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Case 1

Patient Profile
A.K., a 28-year-old single man, had HIV antibody screening performed 2 weeks ago when he
was seen at a health clinic for flu-like symptoms. At that time he revealed that he had a history of
multiple sexual partners. He has returned to the clinic for the results of his screening.

Subjective Data
• Vague symptoms of fatigue and headache
• Reports occasional night sweats

Objective Data
• Positive Western blot test for HIV
• Temp: 100°F (37.8°C)
• Enlarged cervical and femoral lymph nodes

Discussion Questions
Using a separate sheet of paper, answer the following questions:
1. Priority Decision: What are the priority posttest counseling activities that should be
performed by the nurse during A.K.’s visit?

2. A.K.’s CD4+ T-cell count is 650/μL. What stage of HIV infection is he most likely
experiencing?

3. What additional diagnostic tests might be performed at this visit?

4. What prophylactic treatments should be used at this time to prevent the development of
opportunistic diseases?

5. The health care provider encourages A.K. to consider starting combination antiretroviral
therapy. What can the nurse tell A.K. about the expected effect of this therapy?

6. If A.K. does not respond to treatment with an increased CD4+ T-cell count and a
decreased viral load, what tests could be used to identify resistance to the antiretroviral
agents?

7. Priority Decision: Based on the assessment data presented, what are the priority nursing
diagnoses? Are there any collaborative problems?
CASE 2

Patient Profile
R.M. is a 65-year-old African American man who was recently diagnosed with metastatic
lung cancer. He began treatment with chemotherapy through a peripherally inserted central
venous catheter 5 days ago.

Subjective Data
• States he has almost continuous nausea, which becomes severe and causes vomiting
following his dose of chemotherapy
• States he has no appetite
• Expresses no hope that the chemotherapy will have a positive effect

Objective Data
• Temp: 99.4°F (37.4°C)
• WBC count: 3200/μL (3.2 × 109/L)
• Neutrophils: 500/μL (0.5 × 109/L)
• Skin warm with decreased turgor

Discussion Questions
Using a separate sheet of paper, answer the following questions:
1. What factors may be responsible for R.M.’s decreased WBC and neutrophil count?
2. What assessment data indicate that R.M. may be experiencing an infection?
3. What additional assessment data should be collected from R.M. to determine the presence
of an infection?
4. What factors may contribute to his negative attitude toward the chemotherapy?
5. Priority Decision: What are the priority nursing measures that should be used to help
control his anorexia, nausea, and vomiting?
6. His daughter is visiting and wants to know how the cancer metastasized to his lung. What
should the nurse teach her about metastasis?
7. During her visit, R.M.’s daughter questions how likely she is to get cancer. What should
the nurse explain to her about risk factors and screening tests?
8. Priority Decision: What are the priority teaching measures that should be included in the
teaching plan for R.M. and his family to prevent infection?
9. Priority Decision: Based on the assessment data presented, what are the priority nursing
diagnoses? Are there any collaborative problems?
CASE 3

Patient Profile
H.C., a 47-year-old Navajo woman, comes to the emergency department with a burning
sensation in her epigastric area extending into her sternum.

Subjective Data
• Has had chest pain with activity that is relieved with rest for the past 3 months
• Has had type 2 diabetes mellitus since she was age 35
• Has a smoking history of one pack a day for 27 years
• Is more than 30% over her ideal body weight
• Has no regular exercise program
• Expresses frustration with physical problems
• Is reluctant to get medical therapy because it will interfere with her life
• Has no health insurance

Objective Data

Physical Examination
• Anxious, clutching fists
• Appears overweight and withdrawn

Diagnostic Studies
• 12-lead ECG
• Cholesterol: 248 mg/dL (6.41 mmol/L)
• LDL: 160 mg/dL (4.14 mmol/L)
• Glucose: 210 mg/dL (11.7 mmol/L)

Collaborative Care
• Metoprolol (Toprol) XL 100 mg PO daily
• Nifedipine (Procardia) 10 mg tid
• Nitroglycerin 0.4 mg sublingual PRN for chest pain
• Exercise treadmill testing

Discussion Questions
Using a separate sheet of paper, answer the following questions:
1. What are H.C.’s risk factors for CAD?
2. What symptoms should lead the nurse to suspect the pain may be angina?
3. What nursing actions should be taken for H.C.’s discomfort?
4. What kind of ECG changes would indicate myocardial ischemia?
5. What information should the nurse provide for H.C. before the treadmill testing?
6. Priority Decision: What are the priority nursing measures that should be instituted to
help H.C. decrease her risk factors?
7. Should H.C.’s angina become chronic stable angina, explain the treatment that would
be used using the mnemonic A, B, C, D, E, and F.
8. Priority Decision: Based on the assessment data presented, what are the priority
nursing diagnoses? Are there any collaborative problems?