NR 325 Week 3 Case Study

Student Name

Chamberlain University

NR-325 Adult Health II

Prof. Name

Date

NR 325 Adult Health II – Case Study #1

Patient Profile

P.J. is a 74-year-old female with a complicated medical background. She was discharged recently after a 14-day hospital stay following a gangrenous open cholecystectomy, which required gallbladder removal. Her postoperative recovery was complicated by a bile leak extending into the common bile duct. She also has a history of diabetes and reports decreased vision in her left eye for the past week.

Her prescribed medications include valsartan 160/25 mg daily (angiotensin II receptor blocker for hypertension), amitriptyline 25 mg daily (antidepressant), aspirin 81 mg daily (antiplatelet/NSAID), and alprazolam 0.25 mg every six hours as needed (benzodiazepine for anxiety).

Subjective Data

P.J. explains that her left eye vision appears “fuzzy and distorted.” She remarks, “I survived that horrid ordeal with my gallbladder, and now I have trouble with my vision.” Though unmarried, she maintains a supportive network of friends and caretakers.

Objective Data

• Vital Signs: Blood pressure 119/79 mmHg, pulse 82 beats/min, temperature 97.7°F, respirations 16 breaths/min.

• Mental Status: Alert and oriented to person, place, and time.

• Respiratory Examination: Decreased breath sounds in both posterior lower lobes, likely indicating postoperative atelectasis. There is concern for early pneumonia; oxygen saturation remains 96% on room air.

Potential Causes of Blurry Vision, Focused Assessment, and Interventions

Case Study Progress

The ophthalmologist’s evaluation revealed scarring in the central macular area, confirming a diagnosis of age-related macular degeneration (AMD). Photodynamic therapy was recommended to prevent further deterioration.

1. Early Signs of AMD

Patients with AMD often experience blurred or distorted central vision, difficulty recognizing faces, and a need for brighter light during reading tasks. These symptoms are progressive and typically start subtly before worsening.

2. Risk Factors for AMD

Risk factors for AMD include smoking, hypertension, female gender, family history of macular degeneration, shorter stature, nutritional deficiencies (low carotene and vitamin E), and prolonged sun exposure without protection.

3. Dietary Teaching for AMD Prevention

To slow progression, P.J. should adopt a nutrient-rich diet. Recommended foods include:

• Leafy greens: spinach, kale, collard greens

• Proteins and healthy fats: eggs, nuts, seeds

• Antioxidant-rich options: berries, citrus fruits

• Whole grains and legumes for vitamin B12 and fiber

These dietary modifications promote eye health and reduce oxidative stress, supporting long-term vision preservation.

NR 325 Adult Health II – Case Study #2

Patient Profile

S.H. is a 25-year-old male who presented to the emergency department with severe vertigo and vomiting for the past 24 hours. He reports recurrent episodes of vertigo and right-sided tinnitus for one month. The vertigo worsens with head movements, causing severe nausea and imbalance. To avoid falls, he has been crawling out of bed.

Subjective Data

• Vertigo worsens with head movement

• Associated nausea and vomiting

• Reports right-sided tinnitus for several weeks

Objective Data

• Vital Signs: Blood pressure 139/72 mmHg, pulse 90 beats/min, temperature 97.7°F, respirations 22 breaths/min

• Neurological Exam: Spontaneous nystagmus in the right eye

• Other Findings: Two vomiting episodes in the last 30 minutes with intermittent diaphoresis

Diagnostic Studies

• Audiogram: Severe sensorineural hearing loss (35.0 dB) in the right ear, particularly at low frequencies

• Weber Test: Confirms right-sided sensorineural hearing loss

Discussion Questions

1. Definition of Vertigo vs. Dizziness

• Vertigo: A false sensation of spinning or movement, often described as the environment moving around the patient.

• Dizziness: A broader term indicating lightheadedness, unsteadiness, or imbalance without the spinning component.

2. Potential Diagnosis for S.H.
The presence of vertigo, right-sided tinnitus, and sensorineural hearing loss strongly suggests Ménière’s disease, a disorder of the inner ear.

3. Additional Diagnostic Tests for Vertigo
Further assessments may include:

• Romberg test (balance assessment)

• MRI/CT scan (to rule out central lesions)

• Vestibular function testing (caloric stimulation, electronystagmography)

4. Causes and Risk Factors of Ménière’s Disease

• Possible causes: inner ear trauma, viral infections, autoimmune factors, or abnormal fluid accumulation (endolymphatic hydrops).

• Risk factors: family history, allergies, high sodium intake, and stress.

5. Priority Nursing Diagnoses for S.H.
The most critical concern is risk for falls related to severe vertigo and imbalance. Additional nursing diagnoses include risk for dehydration (due to vomiting) and anxiety related to sudden symptom onset.

6. Discharge Teaching for S.H.

• Educate about the sedative effects of prescribed medications such as diazepam and prochlorperazine.

• Advise against operating heavy machinery or driving until vertigo subsides.

• Encourage adherence to a low-sodium diet to reduce fluid retention in the inner ear.

• Suggest avoiding caffeine, alcohol, and smoking, which may exacerbate symptoms.

• Recommend follow-up with an otolaryngologist for long-term management.

References

• American Academy of Ophthalmology. (2023). Age-related macular degeneration: Diagnosis and treatment. https://www.aao.org

• Mayo Clinic. (2024). Macular degeneration: Symptoms and causes. https://www.mayoclinic.org

• National Institute on Deafness and Other Communication Disorders. (2024). Ménière’s disease fact sheet. https://www.nidcd.nih.gov

NR 325 Week 3 Case Study

• Smeltzer, S. C., Bare, B. G., Hinkle, J. L., & Cheever, K. H. (2022). Brunner & Suddarth’s textbook of medical-surgical nursing (15th ed.). Wolters Kluwer.