ST Thomas University Frequents Headaches Case Study
For this Discussion, you will take on the role of a clinician who is building a health history for one of the following cases. Your instructor will assign you your case number.Case 1Case 2Case 3Chief Complaint(CC) “It burns when I urinate”“I had a severe headache yesterday with difficulty to speak”“I have been having frequents headaches lately”History of Present Illness (HPI)A 68-year-old Caucasian male who reports to have increase on the frequency of urination with urgency for the last 5 days. He also present dysuria and nocturia.A 64-year-old African American female who reports having a severe pulsatile diffuse headache yesterday with sudden difficulty to talk with last for about two hours. She did not seek medical attention. This morning she woke up with no problems but is here today due her husband advise.A 25-year-old Hispanic female presents to your clinic with a headache located on right temporal area, pulsatile.PMHBenning prostatic hyperplasia diagnosed 3 years ago, UTI 6 months ago, Lithotripsy left kidney 10 years ago. No issues after treatmentAtrial Fibrillation, Hypertension. Is allergic to Non-steroidal Anti-inflammatory drugs AspirinFrequent headaches since I was 15, with menses.Drug HxRosuvastatin 20 mgOlmesartan 20 mgLosartan 50 mgXarelto 15 mg BIDIbuprofen for HeadachesSubjectiveFever and chills, no changes in vision or hearing, no difficulty chewing or swallowing. No sexually active, nocturia, dysuria.Yellowish urethral secretion.Feels Palpitations, joint pain with yesterday’s episodeLight makes headache worst Nausea associated with headaches. No vomiting, Headaches improve usually with rest, ibuprofen, and sleep, but it is annoying to have to sleep all-dayObjective Data VSB/P 150/96; Pulse 89; RR 16; Temp 99.4; Ht 6,1; wt 180;B/P 131/80; temperature 98.2°F; (RR) 18; (HR) 84, irregular; oxygen saturation (PO2) 96%;B/P 108/64; Pulse 86; RR 16; Temp 98.6; Generalwell-developed male, no acute distresswell-developed female, no acute distress25-year-old female appears well developed and well-nourished, healthy appearing, wearing dark glasses in a dim room HEENTAtraumatic, normocephalic, PERRLA, EOMI, arcus senilus bilaterally, conjunctiva and sclera clear, nares patent, nasopharynx clear, edentulous.Atraumatic, normocephalic, PERRLA, EOMI, conjunctiva and sclera clear; nares patent, nasopharynx clear, good dentition.no injection, anicteric, PERRLA, EOMs intact, without pain to movement; normal visionLungsCTA AP&LCTA AP&LCTA AP&LCardS1S2 without rub or gallop S4 presentIrregular heart beat with normal rateS1S2 without rub or gallopAbdNo tenderness normoactive bowel sounds x 4;No tenderness normoactive bowel sounds x 4;benign, normoactive bowel sounds x 4;Rectal examWarm, swollen and painful prostate glandNon contributoryNon contributoryIntegumentgood skin turgor noted, moist mucous membranesintact without lesions masses or rashes.intact without lesions masses or rashes.NeuroNo obvious deformities, CN grossly intact II-XIINo obvious deficits and CN grossly intact II-XIICranial nerves II to XII intact; sensation intact, DTRs 2+ throughout.Functional neurological exam is WNLOnce you received your case number, answer the following questions:What other subjective data would you obtain?What other objective findings would you look for?What diagnostic exams do you want to order?Name 3 differential diagnoses based on this patient presenting symptoms?Give rationales for your each differential diagnosis.What teachings will you provide?Submission Instructions:Your instructor will assign you your case number and you will post on the case number you have been assigned.You will reply to the other two case studies (One of each).Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources. Your initial post is worth 8 points.You should respond to at least two of your peers by extending, refuting/correcting, or adding additional nuance to their posts. Your reply posts are worth 2 points (1 point per response.) All replies must be constructive and use literature where possible.Grading Rubric Your assignment will be graded according to the grading rubric.Discussion RubricCriteriaRatingsPointsIdentification of Main Issues, Problems, and Concepts5 pointsDistinguishedIdentify and demonstrate a sophisticated understanding of the issues, problems, and concepts.4 pointsExcellentIdentifies and demonstrates an accomplished understanding of most of the issues, problems, and concepts.2 pointsFairIdentifies and demonstrates an acceptable understanding of most of the issues, problems, and concepts.1 pointPoorIdentifies and demonstrates an unacceptable understanding of most issues, problems, and concepts.5 pointsUse of Citations, Writing Mechanics and APA Formatting Guidelines3 pointsDistinguishedEffectively uses the literature and other resources to inform their work. Exceptional use of citations and extended referencing. High level of APA precision and free of grammar and spelling errors.2 pointsExcellentEffectively uses the literature and other resources to inform their work. Moderate use of citations and extended referencing. Moderate level of APA precision and free of grammar and spelling errors.1 pointFairIneffectively uses the literature and other resources to inform their work. Moderate use of citations and extended referencing. APA style and writing mechanics need more precision and attention to detail.0 pointPoorIneffectively uses the literature and other resources to inform their work. Unacceptable use of citations and extended referencing. APA style and writing mechanics need serious attention.3 pointsResponse to Posts of Peers2 pointsDistinguishedThe student constructively responded to two other posts and either extended, expanded, or provided a rebuttal to each.1 pointFairThe student constructively responded to one other post and either extended, expanded, or provided a rebuttal.0 pointPoorThe student provided no response to a peer's post. 2 points