Case study A
Trauma and Immobility
L.D. is a 27 year old man who has no chronic health problems. He prides himself on keeping fit and enjoys living on the edge. Last weekend he was thrown from his motorcycle when it spun out on a wet patch of pavement. In the emergency department he was diagnosed with fractures of the left tibia and ribs. He reported being in pain and having difficulty breathing. He was discharged with a full leg cast and medication for pain to be taken every 4 hours as needed. He was told not to bear any weight on his affected leg and was shown how to walk with crutches.
1. How will L.D.’s broken rib affect his respiration and what potential problem may occur if L.D. does not follow instruction to breathe deeply and cough?
2. How does the pain medication affect his ability to deep breathe and move?
3. How will L.D. lifestyle, health habits, and age affect healing of the damaged tissues?
4. L.D pain medication makes him nauseated. Why is it important for him to maintain a diet high in calcium, protein and vitamins C and D?
5. L.D. skin itches under the cast and he finds this very irritating. On one very hot, he resorts to inserting his mother’s knitting needle under the cast to scratch the skin. Why are skin breakdown and infection greater risks in the cast limb?
6. After 4 weeks L.D. cast seems quite loose and it is replaced with a new walking cast. L.D. is distressed to see that the leg is thinner than it was. What is the cause of the change in the size and shape of L.D. fractured leg?
7. What problem is L.D. likely to experience when the cast is finally removed from his leg?
Case Study B
Situational Stress Response
L.D. is a 13years old health teenager who is very anxious about getting her wisdom teeth removed by the dentist. She is afraid that the dentist will use a needle to freeze her mouth. In the past, she has felt light headed and dizzy when receiving routine immunization in the doctor’s office. Her mother thinks that L.D. anxious behavior is silly and tries to reassure L.D. on the drive to the dental office that everything will be fine. The dental office is quite busy and the receptionist states that the dentist has had an emergency patient and there will be a delay before L.D. will be seen. L.D. waits 30 minutes for her appointment.
- What stressors are present for L.D.?
- How will the delay affect L.D.? Stress response? What could reduce L.D. stress during the wait?
- When L.D. is finally called by the receptionist, she gets up and immediately feels like she is going to faint. Which change in the nervous system is responsible for her hypotension? Is this part of the usual response to stressors?
- She is sweating and her pupils are dilated. What specific changes have occurred to cause these manifestations?
- L.D. mother tells her to calm down and be brave. How would this likely affect stress L.D. is experiencing?
The dentist reassures L.D. that she will use a mask to deliver the anesthetic rather than a needle and L.D agrees to go ahead with the procedure. L.D. has four teeth extracted and is sent home. At home she experience pain and stiffness in her jaws.
- How will continued pain and stiffness affect tissue healing and recovery?
- What can L.D. to reduce her stress the next time an invasive procedure is scheduled?
Case Study C
Mr. is a40 old salesperson with a wife and three teenaged children. He has recently begun to have a beer at lunch and a few drinks after work to reduce his work related stress. An economic downturn in the housing industry has reduced the need for new home appliances and his income and sales record has been affected. Several other salespeople have been laid off at his firm. He has been told that if his sales and attendance records do not improve he will be fired. He and his wife are constantly arguing about finances and the children’s increasing demands for money. His drinking has increased to several beers at lunch a continued drinking after dinner. When he returns to work with alcohol on his breath, he is dismissed from his job. He continued to consume alcohol during the day as he attempts a job search. His wife is very concerned as are his teenaged children.
- What is the action of alcohol on the CNS and how has alcohol abuse affected Mr. M.S. ability to deal with customers and his coworkers?
- Mr. M states he is a social drinker and the can stop at any time. How accurate is his self-assessment?
- What stressors are present in Mr. M.s case?
- Why does Mr. M. continue to increase his alcohol intake?
- What changes in the liver function can Mr. M. expect if he continued to drink large amounts of alcohol?
- Mr. complains to his wife that all the stress is causing indigestion. How do stress and alcohol consumption affect GI function?
- Why is Mr. M. at greater risk of trauma?
Mr. M. is convinced to see his doctor and is referred to a center that assists alcoholics recover and remain sober. He recovers over the following year and successfully completes job retraining at a local college. Mr. M is assisted in his job search and settle into work with new colleagues. His relationship with his family improves and he makes several friends among his coworkers. He celebrates his second year of sobriety with his wife.
- What behavior increase the risk of Mr. M revert to alcohol abuse?
- What is the long term prognosis for Mr. M?
Case Study D
E.C is a 24 year old professional firefighter in a western region that has had severe forest fires because of hot, dry, windy weather. He has worked overtime for several weeks and is experiencing continual shortness of breath, fatigue and exercise intolerances which are unusual for him, E.C. complies with health and safety requirement including wearing appropriate protective equipment. Community support agencies are on site to provide water, food, and support as needed. Fatigue forest fires exposes workers to extreme heat, fatigue from working on uneven terrain, toxin used in fire suppression, insecticides, particulate matter and carbon monoxide. Protective equipment reduces exposure to toxic substances, but is not used in down time when exposure can also occur because of wind currents and close proximity to the fire sites.
- What factors in E.C.’ work situation increase the risk of health problem?
- What role do the support agencies play in reducing health problem for the firefighters?
- What are possible causes of E.C exercise intolerance and fatigue?
- How may the toxin in smoke affect lung function if they irritate the lung tissues?
- What long term risks exist for firefighters exposed to smoke from woodland fires?
This is the book we are using for the class
Van Meter, K. C., & Hubert, R. J. (2013). Pathophysiology for the Health Professions. 5 Edition. Amsterdam: Elsevier Health Sciences