How to create a nursing differential diagnosis case study (Solved)
Case study: An 18-year-old white female presents to your clinic today with a 2-week history of intermittent abdominal pain. She also is positive for periodic cramping and diarrhea as well as low grade fever. She also notes reduced appetite. She notes that She admits smoking ½ PPD for the last 2 years. Denies any illegal drug or alcohol use. Does note a positive history of Crohn\’s Disease. Based on the information provided answer the following questions:
What are the top 3 differentials you would consider with the presumptive final diagnosis listed first?
What focused physical exam findings would be beneficial to know?
What diagnostic testing needs completed if any to confirm diagnosis?
Using evidence based treatment guidelines note a treatment plan.
SOLUTION TO THE CASE STUDY
Differential diagnoses
The following are the differential diagnoses for this patient: acute appendicitis, pelvic inflammatory disease, and endometriosis.
Focused physical exam findings
Physical examination reveals low-grade fever with tachycardia. There is localized pain to the right iliac fossa on an abdominal exam at McBurney’s point (Jones, Lopez & Deppen, 2021). There is also rebound tenderness in that area. Movement and abdominal pressure aggravate the pain. For instance, when asked to cough, the pain is localized to the right iliac fossa. There is tenderness and guarding on percussion of the abdomen. A confirmatory physical exam is the Rovsig’s sign by palpating the left iliac fossa to elicit pain in the right iliac fossa (Baird et al., 2017). A positive Rovsig’s signs indicate acute appendicitis.
Diagnostic tests
According to Jones et al. (2021), a complete blood count reveals a high white blood cell count of more than 10,500 cells/µL and neutrophilia of more than 75%. A pregnancy test is performed to rule out pregnancy. A final confirmatory investigation using computed tomography scanning reveals an abnormal appendix or calcified appendicolith and periappendiceal inflammation of a diameter of more than 6 mmw8 (Di Saverio et al., 2020).
Treatment plan
Appendectomy is the most curative treatment for acute appendicitis. Broad-spectrum antibiotics play a significant role in the treatment process. Cefotetan and cefoxitin are the antibiotics of choice in treating acute appendicitis (Jones et al., 2021). However, factors such as the stage of appendicitis during diagnosis determine the administration duration. Several studies agree that prophylactic antibiotics should be administered preoperatively and post-operatively (Jones et al., 2021). Antibiotic treatment should be stopped once the patient becomes afebrile and white blood cells count normalizes.
References
Baird, D. L., Simillis, C., Kontovounisios, C., Rasheed, S., & Tekkis, P. P. (2017). Acute appendicitis. Bmj, 357.
Di Saverio, S., Podda, M., De Simone, B., Ceresoli, M., Augustin, G., Gori, A., … & Catena, F. (2020). Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines. World journal of emergency surgery, 15(1), 1-42.
Jones, M. W., Lopez, R. A., & Deppen, J. G. (2021). Appendicitis. In StatPearls [Internet]. StatPearls Publishing.
Related Posts:
- Describe evidence-based practice (EBP) and its relationship to nursing research, nursing practice, and healthcare. (Domain – Educative Practice, Evidence-informed Practice,‘Process – Scholarship, Patient Safety)
- Evidence-based practice : how evidence-based practice impacted the care of Jahi McMath after she was declared clinically dead following a routine tonsillectomy in California.
- Outline the process for the development of nursing standards of practice for your state, including discussion of the entities involved in developing the standards of practice and how the standards of practice influence the nursing process for your areas of specialty. Outline the concept of professional accountability as it pertains to nursing. Provide examples of how a nurse demonstrates professional accountability in clinical expertise, the nursing process, and evidence- based practice.
- John Hopkins Nursing Evidence-Based Practice Model Vs The IOWA Evidence-Based Practice (EBP) model
- Health scenario: mechanisms in place that are used to improve population health, including health statuses and outcomes, determinant factors, and interventions that address determinant factors and improve outcomes
- Select a model that a healthcare organization might use to improve the culture of quality. Describe whether the ethical theory of Just Culture would improve the quality of a healthcare organization and how.
- Use Evidence to Improve Practice
- Reflection: What future trends may influence how nurses use evidence to improve the quality of patient care?
- Future trends that may influence how nurses use evidence to improve the quality of patient care
- Two areas of nursing practice, which evidence-based practice has improved patient outcomes.
- NURS 6051N – The Role Of A Nurse Leader As A Knowledge Worker
- Assignment: The Nurse Leader As Knowledge Worker
- Knowledge Worker And Nursing Informatics
- The Nurse Leader And The Systems Development Life Cycle
- The multidimensional roles of a contemporary academic nurse educator as a teacher, leader, change agent, and curriculum innovator.
- Using The Data/Information/Knowledge/Wisdom Continuum
- Key Events And Individuals Influencing The Development Of Scientific Nursing Knowledge
- Scholarly Paper and Multimedia presentation for (Advanced Information Management and Application
- Discuss and analyze health information systems SCHOLARLY PAPER
- Evaluate the Health History and Medical Information for Mr. C.
- Telehealth impact in Health care organizations and Patient Safety and the Role of the DNP nursing improving quality of care delivery systems through Telehealth
- Advanced Information Management and the Application of Technology
- Using The Data/Information/Knowledge/Wisdom Continuum
