Case Critical Analysis Paper
FORMAT:
Submitted papers are limited to 10 pages maximum (cover page, reference list, and relevant appendices are not included in to the 10-page maximum). Grading will be limited to the first 10 pages; anything beyond 10 pages will not be marked. Papers should be double-spaced, 12-font, Times New Roman, with 1 inch margins on all sides. Follow APA for format and references.
In this case critical analysis paper, the student will create a diagnostic plan for a client presenting with a specific clinical presentation in the clinical setting. The case critical analysis paper and the consult letter are to be written on the same client.
The goals of this assignment are to:
(a) develop knowledge and skill in organizing thinking related to a particular case, given a profile of characteristics relevant to that particular case by utilizing a framework for a presenting problem;
(b) discriminate between what is relevant and irrelevant, given the particular presenting problem;
(c) demonstrate critical thinking in articulating these findings by defending thinking and
diagnostic reasoning;
(d) integrate advanced practice competencies from a primary health care perspective;
(e) articulate the ‘value-added’ contribution made by NPs in primary health care;
(f) develop skills in the written articulation of presenting clinical findings in a succinct and comprehensive manner.
PART A – Case Critical Analysis Paper (15%)
Select a client with a ‘focused’ health problem seen in clinical practice and relevant to the content of any one of the AHAD I modules.
The following topic headings are suggested to guide the organization of the paper.
Health History (15%)
Physical Examination (10%)
Synthesis of Information (15%)
Medical Diagnoses (20%)
Implications for Advanced Practice Nursing (15%)
Diagnostic Plan (15%)
Organization/Style (10%)
Review the grading criteria for this assignment, focusing on the critical elements to discuss as you develop each section of the paper.
Therapeutic interventions are NOT part of this assignment. Focus on the diagnostic reasoning framework and the diagnostic plan.
Relevant information re: Medical History.
41yr F (C.S.), G2P2, presenting with irr. menses, DUB (dysfunctional uterine bleeding), normal PAP smear results. Was sent for intra-vaginal ultrasound and report states that there is evidence of bilateral ovarian polyps and adenomyosis. The patient is married and has been in this monogamous relationship X16 years. No birth control required as her partner has had vasectomy.
Following these results, CS was informed via telephone appointment. Referral will be sent to Gynecologist for f/u care. PAP, Ultrasound reports will be included. Her history was negative for thyroid disease, liver abnormalities, chronic renal disease, and bleeding or clotting disorders. There was no significant past surgical history. CS reached menarche at age 12, and reported a regular menses approximately every 28 days, which usually lasted 7 days. During her most recent menstrual cycle however, she described a heavy menses; she changed a saturated pad every 2-3 hours for 12 consecutive days. This was repeated every 2-3 months for the past 9 months. In between, her menses were normal/regular.
Family history: Father passed away in 2014. HX of MI and CABGx4 in his late 50’s; CVA age 66, healthy lifestyle, dementia.
Mother passed in 2013 from ovarian CA at the age of 68. She was diagnosed with breast ca in her late 50’s. 2 maternal aunts; both breast ca (late 40’s and 50’s), maternal cousin age 36 diagnosed with cervical ca.
Patient as one brother who is well. Other bro in 2019 at age 48 had angioplasty; 3 stents, non smoker, no alcohol, healthy, normal weight.
Problem list:
Dermatitis, asthma, endocervical polyps (newly diagnosed – purpose of this paper), early family hx CAD
Past medical hx:
Asthma, anxiety, grief due to both parents passing away (2013, 2014), herpes zoster.
2011 G1P1 normal, healthy vaginal delivery
2015 G2P2 same
Medications:
Hydrocortisone 2.5% cream
Betamethasone valerate 0.1% cream
Ferrous fumarate 300mg PO
Allergies: N/A
Risk factors: Never smoked, no alcohol consumption, non-gambler, no recreational drug use, no dietary concerns, moderate exercise 45min X 7days/week.
Physical examination:
CS’s hemodynamic status was evaluated. In examining the patient’s skin, no petechiae and ecchymosis, which may be indicative of a hematologic disorder.
Furthermore, the NP checked for any virilisation including hirsutism, striae, or acanthosis nigricans. Next, the NP examined for thyromegaly and abdominal tenderness, rigidity, or masses.
A thorough gynecological and bimanual exam was performed to verify the bleeding site. No Foreign bodies and discharge, as well as uterine or adnexal tenderness or masses were found. Inspection of the urethra, vagina, cervix, and rectum, including a Hemoccult test, was performed to determine the source of bleeding.
CS was 5’8” and weighed 145 pounds, with a body mass index of 24. Her vital signs were as follows: left arm blood pressure (BP) was 119/66 (sitting) ;pulse at 76 per minute;.
She exhibited no striae or acanthosis nigricans. Ecchymosis and petechiae were not observed. Her thyroid was not palpable. Her heart had normal S^sub 1^ S^sub 2^ heart sounds without murmur. Her abdomen was tender throughout with no masses, splenomegaly, rebound, or rigidity.
Her genital exam was normal, showing no external or internal lesions. She had an active bloody discharge per the cervical os. There was no foreign body detected, nor was there presence of any abnormal discharge. The bimanual exam was normal without any cervical motion, uterine, or adnexal tenderness. There were no masses palpated. The rectal exam was normal and the hemoccult test was negative.
* Laboratory Data
Initial laboratory work included a beta human chorionic gonadotropin, complete blood count with differential, platelet count, reticulocyte count, and cultures for chlamydia and Neisseria gonorrhoea.
CS’s beta human chorionic gonadotropin quantitative was negative, her white blood cell count was normal, hemoglobin and hematocrit were 133g/L and 0.40L/L respectively.
Her platelet count was normal and prothrombin time was normal. The PTT and reticulocyte count were 29 seconds and 56X10(9)/L respectively. Additionally, CS recently had a normal thyroid-stimulating hormone, blood urea nitrogen, creatinine, fasting blood sugar, iron profile, and urinalysis.
Relevant references: https://www.cno.org/globalassets/for/rnec/pdf/competencyframework_en.pdf
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