Week 8 Discussion Forum

Select one of the following case studies to address. In the subject line of your post, please identify which prompt you are responding to, for example, #1 Maria, 49-year-old female, annual exam.

Discuss what questions you would ask the patient, what physical exam elements you would include, what further testing you would want to have performed, differential and working diagnosis, treatment plan, including inclusion of complementary and OTC therapy, referrals and other team members needed to complete patient care.

Use at least one scholarly source other than your textbook to connect your response to national guidelines and evidence-based research in support of your ideas. 

In your peer replies, please reply to at least one peer who chose a different case study.

1. Janeis a 25-year-old female at two weeks’ postpartum clinic visit.  She reports lochia has mostly subsided now with just a little pinkish fluid, breastfeeding without problems, and no issues with her episiotomy from her NSVD.  Her only complaint is a throbbing in her left calf that she noticed about a week ago.  You perform a physical assessment and note that her left calf has a larger circumference than her right calf.

• What is your most immediate concern, and why (discuss postpartum physiology and likely reason for this condition)?
• What are your differential diagnoses and what action must you take?

Provide evidence from the research to support your decision-making.

2. Aileenis a 19-year-old postpartum female s/p C-section 2 weeks ago.  She reports the incision is okay, but that she feels feverish, with aches and chills. Her left breast is swollen, tender, red, and there is a hard area that has increased over the last two days. It has become too painful to breastfeed on that side.  Her temperature is 101.2 F and she looks pale and ill.  Upon PE, you note an approximate 3×3 cm reddened, hard, warm area on her left breast that is painful to the touch. 

• What are your differential diagnoses, and why?
• What is your plan of care for this patient?

Provide evidence from the research to support your decision-making.

3. Suzanne,a 25-year-old G1 P1 patient arrives with her husband for her office visit. She states she delivered her daughter 3 months ago and since then she, the patient, cries all day, cannot sleep, and has no energy. Her husband has taken over most of the care of the baby, but he must return to work. She stopped nursing. Her physical exam is negative.

• What is your plan of care for this patient?
• What treatments, referrals, consults, and patient education will you provide?

Provide evidence from the research to support your decision-making