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Discussion

need help on case study of homeless man with sexually transmitted disease

i'm doing a case study at a free clinic and i have a 53 yearold overweight white man with several obvious problems. his feet are crackedand blistered and he has 3 infected toenails. he says he has been homeless forvarious periods during the last 10 yrs. he has seeping sores in the folds ofhis wrists and under his arms. his gums are bleeding. he has been greatlyconfused over the last 8 months and its getting worse (his purpose for comingto the clinic). he has episodes of ranting and raving and he reports"feeling crazy" and being very scared. upon questioning his healthhistory he reveals very little, saying his memory is bad but he talks a lotabout his past sexual exploits.

i know mental illness is comon in homeless people. i believethat some of this mans neural symptoms are caused by syphilis - general paresis(a form of neurosyphilis). it is causedby the gram negative bacteria, treponema pallidum. if his blood test comes backpositive, can this man transmit the disease and why/why not? should he be treated with antibiotics andwhy/why not? what other infectious disease should he now be tested for if hisblood test came back positive?

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    • Featured Replies

    Homework help.

    So, have they done a physcial and checked for chancres (my spelling sucks, just of nights)?

    Why wasn't and HIV screen done with the other blood work.

    Has the mental health team evaluated this patient?

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    People like this are unlikely to do any follow up and will only seek medical assistance when it gets out of control. If the man is a veteran, he can be referred to the VA. Otherwise, there are other options if he chooses to pursue them. Yes, he needs to be check for all STD's, including Hepatitis, GC, chlamydia, and TB as well as HIV and syphilis. He very well could also be diabetic with his weight, life style and open wounds. He also probably has a multitude of other issues. Many homeless have histories of ETOH and illegal drug use. You already mentioned mental illness, and yes, that is a huge problem with this population. Which came first the chicken or the egg??

    He clearly would benefit from a full checkup, labs, chest x-ray, wound care referral and a med regime. There are a lot of meds that are provided free via health departments or other social services as well as the $4.00 list at many pharmacies. All that said, he is still homeless. He could probably find shelters on cold nights and others if he is sober and well behaved. That is often a big IF.

    Mental health options are horribly limited in this country if you have no money. I suspect this man will continue in his unhealthy ways until he dies of some horrible wound or is killed on the street. Even if you could get this man cleaned up, diagnosed and placed on meds, he is very unlikely to comply. It's a nice idea, but it seldom works.

    Good luck, and welcome to the sad facts of life.

  • Quote
    • Experts

    Moving to Nursing Student Assistance Forum.

  • Quote
    • Experts
    i'm doing a case study at a free clinic and i have a 53 year old overweight white man with several obvious problems. his feet are cracked and blistered and he has 3 infected toenails.

    he says he has been homeless for various periods during the last 10 yrs. he has seeping sores in the folds of his wrists and under his arms. his gums are bleeding. he has been greatly confused over the last 8 months and its getting worse (his purpose for coming to the clinic). he has episodes of ranting and raving and he reports"feeling crazy" and being very scared. upon questioning his health history he reveals very little, saying his memory is bad but he talks a lot about his past sexual exploits.

    i know mental illness is common in homeless people. i believe that some of this mans neural symptoms are caused by syphilis - general paresis(a form of neurosyphilis). it is caused by the gram negative bacteria, treponema pallidum. if his blood test comes back positive, can this man transmit the disease and why/why not? should he be treated with antibiotics and why/why not? what other infectious disease should he now be tested for if his blood test came back positive?

    ok case study.........

    in order to write a case study paper, you must carefully address a number of sections in a specific order with specific information contained in each. the guideline below outlines each of those sections.

    [table]

    [tr]

    [/tr]

    [tr]

    [td]introduction (patient and problem)

    [/td]

    [td]

    • explain who the patient is (age, gender, etc.)
    • explain what the problem is (what was he/she diagnosed with, or what happened?)
    • introduce your main argument (what should you as a nurse focus on or do?)

    [/td]

    [/tr]

    [tr]

    [td]pathophysiology

    [/td]

    [td]

    • explain the disease (what are the symptoms? what causes it?)

    [/td]

    [/tr]

    [tr]

    [td]history

    [/td]

    [td]

    • explain what health problems the patient has (has she/he been diagnosed with other diseases?)
    • detail any and all previous treatments (has she/he had any prior surgeries or is he/she on medication?)

    [/td]

    [/tr]

    [tr]

    [td]nursing physical assessment

    [/td]

    [td]

    • list all the patient's health stats in sentences with specific numbers/levels (blood pressure, bowel sounds, ambulation, etc.)

    [/td]

    [/tr]

    [tr]

    [td]related treatments

    [/td]

    [td]

    • explain what treatments the patient is receiving because of his/her disease

    [/td]

    [/tr]

    [/table]

    http://www.pasadena.edu/hstutoringlab/writing/writingcasestudy.cfm

    [table]

    [tr]

    [td]nursing care plan

    [/td]

    [td][/td]

    [/tr]

    [tr]

    [td]

    nursing diagnosis & patient goal

    [/td]

    [td]

    • explain what your nursing diagnosis is (what is the main problem for this patient? what need to be addressed?)
    • explain what your goal is for helping the patient recover (what do you want to change for the patient?)

    [/td]

    [/tr]

    [tr]

    [td]

    nursing interventions

    [/td]

    [td]

    • explain how you will accomplish your nursing goals, and support this with citations (reference the literature)

    [/td]

    [/tr]

    [tr]

    [td]

    evaluation

    [/td]

    [td]

    • explain how effective the nursing intervention was (what happened after your nursing intervention? did the patient get better?)

    [/td]

    [/tr]

    [tr]

    [td]recommendations

    [/td]

    [td]

    • explain what the patient or nurse should do in the future to continue recovery/improvement

    [/td]

    [/tr]

    [/table]

    a case study how to guide......

    http://scholarworks.umass.edu/cgi/viewcontent.cgi?article=1001&context=nursing_faculty_pubs

    an example of a case study....http://www.pasadena.edu/hstutoringlab/writing/examplecasestudy.pdf

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    • Experts

    I see this is your first post, Welcome to AN! We are happy to help but we don't do homework for you. I will help you in whatever way I can. What have you found out so far?

    What research have you done? What is syphilis? What is tertiary syphilis? What are the sings and symptoms? What does this patient need? Does he need a psyche eval? Are you sure the mental health came after the syphilis or did the syphilis come because he is homeless with mental health issues?

    What other infectious diseases would be present with high risk behavior? What should his testing include? What teaching is needed? What is his level of comprehension? Is he a Veteran? What are his other comorbidities?

    Google is your friend.....

    Let me google that for you syphilis

    Let me google that for you STDs caused by high risk behaviors.

    What do you have so far......

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