Tutor Guide

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PBL case for 1 year ,semester- II generic nursing

Module title: foundation of nursing II

Session: --------------

Problems:
• Diarrhea

• Cold extremities

Write your Hypotheses of diagnosis

Predicted Learning Issues:

• What are the causes of hypovolemic shock?

• Discus the different types of shock?

• describe the management options for hypovolemic shock?

PBL case for 1styear , semester- IIgeneric nursing

Module-medical surgical
Week----------

Patient and visit information

Patient name ------------- abebe nigusa

Age---------------------------27 years

Sex--------------------------- male

Address--------------------- harar- kebele-01

Site of visit------------------ Emergency Opd hiwot fana General Hospital

Date------------------------------ 10/04/2009E.C
Presentation
Ato abebe said that “I have been suffering from Diarrhea and cold extremities for 03days.

Discussion question #1
,
1) List Ato Agmassie s problems.

2) Define your hypotheses and describe the mechanism leading to the problem and which
systems may be involved?

3) What aspects of history would you like to obtain that help you test your hypotheses?

Patient History:

Patient history of presenting illness:

After arriving at DTGH , Emergency OPD at 5:30 AM local time, Agmassie said, “I have faced Diarrhea
and cold extremities before 03 days back and developed Vomiting .’’

There was no any management given before he comes to hospital.

Past medical history_ he has no any previous medical and/or surgical history.

Occupational exposure_ No occupational exposure

Behavioral: - he has no any history of substance abuse.

- No other pertinent findings.

Social History: he has good communication skills with the community and family members.

Family history- His families have no any history of DM, HTN or similar problems.

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Education status: he is 1 year university students.

ROS:
RS: has shortness of breathing

CVS: has palpitation

GIT- No other pertinent data

GUT- No other pertinent data

Discussion question #2
1) Summarize the new information you obtained. How does it help you rerank your hypotheses or
suggest new hypotheses?

2) Is there any relevant data from the history that can cause Agmassie’s illness to be more severe and
even with future recurrence?

3) What significant aspect of patient history do you think is left unmentioned and hence you would
like to add?

4) What data do you require from physical examination? How does it help you refine your
hypotheses?

Physical examination:
General appearance – chronic sick looking

o
Vital sign: BP 60/40mmHg, PR, 110 bpm, RR, 28 bpm, Temp 35.7 c

HEENT- Pale conjunctiva

- Dry mouth and lips

-No ear discharge

LGS – No any enlarged lymph node.

-No lesion and no palpable mass

RS – Chest is clear and resonant

CVS- s1 and s2 well heard

-No murmur no gallop

Abdomen – No abdominal tenderness and no palpable mass.

 - Hyper-active bowel sound

MSS: No edema and joint deformity but he has cold extremities.

IGS – Capillary Refill Time is more than 3 seconds

GUT – No pertinent finding

CNS – he is Lethargic.

Discussion question #3
1. How does the physical examination help you?

2. What more history would you like to take after doing the physical examination that helps
in your hypothesis?

3. Do you want to change the ranking order of the hypothesis based on the physical
examination? How?

4. What investigations would you request to test your hypotheses?

Laboratory Investigation Results:

CBC

Components Normal Value Findings

RBC 4.7–6.1milliom/mm3 5.2 milliom/mm3

Hematocrit 42-52% 25%

Hemoglobin 13-18gm/dl 7gm/dl

MCV 86-98fL 84fL

MCH 28-33pg 28pg

MCHC 32-36% 33%

 WBC 4500-10,500/mm3 12,000/mm3

RBS: 82mg/dl

Blood group: A+

Discussion Question #4
1. Interpret test results and re-evaluate your hypotheses.

2. How would you explain your findings to the patient and what will you do?

3. Based on your hypotheses, what interventions do you consider for Abebe?

4. How would you counsel him?

5. Discuss the pharmacokinetics and pharmacodynamics of drugs which are used for the
management of Hypovolemic shock?