CASE STUDY OUTLINE
Content
Patient Profile
Present a description of the patient in terms of age, sex, race, height, weight, marital
status, occupation, social/cultural history, previous hospital admissions, chief
complaint on current admission, and all diagnoses. This serves to orient the reader to
the case study patient and provide an overview of clinical issues pertaining to the
patient.
Pathophysiology, Treatments, and Medical Respiratory Therapy Standards of
Practice
In this section, the student will provide general information about the medical
conditions and treatments that would be utilized in evaluating and planning care for
the case study patient
.
Explain the patient’s diagnoses and how they are pertinent to their Respiratory
status and the Respiratory care plan
Give a brief description of the disease process in terms of incidence, prevalence,
risk factors/etiology, symptoms, pathophysiology; diagnostic procedures (e.g.,
biopsy, laboratory tests, x-rays); treatments (e.g., medical; surgical; occupational;
physical, or speech therapy; social service, psychological); and prognosis (e.g.,
expected degree of recovery).
•
The role of lifestyle and lifestyle modifications should also be addressed, as
appropriate, including exercise, alcohol, and smoking.
.
Patient history and Clinical Course
The following information will be specific to your case study patient:
Pathophysiology – specific to the patient.
Laboratory tests – report only those abnormal values pertinent to the related
pathophysiology, be prepared to explain the value’s meaning. Compare them to
the normal.
Medications. All medications mentioned in the case study should include a
description of what they are used for. Discuss drugs with respiratory
implications in greater detail than other medications.
Procedures and surgeries
Respiratory Assessment
Patient’s Sensorium. Those with respiratory problems may appear exhausted,
anxious or unresponsive. Hypoxia and hypercapnia can alter the mental state and
cause confusion or disorientation.
Patient’s skin color. Cyanotic with hypoxia. A patient with hypercapnia may
appear flushed because of high carbon dioxide levels.
Case Study Outline
2
Communicate with the patient. Note if he has shortness of breath or uses short
sentences. This could indicate a certain level of respiratory failure.
Observe the patient’s chest rises and falls. A limited movement could point to a
respiratory problem or collapsed lung.
Observe the patient’s respiratory rate per minute, shallow or deep. Note how long
it takes the patient to exhale.
Inspect the patient’s mouth. Look for traces of mucus or blood, which are both
signs of lung problems. Smell the breath for a fruity or fecal smell, which could also
indicate respiratory problems.
References
References should be listed in
American Psychology Association,(APA)
format,
including; use of original source material, data , formation form chart, and p
patient interview
Organization of Paper
Your paper’s body will exceed 3 typed pages. The material should be presented in a
logical, well-organized manner. All APA format.
o
Title page with running head.
o
Font; Times New Roman size 12 throughout
o
Body of paper;
Patient profile, Presentation (how the patient presents), Medical History,
Pathophysiology
o
Medications ( what are they used for) Vital signs, Lab tests ,with normal
values (X ray, Blood gases, labs) treatments modalities and the purpose of
performing them.
o
Summary (summaries the case study, what happened, what was done,
outcome, and future.)
o
References
Do not refer to the patient by name. Instead, use the words “the patient”.
Case Study Outline
3
85 points available
5 points Format,
APA format, 3 page length, cover page
Title page, Body of paper, Summary,
References
5
4
3
2
1
10 Patient Profile, Patient Information, History
age, sex, race, height, weight, marital status, occupation, social/cultural history,
previous hospital admissions, chief complaint on current admission
10
8
6
4
2
20 Pathophysiology, research of disease
general information about the medical conditions and treatments that would be
utilized in evaluating and planning care for the case study patient. Explain the
patient’s diagnoses
20
18
16
14
12
10
8
6
4
2
15 Treatment, Effectiveness of treatment, plan, and research of treatment options
treatments (e.g., medical; surgical; occupational; physical, or speech therapy; social
service, psychological)
15
13
12
10
8
4
10 points Summary
10
8
6
4
2
5 points Reference Page
5
4
3
2
1
10 points Grammar and spelling
10
8
6
4
2
10 Points Respiratory Assessment, Patient’s Sensorium,
Patient’s skin color,
Therapist Contact with the patient
10
9
8
7
6
5
4
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