NR 566 Week 1 Case Study Graded Discussion
i i i i i i i
Purpose
Problem-based ilearning iis ia imethodology idesigned ito ihelp istudents idevelop ithe ireasoning
iprocess iused iin iclinical ipractice ithrough iproblem isolving iactual ipatient iproblems iin ithe
isame imanner ias ithey ioccur iin ipractice. iThe ipurpose iof ithis iactivity iis ito idevelop istudents’
iclinical ireasoning iskills iusing ia icase-based ilearning iexercise. iThrough iparticipation iin ian
ionline idiscussion iforum, istudents iidentify ilearning iissues iin ia iself-directed imanner iwhich
ifacilitates ilearning ifor ithe ientire igroup.
Case iStudy i& iDiscussion iQuestions
John iis ia i46-year-old imale iwho ipresents ifor ihis iyearly iphysical iexamination. iHe ihas ino
icomplaints. iPrevious imedical ihistory iis inotable ifor iobesity iand ihyperlipidemia. iHe ireports
ia ivery isedentary ilifestyle. iHe isits iat ia idesk ifor i8 ito i10 ihours iper iday iand iwhen ihe icomes
ihome ihe i“just iwants ito irelax iin ifront iof ithe itelevision.” iHe idoesn’t ifeel imotivated ienough
ito iexercise ion ia iregular ibasis, ialthough ihe iknows ihe ishould.
John iis iallergic ito ipenicillin i(hives). iMedications iinclude iatorvastatin i10mg idaily iand ia
imultivitamin. iHe ioccasionally itakes iacetaminophen ifor ia iheadache. iFamily ihistory iis
isignificant ifor idiabetes i(mother, imaternal igrandmother, ipaternal igrandfather) iand
ihypertension i(father iand ibrother). iHe iis ia inonsmoker iand ireports idrinking i“a ifew ibeers ion
ithe iweekend iduring ifootball iseason”. iHis idiet ilargely iconsists iof ifast ifood imeals. iHe
idrinks isweet itea iwith ievery imeal iand ian iadditional i3-4 icups iof icoffee iper iday. iPrevious
ilabs iand iexam ilast i year iare iunremarkable.
Vitals itoday: iBP i130/70 imm iHg, ipulse i82 iand iregular, itemperature i98.7, irespirations i18,
iheight i6’1”, iweight i235 ipounds i(up i3 ilbs. isince ihis ivisit i1 i year iago). iHe icompleted ifasting
ilabs iprior ito ithis iappointment ias ihe iwas iinstructed iwhich ireveal ithe ifollowing:
Fasting iplasma iglucose=209 img/dl, iHgbA1C=9.1%, iTSH=4.0mU/L iand iFree iT4=1.1 ing/dl.
iFasting ilipid ipanel iincludes ithe ifollowing: itotal icholesterol=190 img/dL, iHDL=35 img/dL,
i LDL=120 img/dL iand itriglycerides=260 img/dL.
Physical iexam iis iremarkable ifor iobesity ibut iis iotherwise inormal.
1. What iare iyour itreatment igoals ifor iJohn?
2. What iis iyour ipharmacologic iplan iand irationale? i(cite iwith iappropriate iclinical
i practice iguidelines ior ischolarly, ipeer-reviewed ijournals)
3. What iis ithe imechanism iof iaction ifor ieach idrug?
4. Please igive ifive imedication iteaching ipoints ifor ieach idrug iprescribed.
5. How iwould iyou ichange ithe iplan iif ihis iinitial iHbgA1C iwas i14.0 img/dL iand ihis
i fasting iblood iglucose iwas i350mg/dL ialong iwith ia iurine idipstick ithat irevealed i3+
i glucose iand i+ iketones? iProvide ia idetailed ialternative iplan iwith ithe irationale.
i i i i i i i
Purpose
Problem-based ilearning iis ia imethodology idesigned ito ihelp istudents idevelop ithe ireasoning
iprocess iused iin iclinical ipractice ithrough iproblem isolving iactual ipatient iproblems iin ithe
isame imanner ias ithey ioccur iin ipractice. iThe ipurpose iof ithis iactivity iis ito idevelop istudents’
iclinical ireasoning iskills iusing ia icase-based ilearning iexercise. iThrough iparticipation iin ian
ionline idiscussion iforum, istudents iidentify ilearning iissues iin ia iself-directed imanner iwhich
ifacilitates ilearning ifor ithe ientire igroup.
Case iStudy i& iDiscussion iQuestions
John iis ia i46-year-old imale iwho ipresents ifor ihis iyearly iphysical iexamination. iHe ihas ino
icomplaints. iPrevious imedical ihistory iis inotable ifor iobesity iand ihyperlipidemia. iHe ireports
ia ivery isedentary ilifestyle. iHe isits iat ia idesk ifor i8 ito i10 ihours iper iday iand iwhen ihe icomes
ihome ihe i“just iwants ito irelax iin ifront iof ithe itelevision.” iHe idoesn’t ifeel imotivated ienough
ito iexercise ion ia iregular ibasis, ialthough ihe iknows ihe ishould.
John iis iallergic ito ipenicillin i(hives). iMedications iinclude iatorvastatin i10mg idaily iand ia
imultivitamin. iHe ioccasionally itakes iacetaminophen ifor ia iheadache. iFamily ihistory iis
isignificant ifor idiabetes i(mother, imaternal igrandmother, ipaternal igrandfather) iand
ihypertension i(father iand ibrother). iHe iis ia inonsmoker iand ireports idrinking i“a ifew ibeers ion
ithe iweekend iduring ifootball iseason”. iHis idiet ilargely iconsists iof ifast ifood imeals. iHe
idrinks isweet itea iwith ievery imeal iand ian iadditional i3-4 icups iof icoffee iper iday. iPrevious
ilabs iand iexam ilast i year iare iunremarkable.
Vitals itoday: iBP i130/70 imm iHg, ipulse i82 iand iregular, itemperature i98.7, irespirations i18,
iheight i6’1”, iweight i235 ipounds i(up i3 ilbs. isince ihis ivisit i1 i year iago). iHe icompleted ifasting
ilabs iprior ito ithis iappointment ias ihe iwas iinstructed iwhich ireveal ithe ifollowing:
Fasting iplasma iglucose=209 img/dl, iHgbA1C=9.1%, iTSH=4.0mU/L iand iFree iT4=1.1 ing/dl.
iFasting ilipid ipanel iincludes ithe ifollowing: itotal icholesterol=190 img/dL, iHDL=35 img/dL,
i LDL=120 img/dL iand itriglycerides=260 img/dL.
Physical iexam iis iremarkable ifor iobesity ibut iis iotherwise inormal.
1. What iare iyour itreatment igoals ifor iJohn?
2. What iis iyour ipharmacologic iplan iand irationale? i(cite iwith iappropriate iclinical
i practice iguidelines ior ischolarly, ipeer-reviewed ijournals)
3. What iis ithe imechanism iof iaction ifor ieach idrug?
4. Please igive ifive imedication iteaching ipoints ifor ieach idrug iprescribed.
5. How iwould iyou ichange ithe iplan iif ihis iinitial iHbgA1C iwas i14.0 img/dL iand ihis
i fasting iblood iglucose iwas i350mg/dL ialong iwith ia iurine idipstick ithat irevealed i3+
i glucose iand i+ iketones? iProvide ia idetailed ialternative iplan iwith ithe irationale.
