Aligned subject learning outcomes | • Compare selected frameworks and theories in • the application of diagnostic reasoning and clinical decision-making strategies for a range of clinical presentations.
• Accurately articulate the ethical, legal and regulatory considerations regarding the selection, ordering, collection and evaluation of diagnostic test and procedures.
• Apply diagnostic reasoning based on clinical symptomatology, health assessment findings, pathophysiology and diagnostic data to identify health priorities of treatment and care.
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Group or individual | Individual |
Weighting | 50% |
Due date | 1800hrs AEST, 28th September 2020 |
Length | Word Count: 1600 words Word counts 10% above the required word limit will be penalised by 10% deduction of the marks available. The word count must be accurately stated at the end of the written piece. Every printed element between spaces is to be counted including quotations and in-text references (but not including reference list). |
ASSESSMENT TASK 2: DESCRIPTION
A diagnosis is reached by examining the patient history, physical examination, and diagnostic tests. Critically review the patient history and physical examination provided, and with your understanding of pathophysiology develop two (2) possible diagnoses. Provide justification of how you came to this diagnostic conclusion. Critically analyse this case study and identify what diagnostic testing would assist the diagnostic process. Using scholarly literature justify the selection of these diagnostic tests and discuss the risk and benefits of conducting these diagnostic tests on the patient, Denise.
This is a case study, as such it is not necessary to include an introduction or conclusion. Subheadings are acceptable, dot points kept to a minimum and if an appendix is used it must adjunct content not replace the content. The paper must be written in 3rd person and 7th edition APA referencing style and format is to be used throughout the paper.
Case study
Denise, an 82-year female, arrives by ambulance to the emergency department from her home with reported confusion and unexplained abdominal pain. She is unable to provide any history. Jayne, her daughter is sitting beside her. Jayne provides a brief history of current events, “Mum has had chronic lymphatic leukemia (CLL) for about eight years, she also has moderate memory loss. I went to visit her today, mum was sitting on the lounge rocking, looking awfully pale and mumbling ‘take it away, make it stop’. I didn’t know what else to do but call an ambulance.” Jayne also advises that her mum had only been in hospital a week ago with a urinary tract infection.
Past medical history (obtained from daughter and previous hospital admissions)
Advancing CLL, hypertension, angina, atrial fibrillation, GORD and bowel cancer. Denise is a non-smoker and does not drink alcohol or take illicit substances. Denise underwent a right hemicolectomy 6 months ago for adenocarcinoma; her recovery was unremarkable. “We moved mum into an independent living unit in a retirement village about 5 months ago. It is close to where I live, that way I can check in on mum more regularly,” Jayne states. From the information supplied by Jayne you develop the following patient profile about Denise,
• A graceful, fiercely independent woman struggling with memory loss and dependency
• Attends to all meal preparation, laundry, and basic housework, a cleaner attends to the heavy housework
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once a week
• Holds a current driver’s license; drives to the local shops, medical appointments, and other necessary
appointments, and visits a friend in an adjoining suburb
• Struggles a little with technology such as the Internet and remote controls.
• Struggles with introduction of new and unfamiliar items or routines.
• Will not let Jayne attend any medical appointments, protects her privacy.
Review of systems (obtained from daughter)
Negative for headache, vomiting, syncope, dysuria, numbness, focal weakness, dizziness, or visual changes. Positive for two recent falls, intermittent periods of confusion, complaints of nausea, belching, lower abdominal pain, and lower back pain. Jayne explains, “Mum talks of having explosive diarrhoea, but I have never seen any evidence of this.”
•
Physical examination
HR 80, RR 12, BP 150/85, temperature 37.9C, O2Sat 97%. Denise appears distressed, confused, and in pain. Oral exam reveals dry mucous membranes. Cardiovascular exam reveals mild ankle oedema, no murmur, reasonable peripheral perfusion. Pulmonary exam NAD. Abdominal exam tenderness over left lower quadrant, bowel sounds evident across all quadrants. Neurologic exam reveals normal cranial nerve function, motor strength, sensation, deep tendon reflexes, and coordination. Oriented only to person. Musculoskeletal exam tenderness over lower back, otherwise NAD
• Medications
Folic Acid 0.5ug mane | Mebeverine hydrochloride 135mg TDS |
Pantoprazole 40mg BD | Pregabalin 50mg mane |
Allopurinol 100mg mane | Pregabalin 75mg nocte |
Apixaban 2.5mg BD | Paracetamol 1gm QiD |
Irbesartan 150mg mane | Escitalopram 5mg mane |
Dexamethasone 0.5mg mane | Lorazepam 0.5mg nocte |
Fentanyl patch 25mcg/hr 3/7days | Valaciclovir 500mg nocte |
Allergies: Codeine, Celocoxib
ASSESSMENT TASK 2 MARKING CRITERIA
Diagnosis - Weight 30%
Provides a comprehensive, clinically superior analysis of the patient history, physical examination and underpinning pathophysiological concepts to propose two (2) clinically relevant diagnoses.
Diagnostic tests- Weight 15%
Presents clinically astute and case relevant selection of more than three (3) highly appropriate diagnostic tests. Test identification is justified using sophisticated scholarly literature.
Risk and benefits of diagnostic testing ---- Weight 40%
A comprehensive discussion regarding the risks and benefits of conducting these diagnostic tests is evident; supported by an insightful analysis of the impact these tests will have on Denise.
Use of evidence – weight 10%
An extensive range of relevant literature from scholarly sources has been used discerningly to support the analysis and recommendations throughout. APA 7th edition referencing conventions in both in-text referencing and reference list have always been applied accurately and consistently.
Academic language (grammar, punctuation), academic structure (layout)
Weight 5%---
demonstrates advanced written communication skills, with evidence of: .