Tonsillectomy for this 35-year-old patient?
A 35-year-old woman sought care for a fever and sore throat that she’d had for 4 days. She denied symptoms of cough, rhinorrhea, or sputum production.
The patient’s medical history included severe recurrent streptococcal pharyngitis as a child and teenager. At theage of 17, she developed a fever of 105° F with associateddelirium, dysphagia, nausea, and vomiting, and missedseveral days of school. She also lost 82 pounds, developed oral thrush, and continued to feel fatigued for approximately a year. After her primary care physiciannoted a heart murmur on physical exam, she was sent forechocardiography and diagnosed with rheumatic fever secondary to streptococcal pharyngitis.
Eighteen years (and numerous streptococcal infections) later, the patient was at our facility, and we were ordering a rapid antigen detection test (RADT) for her current illness. The throat specimen was positive for group A ß-hemolyticstreptococcus (GAS). The patient’s 8-year-old daughter also had a sore throat, fever, and positive RADT; her symptoms resolved with oral amoxicillin for 10 days. Thepatient’s husband was also treated successfully with oral amoxicillin/clavulanate for 10 days for similar symptoms. The patient herself, however, was unsuccessfully treatedwith oral amoxicillin 500 mg twice daily for 7 days.
She was then given oral amoxicillin/clavulanate 875 mg twice daily for 14 days, but received no relief. Even after receiving clindamycin 600 mg twice daily for 10 days, she had minimal relief and remained positive for GAS on repeat RADT. It was at this point that tonsillectomy wasconsidered as a possible treatment modality for herrefractory GAS pharyngitis.
The patient consented to the procedure and underwent atonsillectomy. She has remained asymptomatic for 2 years and there have been no reported outbreaks of GAS infection in her household.
How To Conduct a Nursing Case Study1. Status of the PatientThe first thing that you should do before doing anything else is to gather necessary information about the patient. In this section, you need to interview the patient and ask for the required information such as his/her medical history and current condition. You will also have to ask if the patient is currently undergoing treatment and other activities that may affect the study. After that, you will, then, write down the reasons why the patient is seeking medical care and the symptoms that he or she is experiencing. The information that you will get in this stage is specific. That’s why you must write down all of it for future use.2. Nursing AssessmentOnce you have all the necessary information about the patient, the next thing that you need to do is to make an assessment based on the information that you gathered. In this section, you will also have to provide details such as reasons and the appropriate action that you can apply for the situation. For example, you diagnosed the patient with cancer. The patient is experiencing difficulty in urination. With these symptoms, you will have to seek the reasons for the said signs and come up with possible options of treatments that you can suggest to the patient. It is crucial to document this process to ensure that you are not missing anything and that you don’t go astray during the process, which can lead to an incorrect recommendation.3. Recommendations/SolutionsAs mentioned earlier, documenting everything plays a vital role in providing the best recommendation for the patient’s condition. In this step, you will describe each of the treatment options that you have gathered in the previous step. You can start by explaining why the treatment is appropriate in the situation and how will you implement the treatment plan. You also have to include the progress expectation. Moreover, you should also discuss all the factors that are affecting the condition.4. ImplementationThe documentation in this stage is the most crucial. You will have to record each activity that has occurred during the process. Then, track the improvement or progress of the steps taken. Just like a scientific study, you will have to analyze the information that you have gathered to form a report of the efficacy of the treatment plan that you have implemented, which you will be doing at the end part of the study.A nursing degree is indeed one of the degrees that we should watch out since it has a promising projection. Given that you will play your cards right, you can have a flourishing career ahead. It will not be impossible if you can acquire the necessary knowledge and master your craft.
