Why do case studies give so little information and expect a multipage response?

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Sorry to vent but here is my case study, this is the only info we are given.

"You are working in an acute care facility medical unit. An 80-year-old female with mild confusion is admitted. No one is available to stay with her. She was a resident in a local nursing home. The nursing home reported that before this illness, she was moderately independent and alert and oriented."

We are expected to come up with 3 impt nursing diagnoses, what specific interventions to use to help facilitate communication and more. I am not really asking for help, just about how they expect us to come to conclusions when the information is so sketchy, I don't even know if she can talk or what illness she has. :angryfire Any general advise when dealing with these types of assignments? Thanks!!!

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You have to be very creative sometimes....Do you have a list of nursing diagnosis, sometimes just looking through them can be a lot of help. I just finished nursing school in May and Passed NCLEX in June, if you are early in the program they just want to see that you can critically think.

If a patient is old, confused, and alone in a new enviroment, what could be a problem?

She could have a UTI.....Old people can become confused due to a UTI....Or could have had a stroke or many other things....just 2 biggies

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Risk for injury related to unfamiliar enviroment---re-orient frequently--keep free from clutter etc

Impaired communication related to disorientation and confusion

risk for skin breakdown r/t incontinence manifested by patient's change in mental status

Risk for falls

risk for impaired nutrition r/t change in patient's mental status

Well I hope this helps!!!!!

GOODLUCK....nursing school can be very tricky and annoying, but it will be worth it

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Specializes in med/surg, telemetry, IV therapy, mgmt.

why do case studies give so little information and expect a multipage response?

critical thinking. use the nursing process. start with step #1 and start pulling information together. assessment is the foundation and what you will base the entire case study upon. it consists of:

  • a health history (review of systems)

  • performing a physical exam

  • assessing their adls (at minimum: bathing, dressing, mobility, eating, toileting, and grooming)

  • reviewing the pathophysiology, signs and symptoms and complications of their medical condition

  • reviewing the signs, symptoms and side effects of the medications/treatments that have been ordered and that the patient is taking

some of the information you have already been given. some you will need to rationally create. the idea is to show how you will manage the care of the patient as a professional nurse.

good luck. if you need help with the 5 steps of the nursing process, see
https://allnurses.com/general-nursing-student/help-care-plans-286986.html
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help with care plans

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Case studies develop your critical thinking but they do take time, what type of case studies are you doing? I do the software for nurses and even though I don't like them bc they are time consuming they do give a lot of info so, maybe try to do a different types to get your mind in the right pathway.

Good luck!

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Daytonite, I always appreciate your advise (not that I don't anyone else's). You advised to look at the history, but they don't give you any to go on, so as a teacher in the past, should the student make up a history to go with the information given? You almost have to do that to rule out all the possibilities it could be...Thanks!!!

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Specializes in med/surg, telemetry, IV therapy, mgmt.

but, you were given history. . .

  • she has lived 80 years
  • she was moderately independent and alert and oriented before admission

this tells me that she was born in 1929. you were told this lady was "moderately independent and alert and oriented" in a nursing home [history] and has now been admitted to an acute hospital with mild confusion. explore this mild confusion business because when it happens in an 80-year old there is something going on. people get admitted to acute hospitals because something has gone wrong and they need skilled, specialized care. acute onset confusion is called delirium. that is something i think you will want to explore and address in your paper.

  • a health history (review of systems) - 80 years old, was moderately independent and alert and oriented before admission. you would want to find out if there had been any recent head trauma or disorders involving the heart, lungs, brain, nervous or metabolic systems. question the nursing home about exactly when the onset of confusion started and what her normal daily routine has been and how that has recently changed. find out what medications she is taking.
  • performing a physical exam - mild confusion (delirium). get a set of baseline vital signs and watch for changes. get a baseline neurological assessment and determine her level of consciousness and watch for changes.
  • assessing their adls (at minimum: bathing, dressing, mobility, eating, toileting, and grooming) - unknown
  • reviewing the pathophysiology, signs and symptoms and complications of their medical condition - the point of doing this case study is to explore causes of this acute confusion and later on in the paper to address what to do about the confusion itself. an understanding of the potential causes is needed for the formation of the etiologies of some of your nursing diagnoses. you need to explore the reason for the confusion just as the doctor is going to do. see:

    [*]reviewing the signs, symptoms and side effects of the medications/treatments that have been ordered and that the patient is taking - unknown

my guess--an acute infection (urosepsis will cause delirium in an 80 year old) or a stroke. monitor for any further symptoms and protect from any potential harm. this is because we really don't know what is going on and only have symptoms to deal with. we can only treat the symptoms at this point. at present, the known symptom is mild confusion, but exploring further into this i would think of it as acute onset of delirium. the entire idea of this paper is to follow the steps of the nursing process 1. . .2. . .3. . .4. . .5 and state what you will do in the management of this patient's care. above, i pretty much laid out my thinking on how i would organize step #1, the assessment part of the paper. that was pretty much off the top of my head. i would probably look in a few references to make sure i was covering all the possible angles as to the causes of her delirium to make sure i would be setting up her assessment correctly, especially, if this was being graded. i can tell you a list of labwork and orders that the docs would want for this: cbc, sed rate, ua, ana, chem panel and electrolytes, ct or mri of the brain, blood cultures if there is a fever and possibly a spinal tap (if there is a fever), and a neurology consult. eeg (to rule out seizures), vdrl (to rule out veneral disease - not uncommon to have gotten from a husband from her era), carotid sonogram (to rule out carotid thrombosis), 4-vessel angiography (to rule out tia), glucose tolerance test (to rule out diabetes), blood smear for parasites (to rule out malaria), a psych consult.

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You rock, Daytonite. I had already hypothesized a UTI for a possible cause of the change of mental status and had started accordingly. Thank you for the ideas, they give a direction.

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