NURSING CASE ANALYSIS ASSESSMENT HELP

Case report:

NATP121: CASE ANALYSIS ASSESSMENT

A 31 year old man comes to your clinic complaining of abdominal pain. He says that the pain is focused in the upper central part of the abdomen, below his sternum, and typically occurs about 3 hours after eating. He describes it as a “burning” type of pain. These symptoms have been occurring for about the one and a half weeks.

Upon further questioning the client tells you that he experiences a lot of gas and bloating after meals. He has been experiencing these symptoms (i.e. bloating and gas) for about the past 5 or 6 years and he feels that they have become progressively worse and more frequent. The bloating, gas and burning pain all seem to be more significant after meals that contain meat.

The client’s medical history reveals that, as a child, he suffered recurring ear, nose and throat infections (about 3 or 4 bouts per year between the age of 4 and 6 years). At the age of 6 he had his tonsils removed and consequently he enjoyed reasonably good health through to the age of 16 when he started to get bouts of indigestion, diarrhea and nausea. At the time these were diagnosed as gastrointestinal infections and treated with antibiotics. He calculates that he probably took 6 or 7 courses of antibiotics between the age of 16 and 19. Although things settled down at that point he reflects on the fact that his digestion “has never been the same since those infections”. Not long after his 21st birthday he suffered a severe attack of abdominal pain that lead to him having his appendix removed.

In questioning the client about his work and lifestyle habits you learn that he is a shares broker-dealer. Three years ago, he and 3 colleagues established their own business and although he loves the challenge of the work it is very stressful. He tells you that a typical day involves waking at 5.30 am and grabbing a coffee before heading off to work. Upon arrival at work he will have a quick breakfast (2 slices of wholemeal toast with butter and vegemite or peanut butter) before getting stuck into work. Lunch is inevitably a take away (roast beef/chicken and salad roll, or pork/beef dumplings, usually with a can of Coke or an energy drink). Throughout the working day he would typically have 6 or 7 coffees (black with 2 sugars).

Thankfully his wife always prepares him a home-cooked meal of an evening although he usually gets home from work around 7.30 pm, which means he doesn’t eat until 8 or 8.30 pm. His wife is always telling him to slow down with his eating. He tends to eat very quickly, taking large mouthfuls and not taking time to chew his food well. A typical evening meal would be either steak with a good selection of steamed vegetables, or grilled fish with a healthy salad, or stir-fried beef/chicken/pork with Asian greens and rice. He usually has 1 or 2 glasses of wine with his evening meal. Over the course of a weekend his alcohol consumption amounts to around 10-15 standard drinks (beer or wine).

Your client feels that the work-related stress he has been experiencing over the past 3 years has contributed to his most recent aggravation of his “digestive problem”. He says he feels like he is in a state of constant anxiety and this interferes with his quality of sleep. Upon questioning he says that he usually goes to bed between 11 and 12.30

and gets up at around 5.30 am although he may wake 2 to 3 times during the night. His lifestyle does not allow much time for physical activity. He owns an exercise bike which he tries to use on Sundays for 20 to 30 minutes to keep fit.

Your impression of your client is that he has a “Type A personality”. He appears to be a high achiever, has set himself high personal goals, and believes in “diving in and getting the job done without delay so (he) can move on to the next challenge”.

Having formed an impression of what you think may be the problem or “pattern of disturbance” you recommend the following:

 Reduce coffee consumption by 2-3 cups per day

 Client handout with alternative meal suggestions, including reduction of meats

and replacement with healthy, easy to digest options, and increasing vegetables

and fruits

 Suggestions for encouraging him to eat in a relaxed environment and to eat

slowly and chew his food more thoroughly

 Start the day at work with a fresh juice/smoothie (his workplace has a

juicer/blender). You recommend a combination of carrot, apple and kale.

 A herbal formula consisting of herbs that have a general tonic action on the

gastrointestinal system

 A flower essence combination for helping him to slow down and become aware

of why he is feeling anxious

You also refer the client to a gastroenterologist for further investigation as you believe he may have a gastric or duodenal ulcer.

The client returns after two and a half weeks. The gastroenterologist conducted an endoscopy which confirmed a gastric ulcer. The endoscopy also showed that the gastric mucosa was pale and had undergone degenerative changes. Upon asking the client how the past two weeks have been, he tells you that he has not experienced the same level of pain or discomfort since implementing the recommendations you made for him last visit. He says that his wife has assisted with encouraging him to implement and stick to the changes, but he “doesn’t really need her help” because he is very disciplined and has “no difficulty sticking to instructions”. His bowel movements have changed over the past three days though. He says that his bowels have been quite loose and that he has needed to go to the toilet 3-4 times per day. He doesn’t know whether this is something he should be concerned about.

You encourage your client to continue with the recommendations from the first consultation and add the following to his treatment regime:

 Include cabbage, carrots and beetroot to his daily juice/smoothie. This will assist with healing the ulcer and improving the mucosa of the stomach

 Adjustment of the herbal formula to include Licorice which will specifically help to heal the ulcer and Poke Root to enhance the function of his lymphatic system, while continuing to improve his general GI function

 Nutritional supplements:

o Formula including glutamine and minerals to assist with healing the ulcer o Probiotic supplement to help improve his gastrointestinal bacteria

 Adjustment of the flower essence formula to include an essence that will address his tendency to be hard on himself and to continually set high expectations in terms of his achievements

 Take 45 minutes for lunch. Go for a walk to the nearby park and eat lunch on the park bench beside the lake.

He leaves feeling enthusiastic and positive about continuing to improve his health.

One week later he calls your practice to make an appointment as soon as possible. He is upset and feels his health has taken a turn for the worse. When you see him he is distressed. He has come down with a bad upper respiratory tract infection, with congestion, thick green discharge from the nose, sore throat and ear ache. He tells you he “hasn’t had this sort of thing since (he) was a kid” and it was bringing back bad memories of having to go to hospital to have his tonsils removed. To make matters worse he has been experiencing emotional upset at work. He has been “feeling slack”, does not feel he has been pulling his weight and has been taking this out on the junior staff, much to their dismay. He says that, when he had his tonsils removed, he had to have time away from school and because of the work he missed while in hospital, he feared that he would fall behind all the other children in his class and be disadvantaged as a result. A similar thing happened when he had to have his appendix removed at the age of 21. He had not long commenced a new job and was concerned, when he was in hospital, that his new employer would think he was slack and not up to the challenge of the job. He has tears in his eyes when he relates this to you and it is clear that he has been giving himself a really hard time of late.

You talk to your client about what is happening and encourage him to keep going with your recommendations and the prescribed treatments, and ask him to check in with you by phone in two or three days time.

Instructions:

Provide responses to each of the following questions that relate to the case above. In preparation for writing your responses, you may discuss the case and questions with your classmates if you wish. In documenting your responses you may use your class notes, set text and do research on the internet. However, materials other than your class notes and set text are not necessary in order to answer the questions. To demonstrate your understanding and application of the concepts and principles covered in this subject so far, your written responses should be, as much as possible, in your own words.

Please ensure that you read the questions carefully and address specifically what each is asking. Do not allow yourself to get sidetracked from the questions at hand. You should aim to provide a concise response of no more than 3 or 4 paragraphs for each question.(40 marks total)

1. Your initial interview of this patient yielded a great deal of in-depth information about the client and his condition. Choose three of the Naturopathic principles that we have studied so far and discuss briefly how each relates to the need for a naturopath to collect such in-depth information from patients.(10 marks)

2. Is this client’s gastric ulcer an acute or chronic condition? What tells you this? Is his indigestion (bloating and gas) an acute or chronic condition? What tells you this? (5 marks)

3. Discuss three of the major disturbing factors/obstacles to cure present in this client’s case when he first comes to see you. Relate each of these to one of Lindlahr’s Three Primary Causes of Disease. (5 marks)

4. For the treatments recommended at the first consultation, briefly discuss where each falls within the Therapeutic Order and why. (8 marks)

5. Make two additional recommendations that intervene at Level 1 of the Therapeutic Order and which you feel would contribute to the success of the treatment (2 marks)

6. Discuss what is happening with this client within the Process of Disease and Healing when he comes in for his third visit with an upper respiratory tract infection and feeling quite emotional. (10 marks)

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