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 Page 11 of 15 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 Criteria HD D C P N 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. Provides a clinically sound analysis of the patient history, physical examination and underpinning pathophysiological concepts to propose two (2) clinically relevant diagnoses. Provides a clinically appropriate analysis of the patient history, physical examination, and links to all or some pathophysiological concepts to propose two (2) clinically relevant diagnoses. Provides a basic analysis of the patient history, physical examination, and links to some pathophysiological concepts to propose two (2) possible diagnoses. An ambiguous discussion relating to the patient history, physical examination, and pathophysiological concepts. Or links between patient history, physical examination and pathophysiological concepts are absent. Or a clinically, case relevant diagnosis was not proposed. 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. Presents clinically and case relevant selection of at least three (3) appropriate diagnostic tests. Test identification is clearly justified using sophisticated scholarly literature. Presents clinically and case relevant selection of at least two (2) appropriate diagnostic tests. Test identification is mostly justified using scholarly literature. Presents an appropriate selection of at least 1 relevant diagnostic test. Test identification is partially justified using scholarly literature. Presents no diagnostic tests or those diagnostic tests presented are partially clinically or case relevant or are ambiguous in nature. Test identification is poorly justified using scholarly literature or no clear justification is evident. 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. A robust discussion regarding the risks and benefits of conducting these diagnostic tests is evident; supported by an effective analysis of the impact these tests will have on Denise A sound discussion regarding the risks and benefits of conducting these diagnostic tests is noted; supported by a sound analysis of the impact these tests will have on Denise. A satisfactory discussion regarding the risks and benefits of conducting these diagnostic tests is noted; supported by a basic analysis of the impact these tests will have on Denise. Limited or absent discussion regarding the risks and benefits of conducting these diagnostic tests is presented. Limited links to how these tests might impact 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. An in-depth range of relevant literature from scholarly sources has been used effectively to support the analysis and recommendations throughout. APA 7th edition referencing conventions in both in-text referencing and the reference list have been used almost always accurately and consistently. A sound range of literature from scholarly sources has been used adequately to support the analysis and recommendations throughout. APA 7th edition referencing conventions in both in-text referencing and the reference list are used but there are inconsistencies. A satisfactory range of literature from varied sources, some of which are not credible or relevant, have been referred to support the analysis and recommendations. Attempt made to adhere to APA 7th edition referencing conventions in both in-text referencing and the reference list, but with some errors and inconsistencies. Literature from sources is largely irrelevant or not credible OR no literature is used to support the analysis and recommendations. Adherence to APA 7th edition referencing conventions in both in-text referencing and the reference list is minimal or nonexistent. Page 13 of 15 Academic language (grammar, punctuation), academic structure (layout) Weight 5% Demonstrates advanced written communication skills, with evidence of: Sophisticated language, including use of accurate terminology. Highly effective sequencing and structure of paragraphs in body. Very well constructed sentences and correct punctuation and spelling. Demonstrates very good written communication skills, with evidence of: Effective language, including use of accurate terminology. Effective sequencing and structure of paragraphs in body. Wellconstructed sentences and very minor punctuation and spelling errors. Demonstrates sound written communication skills, with evidence of: Sound language, including use of accurate terminology. Logical sequencing and structure of paragraphs in body. Soundly constructed sentences and minor punctuation and spelling errors. Demonstrates satisfactory written communication skills, with evidence of: Basic language, including use of largely accurate terminology. Largely logical sequencing and structure of paragraphs in body. Satisfactorily constructed sentences and minor punctuation and spelling errors. Demonstrates poor written communication skills, with evidence of: Poor language, including use of inaccurate terminology. Inconsistent sequencing and structure of paragraphs in body. Poorly constructed sentences and significant punctuation and spelling errors.