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HIV Case Study John, an 18 year-old African American male, presents to his primary care physician (Dr. Beal) for enlarged lymph nodes. He reports swelling in his throat for the past two weeks and believes he is experiencing some continuing effects from a “really bad” case of the flu he had two weeks ago. He reports that he is extremely tired, has frequent headaches, and has also had a rash. The physical exam reveals that John’s inguinal lymph nodes are also swollen. Dr. Beal tells John that his symptoms could be related to a number of things and asks about his last HIV test. He denies a history of ever having an HIV test, adding, “My throat hurts, not my blood, plus I have not lost any weight and I’m not sleeping around.” He shares that has been with Lesli, the same sexual partner for the past four months. “Lesli and I are faithful so we never use condoms,” he reports when asked. He does recall that Lesli complained of similar symptoms about three months ago but “got better” after one week. He also says that Lesli looks healthy and is not sick. 1. What does HIV stand for? 2. What cells do HIV attack? 3. What kind of precautions does a nurse have to take when working with an HIV patient? 4. How is HIV transmitted from one person to another? 5. Why are T-cells so essential to the immune system? 6. How many stages of HIV are there? 7. Summarize what the three stages of HIV are and how they are determined. 8. Why would symptoms resolve during the 1st stage? 9. What are opportunistic infections? 10. What is PrEP? 11. What is PEP? Rheumatoid arthritis Case Study Joy G. is a 48-year old married mother of 3 active boys, ages 12, 15, and 18. She enjoys attending her sons’ sporting events and providing “Mom-Taxi” services for her sons and their friends. She also loves her part-time job as a hairdresser at a popular salon. Seven months ago, Joy began noticing stiffness in both hands in the morning that lasted longer and longer. Stiffness now lasted more than 1 hour every morning and included hands, wrists and ankles. She also had increasing difficulty standing for long periods at work or at home due to foot and ankle pain. She began taking ibuprofen 800mg 3 times daily and found it helped her get through her day with less pain and stiffness. Three months ago, Joy noticed pain in her right and left shoulders when she would cut or blow dry her client’s hair. She also began feeling extremely tired and short tempered. She had no energy to do her usual activities. Ibuprofen was no longer very effective for her pain or stiffness. One morning, Joy could not lift her arms at all without extreme shoulder pain. She knew it was time to get help. She had been speaking with her friends and they encouraged her to see a doctor. She saw her Primary Care Physician (PCP), who examined her and ran a few preliminary blood tests. The blood tests revealed positive rheumatoid factor, CCP antibodies, elevated ESR and C-reactive protein. Joy was informed of these results and her PCP referred her to a Rheumatologist to be seen as soon as possible. 1. What are the risk factors of Rheumatoid Arthritis (RA) 2. How many risk factors does Joy G. have? 3. What are the stages of inflammation and destruction of RA? 4. What are clinical symptoms of RA? 5. What are the treatment options for RA? 6. What medications are commonly used to treat RA? 7. What labs are drawn to typically diagnosis a patient with RA? Systemic Lupus Erythematosus (SLE) A 19-year-old woman presented to the hospital with complaints of progressive shortness of breath, chest pain, and lower extremity edema over the past month. Additional complaints included alopecia, oral ulcers, and bilateral knee arthralgia. Significant findings on examination included elevated blood pressure (150/90 mmHg), malar rash, and diffuse anasarca. Her initial laboratory values were notable for hemoglobin of 9.0 g/dL, platelet count 116,000/μL, and serum creatinine 2.68 mg/dL with 3+ protein and 3+ hemoglobin on urinalysis. 1. What is Lupus? 2. What causes Lupus (how does the immune system make your body an enemy)? 3. What are the signs and symptoms of a flair up? 4. What labs are used to determine Lupus? 5. What information does the above labs give about a patient? 6. What meds are given to treat lupus? 7. What do patients need to avoid to decrease risk of flair ups?
SCIENCE
HEALTH SCIENCE
NURSING
MED/SURG NURSING 245