Nursing Case Study

Purpose

Problem-based learning is a methodology designed to help students develop the reasoning process used in clinical practice through problem solving actual patient problems in the same manner as they occur in practice.  The purpose of this activity is to develop students’ clinical reasoning skills using a case-based learning exercise. Through participation in an online discussion forum, students identify learning issues in a self-directed manner which facilitates learning for the entire group.

Activity Learning Outcomes

Through this discussion, the student will demonstrate the ability to:

1. Synthesize clinical knowledge, didactic learning and research findings to provide appropriate pharmacological care to primary care patients. (CO 1, 2, 3, 4 & 5)

Case Study & Discussion Questions

Margaret is a 59-year-old Caucasian female who presents to the clinic for follow-up of her hypertension.  She reports that she has a worsening of a tremor in her hand over the last few months. She was seen by a neurologist previously and was diagnosed with an essential tremor but opted to not take medication because it wasn’t particularly bothersome.  She reports now that she has difficulty pouring a drink, drinking from a cup, using utensils to eat, and writing or drawing.  Margaret also reports that since you started her on Clonidine last month for her blood pressure, she has been having some difficulties with headaches, dizziness, dry mouth and difficulty urinating. You plan to discontinue the clonidine.

Past Medical History: Hypertension, essential tremor and seasonal allergies.

Surgical History: Tonsillectomy.

Family History: Mother HTN & essential tremor, Father Diabetes, Sister Diabetes all deceased.

Social History: Denies tobacco use, wine one to two glasses a week, denies recreational drugs, exercises twice a week.

Allergies: NKA

Current medications: Multivitamin with Iron 1 tab PO daily, Claritin 10mg daily PO prn for allergies, Clonidine 0.1mg PO BID

All vaccines up to date. 

Vitals: Height 57 inches, Weight 145 pounds, BP 156/85, P 70, R 16.

Physical exam is normal.

· What are your treatment goals for Margaret today?

· What is your pharmacological plan and rationale? (cite with appropriate clinical practice guidelines or scholarly peer-reviewed articles and always include medication name, strength, dosage form, route, frequency and duration when making recommendations)

· Pick one medication from your response above and list five patient-centered teaching points for the medication.

Discussion Guiding Principles

The ideas and beliefs underpinning the discussions guide students through engaging dialogues as they achieve the desired learning outcomes/competencies associated with their course in a manner that empowers them to organize, integrate, apply and critically appraise their knowledge to their selected field of practice. The use of discussions provides students with opportunities to contribute level appropriate knowledge and experience to the topic in a safe, caring, and fluid environment that models professional and social interaction. The ebb and flow of a discussion is based upon the composition of student and faculty interaction in the quest for relevant scholarship. Participation in the discussion generates opportunities for students to actively engage in the written ideas of others by carefully reading, researching, reflecting, and responding to the contributions of their peers and course faculty. Discussions foster the development of members into a community of learners as they share ideas and inquiries, consider perspectives that may be different from their own, and integrate knowledge from other disciplines.

Direct Quotes

Good writing calls for the limited use of direct quotes. Direct quotes in discussions are to be limited to one short quotation (not to exceed 15 words). The quote must add substantively to the discussion. Points will be deducted under the grammar, syntax, APA category.

 

DISCUSSION CONTENT
Category Points % Description
Application of Course Knowledge 35 35% 1. Decisions are well supported with EBM arguments that are in-line with the scenario; AND

2. Proper rationale and reasoning skills are demonstrated; AND

3. Information is taken from source(s) with appropriate interpretation/evaluation to develop a comprehensive analysis or synthesis of the topic at hand; AND

4. Applies concepts to personal experience in the professional setting and/or information has relevant application to real life; AND

5. All of the post makes direct reference to concepts discussed in the lesson; AND

6. Posts are on topic and answer all presented questions which demonstrates a solid understanding of the topic.

(6 critical elements)

Support from Evidence-Based Practice (EBP) 35 35% 1. Discussion post is supported with appropriate, scholarly sources; uses valid, relevant, and reliable outside sources to contribute to the threaded discussion; AND

2. Sources are published within the last 5 years (unless it is the most current CPG); AND

3. Reference list is provided and in-text citations match; AND

4. Provides relevant evidence of scholarly inquiry clearly stating how the evidence informed or changed professional or academic decisions

(4 critical elements)

DISCUSSION FORMAT
Category Points % Description
Grammar, Syntax, Spelling & Punctuation 15 15% Discussion post has minimal grammar, syntax, spelling, punctuation, or APA format errors*

(*) APA style references and in text citations are required; however, there are no deductions for errors in indentation or spacing of references. All elements of the reference otherwise must be included.

 

      Total FORMAT Points= 15 pts

 

 

 

Discussion Rubric

Criteria Ratings Pts
This criterion is linked to a Learning OutcomeApplication of Course Knowledge

1. Decisions are well supported with EBM arguments that are in-line with the scenario; AND 2. Proper rationale and reasoning skills are demonstrated; AND 3. Information is taken from source(s) with appropriate interpretation/evaluation to develop a comprehensive analysis or synthesis of the topic at hand; AND 4. Applies concepts to personal experience in the professional setting and/or information has relevant application to real life; AND 5. All of the post makes direct reference to concepts discussed in the lesson; AND 6. Posts are on topic and answer all presented questions which demonstrate a solid understanding of the topic. (6 critical elements)

35.0 pts

Excellent

All 6 critical elements are present.

32.0 pts

V. Good

1 critical element is missing.

29.0 pts

Satisfactory

2-3 critical elements are missing.

18.0 pts

Needs Improvement

4-5 critical elements are missing.

0.0 pts

Unsatisfactory

All 6 critical elements are missing.

 

35.0 pts
This criterion is linked to a Learning OutcomeSupport from Evidence-Based Practice (EBP)

Support from Evidence-Based Practice (EBP) 1. Discussion post is supported with appropriate, scholarly sources; AND  2. Sources are published within the last 5 years (unless it is the most current CPG); AND 3. Reference list is provided and in-text citations match; AND 4. Provides relevant evidence of scholarly inquiry clearly stating how the evidence informed or changed professional or academic decisions (4 critical elements)

35.0 pts

Excellent

All 4 critical elements are present.

32.0 pts

V. Good

1 critical element is missing.

29.0 pts

Satisfactory

2 critical elements are missing.

18.0 pts

Needs Improvement

3 critical elements are missing.

0.0 pts

Unsatisfactory

4 critical elements missing. *Students should note that factitious sources, sources that are clearly not read by the student and used, or sources that have incorrect dates will result in an automatic ZERO (0) for this section for the week.

 

35.0 pts
This criterion is linked to a Learning OutcomeGrammar, Syntax, Spelling, & Punctuation

Discussion post has minimal grammar, syntax, spelling, punctuation, or APA format errors* (*) APA style references and in text citations are required; however, there are no deductions for errors in indentation or spacing of references. All elements of the reference otherwise must be included.

15.0 pts

Excellent

0-1 errors in grammar, syntax, spelling, punctuation, or APA format*

13.0 pts

V. Good

2-3 errors in grammar, syntax, spelling, punctuation, or APA format*

12.0 pts

Satisfactory

4-5 errors in grammar, syntax, spelling, punctuation, or APA format*

7.0 pts

Needs Improvement

6-9 errors in grammar, syntax, spelling, punctuation, or APA format*

0.0 pts

Unsatisfactory

10 or more errors in grammar, syntax, spelling, punctuation, or APA format*

 

15.0 pts
This criterion is linked to a Learning OutcomeParticipation
0.0 pts

Discussion late penalty deductions

A 10% late penalty will be imposed for discussions posted after the deadline on Wednesday, regardless of the number of days late. NOTHING will be accepted after 11:59pm MT on Sunday (i.e. student will receive an automatic 0)

0.0 pts

Total Participation Responses:

A 10% penalty will be imposed for not entering the minimum number of interactive dialogue posts (3) OR not posting on the minimum required number of days (3). NOTHING will be accepted after 11:59pm MT on Sunday (i.e. student will receive an automatic 0)

 

0.0 pts

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