CASE STUDY XIII Phina Jeannite Dim KuntongNabirye Ab.docx

CASE STUDY XIII
Phina Jeannite
Dim Kuntong
Nabirye Abalinabyo
TABLE OF CONTENT
► Introduction
► Review of Systems
► Physical Assessment & Examination
► Medications
► Medications Educations Demonstrations
► Health Promotion
► References
Introduction:History of illness
★ Nancy Halpert (N. H.) is a 75-year-old African American
female who
comes in the office today for her physical annual exam. she has
been
diagnosed with :
★ uncontrolled diabetes mellitus type 2,
★ diabetic ketoacidosis,

★ obesity and possible depression.
Review of System
general overall health:N.H was diagnosed with type 2 diabetes
mellitus
Subjective
● She denies any headaches, nausea, vomiting
● She reports Dysuria,
● she is “worried” and nervous about having to need insulin .
Physical
Assessment and
Examination
H: 5’2 wt: 235 lbs BMI: 43
snellen vision chart: No eye corrections
Right eye: 20/20 Left eye:20/20
BP: 119/78 mmHg left arm, sitting position
T: 98.7 F orally, P:96 bpm
R: 16/min o2 Sat: 98%Miss Nancy is alert and
oriented X4. General
appearance is appropriate
for her age but there is
noticeable obesity

Pain assessment: 0/10
Physical Exam
Skin: dry, good skin turgor
Head & face: symmetrical, no pain or tenderness, no lesions No
lice.
Eyes: Nice and pink, symmetrical, reactive to light bilaterally
Nose: No discharge, tenderness, no nasal obstruction
Mouth: Oral mucosa pink, no gums bleeding, no toothache, gag
reflex
present
Throat: clear speech, no sore throat, no pain
Neck: trachea in midline, no lymphoedema, jugular veins pulse
present, no
bulging, no bruits- carotid pulse 2+
Physical Exam
Upper extremities: Full range of motion without pain, no
abnormality noted
Chest and lungs: no SBO, bilaterally symmetric expansion of
lungs, clear
breathing sound,

posterior & anterior: no crackles, no wheezing symmetrically
bilateral
Breast: bilaterally symmetrical, no pain or tenderness, no lump
or rash
Heart: regular heart rate and rhythm, no murmurs, no extra
sounds or bruits.
no chest pain
Abdomen: symmetrical, flat, uniform in color, no tenderness,
active bowel
sound present in all four quadrant; no abdominal pain.
Physical Exam
Inguinal area: no enlargement of nodes.
Lower Extremities: no injury or pain, no dislocation, 2+ pulse is
bilaterally
present.
Neurological: no history of seizure, stroke, and no problem with
coordination,
difficulty speaking or swallowing
Musculoskeletal: no history of arthritis or limitation with
movement.
Medication
Rx: Metformin 500 mg po bid

THERAPEUTIC USE//MoA ADMINISTRATION
CONSIDERATIONS Medications
Management of type 2 diabetes mellitus
Metformin decreases hepatic glucose production, decreases
intestinal absorption of glucose, and improves insulin
sensitivity by increasing peripheral glucose uptake and
utilization. With metformin therapy, insulin secretion remains
unchanged while fasting insulin levels and day-long plasma
insulin response may decrease.
Follow dosage and schedule
Take twice a day with the morning and evening meal
Do not crush or chew the pill
ADVERSE EFFECTS PATIENT INSTRUCTIONS
Nausea, diarrhea, anorexia -Expect these effects to diminish as
drug therapy continues
-Lie down when feeling nauseated
-Maintain adequate carbohydrate and fluid intake
INTERACTIONS
Drug- Drug (Rx � Rx) N/A
Drug- Condition (Rx � Dx) N/A
Drug-Food (Rx � Food/Herbal)
Alcohol- Increase risk of lactic acidosis
Garlic and Ginseng- increase hypoglycemic effects

APPOINTMENTS
F/U Appt/Labs/Tests/Referral
Medications Education Demonstration
Health Promotions
References
https://www.rxlist.com/glucophage-drug.htm#clinpharm
https://www.obesityaction.org/community/article-
library/obesity-in-the-elderly/
https://www.rxlist.com/glucophage-drug.htm#clinpharm
https://www.obesityaction.org/community/article-
library/obesity-in-the-elderly/
CRM 123 – Case Analysis 5 Fact Patterns
Write an analysis for each scenario below. See the Case
Analysis Instructions for further information about completing
the assignment.
1. Jonas is 18 and recently finished high school. He lives at
home with his mom and dad. While collecting dirty laundry in
his room one day, Jonas’ mother discovered some of Jonas’
clothing with dried blood on them. She also found a bloody
survival knife and muddy boots under his bed, as well as a
bracelet that said “Lynn.” A few days earlier, police had

discovered the missing body of Jonas’ high school sweetheart,
Lynn, in the woods. Lynn had recently broken up with him. The
medical examiner had determined that Lynn had died from
repeated stabbing. When Jonas had been questioned by the
police at the station, he claimed he knew nothing of the
incident, and the police have no evidence tying Jonas to the
disappearance or murder. Analyze these facts using ethical
concepts or concerns from Module 8. (You are not evaluating
elements of murder, or due process issues for example.)
2. District Attorney Schultz has brought charges against three
players of the University football team. They have been charged
with raping a stripper at a party attended by team members. The
case has received much publicity and the media have discovered
that the three players have a history of violence towards women.
(Last year, two other women claimed they had been raped, but
the cell phone video showing the forced sex had been excluded
based on an illegal police search, and the players were found
"not guilty.”) Shultz believes these players are guilty, and has
given approximately 60 media interviews on the case. Schultz
has also been campaigning for reelection, and a conviction here
would go a long way. Unfortunately for Schultz, the DNA tests
he ran do not match any of the three players to the victim’s
assault. When he questioned her about this, the victim made
contradictory statements, and she had no other evidence to
corroborate the events. In fact, while her statements confirm
that they raped her, she admitted to having consensual sex with
two other men at the party, which weakens the case. Schultz
decides to not tell anyone about the DNA results unless asked,
and instructs the victim/witness to deny the other sexual
encounters at trial. Analyze these facts using ethical concepts or
concerns from Module 8. (You are not evaluating elements of
rape or due process issues for example.) Assuming that Schultz
had a strong belief that the defendants were guilty, include in
your analysis whether this affects the moral and legal
permissibility of his conduct.

3. Michelle worked two jobs as a security guard in Phoenix,
Arizona. She was walking outside the building where she works
at 6:30 AM, Monday, when two bundles of money fell out of an
armored truck en route to a bank. Inside the bundles was
approximately $500,000. Michelle had an inheritance that would
post to her bank account on Wednesday. She decides to take the
day off and head to Las Vegas to play poker. Unfortunately,
Michelle lost all of the money she gambled, but luckily, as
expected, on Wednesday, her inheritance was paid. Michelle
turned all of the $500,000 in to the FBI on Thursday morning,
three days after finding it. Analyze these facts using ethical
concepts or concerns from Module 8. (You are not evaluating
elements of theft, conversion, or torts.) Include in your analysis
whether Michelle was morally obligated to return the money.
Should Michelle be penalized for using the money or for
waiting three days to return the money?
CRM 123 – Case Analysis Instructions
Purpose
The goals of this assignment are to provide a valuable skill and
to assess your ability to comprehend and
apply case law. Reading, briefing, and applying what you are
reading in your textbook and learning in the
modules are effective ways to become literate in the process of
the U.S. legal system.
Conducting an Analysis
Before making and defending a decision, you must be familiar
with the relevant law. For our purposes,
your textbook and course material provide all the legal concepts
needed to apply the law to a factual
situation. Once you are familiar with the general content of the
chapter, you should be able to recognize

the issue involved in a case and find the legal concepts that will
help you decide the case. For your
reference, a sample analysis is provided at the end of this
document.
First, you will read the assigned fact patterns (provided via a
link in the module). Then, you will complete
an analysis for all fact patterns presented. Each analysis should
contain the following:
1. The main issue. Identify and write (in your own words, at
least 50% original) the central issue to be
decided. As much as possible, set the issue in legal terms and
concepts.
2. Relevant legal concepts quoted from textbook court opinions.
Search the assigned chapter for legal
concepts that will help you decide and justify your decision.
Once you find the quotations you wish to use,
copy them into the appropriate places in your analysis.
3. Relevant case law quoted from the textbook.
4. Rationale. Write (in your own words, at least 50% original) a
complete explanation about how you
used the legal concepts you cited to make a decision about how
the case should be resolved.
5. Ruling. Describe (in your own words, at least 50% original)
what should happen to the parties involved
as a result of your decision.
Submit your Case Analysis to the Assignment box no later than
Sunday 11:59 PM EST/EDT of the
assigned module. (The Assignment box for these assignments
maybe linked to Turnitin.)

Grading Rubric
Ratings:
Exceptional corresponds to an A (90-100). Performance is
outstanding; significantly above the usual
expectations.
Proficient corresponds to a grade of B- to B+ (80-89%). Skills
are at the level of expectation.
Basic corresponds to a C- to C+ (70-79%). Skills are acceptable
but improvements are needed to meet
expectations well.
Novice corresponds to a D to D+ (60-69%). Performance is
weak; the skills are not sufficiently
demonstrated at this time.
0 This criterion is missing or not in evidence.
Criteria
Ratings
0 Novice Basic Proficient Exceptional
Correctly framing the specific legal question
to be decided
12-13 14-15 16-17 18-20

Identifying and quoting relevant material from
the assigned chapter
12-13 14-15 16-17 18-20
Correctly applying the cited legal concepts to
your decision
12-13 14-15 16-17 18-20
The insightfulness and organization of your
rationale
12-13 14-15 16-17 18-20
Originality and writing quality 12-13 14-15 16-17 18-20
Total 100
Academic Honesty
This assignment should include your original work and be
treated as a take-home examination. You may
copy legal concepts and case law from the textbook into the
“Relevant legal concepts” and “Relevant
case law” sections, but the rest should be written “in your own
words” (at least 50% original). The
Dropboxes for all Case Analyses are linked to Turnitin, and
each submission will be scanned for
originality. Substantial overlap with the writing of other

students constitutes academic dishonesty and will
result in appropriate sanctions.
Sample Analysis Using Headings
Main Issue (your own words)
Has the State of Kentucky violated procedural due process by
depriving inmates of a protected liberty
right to prison visitors with our a hearing to challenge a visitor
who is banned?
Relevant Legal Concepts From Text (quoted from textbook
opinions)
Procedural Due Process - 14th Amendment – Section 1. “...nor
shall any state deprive any person of life,
liberty, or property, without due process of law; ...” (pp. 23 &
A-2)
Relevant Liberty Definition: “...a vast scope of personal rights.
It also infers the absence of arbitrary and
unreasonable government restraints. (p. 24)
“The due process guarantee protects people from unfairness in
the operation of both substantive and
procedural law.” Procedural law prescribes the method used to
enforce legal rights. It provides the
machinery by which individuals can enforce their rights or
obtain redress for the invasion of such rights.”
(p. 24).
Since procedural due process rights cost the government time
and money: “Courts generally therefore
generally try to balance accuracy against its cost on a case-by-
case basis.”
Relevant case law from text:

Melinda Speelman v. Bellingham Housing Authority “Finally,
… both the parties and the public have an
interest in ensuring that BHA administers its programs lawfully,
Contrary to … contention, Speelman is
not asking for an exception to be applied to her case. She is
asking that she be given the process due
her and everyone else in her situation. Therefore, the equities
favor granting Speelman a preliminary
injunction.” (p.38)
Rationale (your own words):
Since BHA was aware that Speelman was in jail, they had an
obligation to do more, even though they
reasonably attempted to reach Speelman. She was entitled to
more due to the unusual set of
circumstances presented in the case and the failure to take
additional action to properly serve Speelman
deprived her of her constitutionally guaranteed due process
rights and she was put in a position of facing
eviction without benefit of a hearing.
Ruling (your own words)
The State of Kentucky need not provide hearings for denial of

inmate visitors.
Sample Case Analysis in Essay Style
The main issue in this case is whether the State of Kentucky
violated procedural due process by
depriving inmates of a protected liberty right to prison visitors,
without a hearing to challenge a visitor who
is banned.
This is a due process case. Procedural Due Process is in the
14th Amendment – Section 1. “...nor shall
any state deprive any person of life, liberty, or property,
without due process of law...” (pp. 28 & 671). The
relevant definitions here is the definition of liberty: “...a vast
scope of personal rights. It also infers the
absence of arbitrary and unreasonable government restraints. (p.
29)
“The due process guarantee protects people from unfairness in
the operation of both substantive and
procedural law.” Procedural law prescribes the method used to
enforce legal rights. It provides the
machinery by which individuals can enforce their rights or
obtain redress for the invasion of such rights.”
(p.29) Since procedural due process rights cost the government
time and money: “Courts generally
therefore generally try to balance accuracy against its cost on a
case-by-case basis.
The Court examined this issue in Connecticut Department of
Public Safety v. John Doe, stating “In cases
such as Washington v. Constantineau (1971) and Goss v. Lopez
(1975) we held that due process
required the government to afford the plaintiff a hearing to
prove or disprove a particular set of facts.”

However, “...a convicted offender has already had a
procedurally safeguarded opportunity to contest.”
“Plaintiffs who assert a right to a hearing under the Due Process
Clause must show that the facts they
seek to establish in that hearing are relevant under the statutory
scheme.” (p. 46)
Since the State of Kentucky had “...established regulations to
guide prison officials in making visitation
decisions,” one could argue that an inmate’s liberty to have
visitors has been recognized. It could be
further argued that denial of a hearing to challenge the finding
that a specific visitor could be barred is
protected by due process. However, conducting court hearings
requiring an adversary proceeding could
be unduly burdensome of the state and the liberty of an inmate
has been deprived initially in a
procedurally safeguarded hearing. Deprivation of the liberty of
convicted inmates to have specific visitors
is outweighed by the burden of conducting such hearings.
The court should rule in favor of the State of Kentucky.
Final Case Study Presentation Grading Criteria
Case Study # ____________ Team #
__________________ Total Score:
_______/50
Excellent- 5

Good – 4
Satisfactory- 3
Needs Improvement- 2-0
I. Presentation Content
Introduction
Score:____________
History of Present Illness/Health is well described with visual
aids. Patient context, scenario, and reason for seeking care is
clearly detailed to audience.
History of Present Illness/Health is well described. Patient
context, scenario, and reason for seeking care is clearly detailed
to audience.
History of Present Illness/Health is well described. Patient
context, scenario, and reason for seeking care is stated to
audience.
History of Present Illness/Health is poorly communicated.
Patient context, scenario, and reason for seeking care is not
clearly communicated
Review of Systems
Score: _________
Included comprehensive and specific subjective data of their
Review of Systems on their patient.
Included basic subjective data of their Review of Systems on
their patient.
Included minimal subjective data of their Review of Systems on
their patient.
Included objective data and subjective data. Did not
differentiate the findings during the Review of Systems and
Physical Assessment Examination.

Physical Assessment and Examination
Score: _________
Included comprehensive and specific objective data of their
physical assessment and examination on their patient.
Included basic objective data of their physical assessment and
examination on their patient.
Included minimal objective data of their physical assessment
and examination on their patient.
Included objective data and subjective data. Did not
differentiate the findings during the Review of Systems and
Physical Assessment Examination.
Medications
Score: _________
Team thoroughly describes:
· Why/How patient takes ALL their medications
· List >3 most common side effects & symptom(s) to report
· Address ALL patient medication related concerns
Team adequately describes:
· List 3 most common side effects & symptom(s) to report
· Address ALL patient medication related concerns
Team minimally describes:
· Address patient medication related concerns

Team inadequately describes:
· Why/How patient takes their medications
· Address patient medication related concerns
· Crucial points missing
Medications
Team thoroughly demonstrates patient education for one
medication listed.
Team adequately demonstrates patient education for one
medication listed.
Team minimally demonstrates patient education for one
medication listed.
Team inadequately demonstrates patient education for one
medication listed.
Health Promotion
Score: _________
Team states 3 areas where health promotion is needed for their
patient. Provides more than three specific examples of how they
gave patient education. Clearly described how their health
promotions fall in line with the Healthy People 2020
Objectives.
Group states 3 areas where health promotion is needed for their

patient. Provides three specific examples of how they gave
patient education. Described how their health promotions fall in
line with the Healthy People 2020 Objectives.
patient. Provides three examples of how they gave patient
education. Described how their health promotions fall in line
with the Healthy People 2020 Objectives.
patient. Provides less than three examples of how they gave
patient education. Did not describe or poorly described how
their health promotions fall in line with the Healthy People
2020 Objectives.
References
Score: _________
References are included at the end of the presentation.
References are all listed in APA format and can be read by the
audience. Healthy People 2020 is referenced.
References are included at the end of the presentation.
References are all listed in APA format and can mostly be read
by the audience. Healthy People 2020 is referenced.
References are included at the end of the presentation and cited
in a specific format (APA, MLA, etc.). Healthy People 2020 is
referenced.
No references are included or references are cited without a
format. Healthy People 2020 is not referenced.
II. Delivery

Score: _________
All members have a clear role in the presentation. All members
are enthusiastic speakers and take part in the presentation.
Maintains appropriate volume and eye contact with audience.
On-time (20 minutes)
Including Q&A
All members speak during presentation and most are
enthusiastic. Maintains appropriate volume and eye contact with
audience.
Including Q&A
All members speak during the presentation and maintain eye
contact with the audience. Words are clear and enunciated.
Including Q&A
Poor or inconsistent eye contact. Volume of the speakers are too
loud or low. Presentation is dominated by one or two speakers.
Poor enthusiasm from the group.
Over-time (> 20 minutes)
Including Q&A
III. Visual Aids
Score: _________
All photos, designs, transitions, and animations are aesthetically
incorporated. Words are large enough for audience to read. All
visual aids enhance the presentation.
All visual content are pleasing to the eye and contributes to the
presentation. White space, headings, and words are used
appropriately.
Appropriate use of white space. Visual content is adequate.
Most words are large enough for audience to read.

Show some structure. Visual contents are pixelated, cluttered,
and unrelated to presentation. Most words are too small to read.
Inappropriate use of white space.
IV. Question and Answer Period
Score: _________
Statements are uniformly answered with consistent information.
All members of the group take part in the question and answer
period. Answers from the group members show knowledge at a
proficient and professional level.
Some members of the group take part in the question and
answer period. Answers from the group members show
knowledge at a professional level.
Some members of the group take part in the question and
answer period. Answers from the group members show basic
knowledge of the content.
Statements are not uniformly answered with varying
information. One member of the group takes part in the question
and answer period. Answers from the group members show gaps
in knowledge of the content.
CASE STUDY XIII
Nancy Halpert (N. H.) is a 75-year-old African American
female who lives in a one-bedroom apartment in Washington
D.C. She is widowed. She had a daughter who passed away at
the age of 40 due to breast cancer. Her remaining two children
live in different states, one in Ohio and the other in California.
Her 25-year old granddaughter stays with her on the weekends

when she is not working. Nancy’s children call her every week
to see how she is doing. She has a neighbor who checks on her
daily to see if she needs anything. Nancy visits the senior
citizen center located one block from her apartment once per
week.
N. H. was diagnosed as a Type 2 diabetes five years ago. Her
last physical exam was two years ago. She doesn’t like to go to
the doctor because she is afraid she will need insulin. She takes
glyburide daily and “tries to watch what I eat.” Her blood
glucose has been consistent with an average AM reading of 180
mg/dl. She eats fast food from nearby restaurants frequently
because she doesn’t feel like cooking for just herself and she
likes to have her meals delivered. She often says, “I like to get
visitors. I enjoy the company.” She sleeps only 3-4 hours per
night, and sleep is often interrupted. She reports having
difficulty sleeping ever since she turned 70. She complains of
feeling tired most days. She has frequent periods of
restlessness at night and must urinate frequently. She does not
have difficulty with hygiene activities but states, most days she
doesn’t feel like grooming herself since she doesn’t go
anywhere. N. H. is 35 pounds overweight and reports she would
like to lose some weight but doesn’t know what to do.
For the past five days, N. H. has been feeling “dizzy and more
tired than usual.” She has been unable to keep any food down
and reports nausea, vomiting, and abdominal pain. She noticed
a fruity odor to her breath. When she checked her glucose this
morning, it was
690 mg/dl. Also, she has been experiencing headaches, frequent
urination, and increased thirst. When her neighbor came to
check on her, she noticed N. H. was confused and had trouble
concentrating. Her neighbor bought her to the to the E.R.
immediately. Her blood pressure was 135/80. Lungs were clear
upon auscultation. Her face was flushed, and she was restless
and having some difficulty breathing. Lab tests revealed a

blood glucose level of 750 mg/dl and a hemoglobin A1c of 8%.
N. H. was treated with intravenous fluids, electrolyte
replacement and insulin. After she was stabilized, she was
admitted for two days for observation, and then released.
On discharge, the medical diagnoses were as follows:
1. Uncontrolled diabetes mellitus
2. Diabetic ketoacidosis
3. Obesity
4. Possible depression
Her discharge orders were as follows:
1. Metformin 500 mg po bid
2. 2000 calories ADA diet
3. Diabetic teaching classes
4. Follow up with primary provider within two weeks for
physical exam and depression screening
You are the nurse working in the primary care office. Since N.
H.’s last physical exam was one year ago, a complete health
history and physical exam is indicated at the next scheduled
visit.
When N. H. arrives for her exam, she denies any headaches,
nausea, vomiting, but still has frequent urination. She reports
since being in the hospital she has tried to cook just for herself
but has had to eat fast foods for at least one meal a day. On the
day of her physical, N. H.’s weight is 235 pounds, height 5’2”,
which calculates to a BMI of 43 indicating obesity. She is
talkative during the assessment, answers questions politely and
appropriately, and makes frequent eye contact. She is alert and
oriented x 4, speech is clear and not pressured, and thoughts are
logical.
As you begin taking her health history, N. H. admits she is
“worried” and nervous about having to need insulin. She wants

to change her diet so that she can live a healthier lifestyle.
You explain to N. H. the role of insulin in her body and the
benefits of adding an insulin sliding scale to the treatment plan
to control her glucose and prevent the complications of
hyperglycemia. You also teach her how to self-administer
insulin and provide her with the opportunity to return the
demonstration. You also include the manifestations of
hypoglycemia and how to prevent it from occurring.
You see a patient who is eager to learn and willing to make
changes. You decide to use this healthcare opportunity to
provide education and health promotion.

CASE STUDY XIII Phina Jeannite Dim KuntongNabirye Ab.docx

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