatigue.

Encourage
diversional
activities
when
recovery and
convalescenc
e are
prolonged.
Encourage
gradual
resumption of
activities and
mild exercise
during
convalescent
period.

Stress
importance of
proper public
and home
sanitation and
proper
preparation
and
dispensation
of foods.

Encourage
specific
protection for
close
contacts.

Explain
precautions
about
transmission
and
prevention of
transmission
to others to
the patient
and family.

Warn the
patient to
avoid trauma
that may
cause
bruising.

Stress the
 need to follow
precautions
with blood
and
secretions
until the
patient
deemed free
of HBsAg.

-Emphasize
that most
hepatitis is
self-limiting,
but follow up
is needed for
liver function
tests is

Digestive Parotitis Pain where the Superficial

System gland is swollen, Characteristic When parotitis is parotidectomy (SP) Educate patient
fever, chills, clinical features of caused by a viral, and near-total about mumps.
headache, sore parotidectomy
throat, general parotitis and bacterial or fungal (NTP)
malaise or prodrome alone. infection, your Encourage
tiredness, loss of Laboratory healthcare hydration and
appetite, and dry diagnosis is based provider will rest.
mouth or dry on serological or prescribe the
eyes. salivary appropriate
confirmation, medication
Educate about
detection of viral (antivirals,
hand washing.
nucleic acid, or antibiotics or
isolation of the antifungals).
virus from body Over-the-counter
fluids. pain relievers — Tell patient to
such as keep away from
acetaminophen school or work
and ibuprofen — until symptoms
can help ease subside.
tenderness or
discomfort. Your
provider may also Educate
recommend caregiver on
massaging or vaccination.
applying heat to
your swollen
parotid glands. Take
acetaminophen
for pain.

Use saltwater
gargles for sore
throat.
 Evaluate
patient for other
complications
like pancreatitis,
orchitis, aseptic
meningitis,
weakness, etc.

Immune LEUKOCYTOSIS Fever, fatigue, Complete Blood Antibiotics -

System pain, difficulty Count (CBC), bacterial infection
breathing, Peripheral blood Antihistamine -
wheezing, night smear, Bone allergic reaction
sweats, marrow biopsy
unexpected Anti-inflammatory
weight loss, rash medications.

Inha

Endocrine Hyperthyroidism -Fever Thyroid Blood Antithyroid Thyroidectomy -Obtain a

System -Malaise Test medications -This is the consistent data
-sensitivity to heat - tests the level of -Generally acts on excision of one or of vital signs for
-Muscle T3 and T4 thyroid gland’s all of the lobes of proper
weakness. hormone in the ability to produce the gland to get monitoring
-Diarrhea blood to detect hormones and rid of the especially on
-Mood swings. any excess or lack inhibits this ability. overproduction of the patient BP
-Difficulty sleeping of the hormone. Radioactive thyroid hormones. and Heart Rate
-nervousness Iodine Ablation -Note any sign
 -anxiety and -Kills overactive of chest pain
irritability. thyroid cells or which could tell
shrinks an us if the heart
enlarged thyroid has overworked
gland. -Monitor patient
weight
-Administer
antithyroid
medication as
prescribed
-Educate on the
possibility of
having a
surgery for the
thyroid and on
what to do
before and after
the surgery.
-Since diarrhea
can be a
common
occurrence,
monitoring of
patient’s I and
O is very
important.
-Provide bed
bath if patient is
feverish/febrile

Urinary Urinary Tract -Low grade Fever Urinalysis Main therapy of Removal of -Monitor blood
System Infection -Body malaise -This test can Antibiotics Etiological tests such as
-Pain or burning check for any -Whether the type Cause patient WBC
feeling when presence of of UTI is -Some infections count for the
Urinating bacteria or white recurring, acute or are recurrent status of the
-Pain in the Lower blood cells within chronic, the main which means that infection.
abdomen the urine which is drugs used are for it can come back -Bladder
-Some back pain a definite sign for killing the bacteria due to an palpated every
-Cloudy Urine infections. causing the unsolved etiology 4 hours to
-Foul smelling Bacterial Culture infection. This can of the infection check for any
urine -This is to check either range from which could either bladder
on what type of a short therapy be structural in retention
bacteria is causing duration of weeks nature like a non -Increasing
the issue and to to months of responsive hydration is
develop a proper medication, some bladder or an great for the
antibiotic plan. even through an obstruction of patient to
IV. either a stone or a facilitate
Pain tumor which frequent output
Management causes a backup of urine and
-Phenazopyridine of urine and waste products.
Is a staple in pain causes a high -Give acidic fruit
management for chance of drinks like
UTI since it infection. Surgical lemon or
specifically acts removal of such cranberry juice
on soothing the etiology will help to increase
urinary tract itself. resolve the acidity of urine
Fever recurrent infection and help fight
Management of the Urinary off microbes.
-UTIs can also tract. -NSAIDS
cause fevers, so should be
antipyretics avoided for pain
should also be management
used whenever so that UO
episodes of fevers won’t be
are experienced. inhibited
Lymphatic TONSILLITIS - High Fever Throat swab - Tonsillectomy - Create
System - Malaise -The sample will Pharmacotherapy -Mostly done to environment
- Sore be checked in the of Antibiotics manage tonsillitis conducive for
Throat clinic or in a lab for - Pain that does not rest
- Headache streptococcal Management of respond to -Increase
- Swollen bacteria. Analgesics antibacterial patient
Lymph pharmacotherapy. hydration to
Glands Common types of prevent dryness
- Hoarse tonsillitis that of the throat
voice might need -Give saltwater
- Coughing surgical gargles to help
intervention are soothe throat
recurring, chronic, - Humidify the
and bacterial air, if possible,
tonsillitis. to create a cool
and moist
environment so
that the
patient’s throat
won’t get
irritated
- Teach the
patient to avoid
irritating food or
scents.
- Provide bed
bath to help
ease patient
body
temperature.
 LEUKOCYTOSIS

Integumentary Cellulitis Fever with chills Complete blood Antibiotic therapy, Amputation would >Assess the
system and sweating, count, bacterial analgesic,antipyre only be required if patient’s skin
body malaise, culture, tic,drainage the affected area on his/her
pain or becomes whole body.
tenderness in the gangrenous or >Asess for
affected area, skin necrotic. signs of
redness or infection and
inflammation, skin always monitoy
sore or rash, tight lab results.
glossy stretched >Administer
appearance on antibiotics as
the skin, warm prescribed.
skin in the area of Ensure that the
redness, muscle patient finishes
aches and joint the course of
stiffness, nausea antibiotic
and vomiting prescribed by
the physician.
>Apply
corticosteroids
over the
affected skin as
prescribed by
the physician
>Trim the
patient’s
 fingernails and
ensure frequent
hand hygiene.
Advise the
patient and
caregiver to
prevent
scratching the
affected areas.
>Educate the
patient and
caregiver about
proper skin
hygiene
through
washing it with
soap and water.
>Prevent the
use of occlusive
dressing over
the affected
area.

Integumentary
system