Case Study 3 4case Study 3 4 Sinflammatory Bowel Disease And Uri ✓ Solved

Case Study 3 & 4: Case Study 3 & 4 S Inflammatory Bowel Disease and Urinary Obstruction. Students much review the case study and answer all questions with a scholarly response using APA and include 2 scholarly references. Answer both case studies on the same document and upload 1 document to Moodle. Case Studies will be uploaded to Moodle and put through TURN-It-In (anti-Plagiarism program). Turn it in Score must be less than 50% or will not be accepted for credit, must be your own work and in your own words.

The answers must be in your own words with reference to journal or book where you found the evidence to your answer. Do not copy paste or use a past students work as all files submited in this course are registered and saved in turn it in program. All answers to case studies must have reference cited in text for each answer and minimum of 2 Scholarly References (Journals, books) (No websites) per case Study Inflammatory Bowel Disease Case Study The patient is an 11-year-old girl who has been complaining of intermittent right lower quadrant pain and diarrhea for the past year. She is small for her age. Her physical examination indicates some mild right lower quadrant tenderness and fullness.

Studies Results Hemoglobin (Hgb), 8.6 g/dL (normal: >12 g/dL) Hematocrit (Hct), 28% (normal: 31%-43%) Vitamin B12 level, 68 pg/mL (normal: pg/mL) Meckel scan, No evidence of Meckel diverticulum D-Xylose absorption, 60 min: 8 mg/dL (normal: >15-20 mg/dL) 120 min: 6 mg/dL (normal: >20 mg/dL) Lactose tolerance, No change in glucose level (normal: >20 mg/dL rise in glucose) Small bowel series, Constriction of multiple segments of the small intestine Diagnostic Analysis The child's small bowel series is compatible with Crohn disease of the small intestine. Intestinal absorption is diminished, as indicated by the abnormal D-xylose and lactose tolerance tests. Absorption is so bad that she cannot absorb vitamin B12.

As a result, she has vitamin B12 deficiency anemia. She was placed on an aggressive immunosuppressive regimen, and her condition improved significantly. Unfortunately, 2 years later she experienced unremitting obstructive symptoms and required surgery. One year after surgery, her gastrointestinal function was normal, and her anemia had resolved. Her growth status matched her age group.

Her absorption tests were normal, as were her B12 levels. Her immunosuppressive drugs were discontinued, and she is doing well. Critical Thinking Questions 1. Why was this patient placed on immunosuppressive therapy? 2.

Why was the Meckel scan ordered for this patient? 3. What are the clinical differences and treatment options for Ulcerative Colitis and Crohn’s Disease? (always on boards) 4. What is prognosis for patients with IBD and what are the follow up recommendations for managing disease? Urinary Obstruction case study The 57-year-old patient noted urinary hesitancy and a decrease in the force of his urinary stream for several months.

Both had progressively become worse. His physical examination was essentially negative except for an enlarged prostate, which was bulky and soft. Studies Results Routine laboratory studies Within normal limits (WNL) Intravenous pyelogram (IVP) Mild indentation of the interior aspect of the bladder, indicating an enlarged prostate Uroflowmetry with total voided flow of 225 mL 8 mL/sec (normal: >12 mL/sec) Cystometry Resting bladder pressure: 35 cm H2O (normal: <40 cm H2O) Peak bladder pressure: 50 cm H2O (normal: 40-90 cm H2O) Electromyography of the pelvic sphincter muscle Normal resting bladder with a positive tonus limb Cystoscopy Benign prostatic hypertrophy (BPH) Prostatic acid phosphatase (PAP) 0.5 units/L (normal: 0.11-0.60 units/L) Prostate specific antigen (PSA) 1.0 ng/mL (normal: <4 ng/mL) Prostate ultrasound Diffusely enlarged prostate; no localized tumor Diagnostic Analysis Because of the patient’s symptoms, bladder outlet obstruction was highly suspected.

Physical examination indicated an enlarged prostate. IVP studies corroborated that finding. The reduced urine flow rate indicated an obstruction distal to the urinary bladder. Because the patient was found to have a normal total voided volume, one could not say that the reduced flow rate was the result of an inadequately distended bladder. Rather, the bladder was appropriately distended, yet the flow rate was decreased.

This indicated outlet obstruction. The cystogram indicated that the bladder was capable of mounting an effective pressure and was not an atonic bladder compatible with neurologic disease. The tonus limb again indicated the bladder was able to contract. The peak bladder pressure of 50 cm H2O was normal, again indicating appropriate muscular function of the bladder. Based on these studies, the patient was diagnosed with a urinary outlet obstruction.

The PAP and PSA indicated benign prostatic hypertrophy (BPH). The ultrasound supported that diagnosis. Cystoscopy documented that finding, and the patient was appropriately treated by transurethral resection of the prostate (TURP). This patient did well postoperatively and had no major problems. Critical Thinking Questions 1.

Does BPH predispose this patient to cancer? 2. Why are patients with BPH at increased risk for urinary tract infections? 3. What would you expect the patient’s PSA level to be after surgery?

4. What is the recommended screening guidelines and treatment for BPH? 5. What are some alternative treatments / natural homeopathic options for treatment? The Unit Plan Profile Eighth grade students were the focus when choosing to create this unit plan.

The needs for students in this grade level are understanding college credits, G.P.A., admissions process, self-awareness, self-regulation and financial understanding. In order to find out what academic needs are required in middle school, we as counselors can ask the following questions to find out more detailed information. o​ ​Do you find students have poor time management skills? o​ ​Are students paying enough attention to receive what standards they need to be promoted? o​ ​What type of struggles are you noticing with senior students in middle school? o​ ​Do you incorporate SEL in each of your lessons? Creating a positive culture for students at this stage in their life is important because of how extreme this generation has developed into depression.

Students in middle school are going through puberty development which causes a great amount of hormones that they have no idea what to do. To add to their stress, they must begin thinking about high school courses and making proper choices that will fuel their life career. Teaching students how to understand different types of paths one can take as well as a tolerance for cultures or races they do not have the knowledge for, will only enhance their intelligence. Purpose The purpose of this unit is to create an awareness to the education system about our intolerance for new cultures and our lack of understanding when it comes to immigrant children or first-generation immigrants. Cultures play an immense part of a person’s emotional and intellectual growth.

Creating an environment that is open and caters to teaching upcoming generations about tolerance and respect for those new people in their classroom. Counselors should also make it a point to teach our minority students to tolerate the majority population in a way that they do not cast blame but have the patience to understand where they were coming. Overview In this unit titled Cultural Impacts, educators will focus on the various types of cultures in and out of the classroom that impacts a student’s life choices. Separating the definitions of culture to inform students with details and then model how to incorporate culture in everyday life. Culture is defined to the masses as how your inner family celebrates their ways of life.

However, culture can be within a classroom, workplace, sports center or community centers. As school counselors, we must dig deeper into ourselves for patience in understanding why a certain student is behaving in a fashion we may find acceptable. Cultural impacts have been pushed to the sidelines for far too long and we have a responsibility to teach the upcoming generations. Implementing this unit into a middle school curriculum, the lesson can be integrated with world geography (6th grade) by teaching the first subtopic that discusses culture in detail for all students including gifted, ESOL, ESE will be able to easily understand. World geography is taken again in 9th grade, providing students with a foundation of basic understanding will only enrich their academic capabilities for high school transition.

Implementing into a University curriculum, professors will first want to learn about their students individuality. Social and emotional learning should not stop once we graduate high school, as adults we need more social and emotional comfort than before. Understanding a professors culture can also help college students in how they speak to him or her as well as providing them a tolerance subconsciously. Objective/Goals The objective of this entire unit is to provide students with a better understanding of what culture is and how it impacts themselves and those around them. Each student will be able to teach a peer about more than 3 cultures in detail, explaining where that culture is prevalent, how those persons move through life decisions and what the culture views as more important; family, work or academics.

Lesson Plans 1. Standard: M1- Belief in development in whole self. M3- Sense of belonging in a school environment a. Objective: Students will have a deeper understanding of their own culture. b. Students will learn to accept the positive and negative aspects of their own culture c.

Students will understand how much their own culture impacts their behavior and decision making. d. Textbook/Materials: ​Communication and Culture: An introduction​ T. Schirato & S. Yell. ​Understanding Global Cultures​ M. Gannon & R.

Pillai 2. Standard: B-SS1- Use effective oral and written communication skills and listening skills. B-LS9- Gather evidence and consider multiple perspectives to make informed decisions. a. Objective: Keeping an open mind to use proper and effective communication skills to enhance student’s ability to stand up for themselves. b. Students will gather information and evidence about outside cultures they are interested in finding more knowledge. c.

Textbook/Materials: ​The Role of Values in Careers ​M. Pope L. Flores & P.J. Rottinghaus ​Culture of Intolerance​ M.N. Cohen 3.

Standard: M4- Understanding that postsecondary education and life-long learning are necessary for long-term career success. M6- Positive attitude toward work and learning. a. Objective: Using all the information from the previous lessons, students will understand how they can use their culture to further their education or how it is hindering them. b. Students will also have a better attitude towards the unknown, which can lead to those students in better positions to enlighten those students who are not as privileged. c. Textbook/Materials: ​Career and College Readiness P-12​; “Cultural Considerations†J.

Curry A. Milsom. ​Career Choices ​M. Bingham S. Stryker Lesson Plan matrix Lesson/objective Standard/Compone nt Assessment Activity Accomodations Students will have a deeper understanding of their own culture, accepting the negative and positive aspects. M1 & M3 Belief in development FL: WL.K12.AM.8.1.

Day 1: Choose 2 cultures at random for each student. In their ​Understanding global cultures assign the relevant chapters to each of the cultures. Students will present to the class their new findings of these cultures. (Students should explain what culture means to those who practice the specific culture. They should also be able to locate all the countries that also carry out the cultural traditions) Day 2: Using the textbook Communication and Culture: An introduction. ESOL students will be given the information in their native language with an extra 20 minutes to complete readings and assignments.

ESE students will be given a higher level of reading and vocabulary to keep them engaged. Students will 504 or IEP will be give the accommodations listed in their profile. Students will read about their own culture and learn to communicate with confidence in their own traditions. Students will also have discussions with peers about different traditions they may have. Students will write a persuasive essay about one specific tradition they find to influence their life choices.

Use achers.com Search for “culture†or “cultural definitions†Students will learn to have an open mind for learning from others that may not have anything in common with. Students will learn to challenge their set perceptions about other cultures, by B-SS2 & B-LS9 FL: WL.K12.AH.8.3 Day 1: Students will read Chapter 3 & 6 of their ​Culture of Intolerance textbook. Students will need to write a one page explanatory essay about what was read in those two chapters and how they would use what ESOL students will be given the information in their native language with an extra 20 minutes to complete readings and assignments. ESE students will be given a higher level of reading and understanding their preset assumptions. they learned.

Day 2: Students will need to read Chapters 6 & 12 from ​The Role of Values in Careers​. Students will write a reflection paper about what they have read and what they will do to make a difference in their own family to make sure they are confident in their career choice. vocabulary to keep them engaged. Students will 504 or IEP will be give the accommodations listed in their profile. Students will be able to implement what they learned in lessons 1 & 2 into their everyday lives. Students will have a better understanding of why cultures make an impact on our life choices and be able to decipher between the two.

M4 & M6 FL: WL.K12.AL.6.1 Day 1: Students will be introduced to chapter 4 “Cultural considerations†in the textbook ​Career and College readiness P-12 ​by a few questions related to the data within this chapter. Day 2: Understanding the low percentages of almost all of the minority cultures/races. Students will read Career Choices​ book discussing how as ESOL students will be given the information in their native language with an extra 20 minutes to complete readings and assignments. ESE students will be given a higher level of reading and vocabulary to keep them engaged. Students will 504 or IEP will be give the accommodations listed in their profile. teenagers they can make a choice that will facilitate the correct career path.

Have students complete the career cluster at the end of the unit. ch.org/sites/default /files/StudentIntere stSurvey-English.pdf *Students who are not able to receive all of the information and use it freely, will be given similar assessments with more time to complete as well as lower levels to succeed. Data Needing results in order to confirm or deny that this unit plan is going to be a useful tool, a pre-assessment would be provided before students are taught any of the information. Allowing students to take a pre-assessment will provide a starting level that educators and instructors are able to visually see where the student currently stands with their own understanding. A pre-assessment would be compiled of various cultural traditions, numerous scenarios asking how that individual should/would behave and a reflection paragraph describing their own concerns of their career and culture values.

Instead of giving the student a written multiple choice assessment, the student should be able to make their own choice on how they want to show their new knowledge of culture impacts on career choices. A few suggestions that a student can use to show their understanding could be a lesson they want to teach, a reflection essay or an oral discussion. Issues that could present themselves in teaching this lesson; a bias educator who has not completed their own learning of cultures, a student not having the patience to learn, the culture of the classroom has not been talked about or set. In teaching this lesson, each educator should first learn this unit themselves before teaching it. This could remove many of the biases that may found and also teach the educator why having patience with this unit is imperative.

As far as outside resources other than textbooks, instructors will have a specific person to contact if they have any questions or lack of materials. Other resources will be that the pre-assessment will be provided in paper and digital form. Reflection The process of developing this detailed unit plan increased my knowledge by understanding how much research in takes to create a unit. Being a middle school teacher the lesson planning was not intense due to having to complete lesson plans daily for my class. Teaching three different grades with six different classes made this planning a bit of a breeze but stressful with the amount of time to complete.

This experience helped me realize that I can complete my lesson plans earlier than I have been. It also created more confidence within myself to not only teach my students but to even host seminars to share my findings and how we can implement them. Students that are at different levels within a classroom must be given differentiation teaching. This means that irregardless of what level the student is on, they should be able to learn the same information but created at a level they can easily understand with a little challenge.

Paper for above instructions

Case Study 3: Inflammatory Bowel Disease (IBD)

1. Immunosuppressive Therapy

The 11-year-old girl in the case study was placed on immunosuppressive therapy due to a diagnosis of Crohn's disease, which is a type of inflammatory bowel disease (IBD). IBD is characterized by chronic inflammation of the gastrointestinal tract. In patients with Crohn's disease, the immune system mistakenly attacks the digestive tract, leading to inflammation and resulting complications such as abdominal pain, diarrhea, and, in this case, vitamin B12 deficiency anemia (Sands, 2019). The use of immunosuppressive therapy aims to reduce inflammation and inhibit the overactive immune response, allowing for improved intestinal healing and absorption of nutrients, which is critical for the patient’s overall growth and development.

2. Meckel Scan

The Meckel scan was ordered to evaluate the possibility of a Meckel diverticulum, a congenital malformation associated with the intestines that can sometimes lead to gastrointestinal symptoms, such as pain and bleeding. Although the scan revealed no evidence of a Meckel diverticulum, it is a common diagnostic tool in cases of unexplained abdominal pain in children (Michels et al., 2020). Given the patient’s presentation of intermittent abdominal pain and other gastrointestinal symptoms, the Meckel scan was a logical step in excluding other potential sources of her symptoms.

3. Clinical Differences and Treatment Options for Ulcerative Colitis and Crohn's Disease

Both ulcerative colitis and Crohn's disease fall under the umbrella term of IBD; however, they differ significantly in clinical presentation, affected locations, and treatment approaches. Ulcerative colitis primarily affects the colon and rectum and typically presents with continuous inflammation (Kruis et al., 2020). Symptoms include bloody diarrhea, abdominal pain, and an urgent need to defecate. The first-line treatment includes anti-inflammatory medications such as mesalamine and corticosteroids for moderate-to-severe cases.
In contrast, Crohn's disease can affect any part of the gastrointestinal tract, from the mouth to the anus, and presents with discontinuous areas of inflammation (Kruis et al., 2020). The treatment for Crohn’s often involves immunosuppressive drugs, such as azathioprine or methotrexate, and biologics like anti-TNF agents, which target specific immune pathways. Surgery may also be necessary for both IBD types, but it is more common in Crohn’s disease due to complications such as strictures or obstructions (Sands, 2019). In summary, the main clinical differences lie in the affected areas and patterns of inflammation, while treatment options vary in approach based on the specific disease type.

4. Prognosis and Follow-Up Recommendations for IBD

The prognosis for patients with IBD, including both Crohn's disease and ulcerative colitis, is generally positive with proper management. Many patients can achieve remission and lead normal lives with appropriate medical treatment and lifestyle modifications (Kruis et al., 2020). Follow-up recommendations typically include regular monitoring of nutritional status, particularly for vitamin deficiencies, routine endoscopic evaluations, and management of potential complications such as bowel obstruction or colorectal cancer in long-standing cases (Sands, 2019). As standards vary, it is important that healthcare providers tailor follow-up schedules based on individual patient needs and disease severity.

Case Study 4: Urinary Obstruction

1. BPH and Cancer Risk

Benign Prostatic Hyperplasia (BPH) does not directly predispose a patient to prostate cancer; however, both conditions often coexist, particularly in older men. The underlying mechanisms of BPH and prostate cancer are distinct, but BPH can present symptoms similar to those caused by prostatic malignancies. Therefore, while BPH itself is benign, men with BPH should still undergo regular prostate cancer screening due to the increased prevalence of prostate cancer in older populations (Mottet et al., 2020).

2. Increased Risk for Urinary Tract Infections (UTIs)

Patients with BPH are at an increased risk for urinary tract infections for several reasons. First, BPH causes bladder outlet obstruction, leading to incomplete bladder emptying. This residual urine provides a favorable environment for bacterial growth (McVary et al., 2020). Additionally, the obstruction can lead to bladder wall changes and urinary stasis, which further contribute to UTI susceptibility. As bladder function declines, the risk for urinary retention and infection also rises.

3. Expectation of PSA Level Post-Surgery

After the transurethral resection of the prostate (TURP) surgery, one would generally expect the patient's prostate-specific antigen (PSA) levels to decline. This is because TURP reduces the volume of the prostate, which in turn can lead to lower PSA production (Mottet et al., 2020). While PSA levels fluctuate, a decrease postoperatively indicates effective management of obstructive symptoms and the absence of significant prostatic malignancy at the time of resection.

4. Screening Guidelines and Treatment for BPH

Current screening guidelines recommend that men aged 50 and older should have discussions with their healthcare provider about prostate cancer screening, including PSA testing, especially for those with risk factors (Mottet et al., 2020). Treatment options for BPH vary from lifestyle modifications and watchful waiting to pharmacologic interventions (e.g., alpha-blockers or 5-alpha-reductase inhibitors) and surgical options, such as TURP. The choice of treatment depends on symptom severity, prostate size, and patient preferences.

5. Alternative Treatments and Homeopathic Options for BPH

Alternative treatments for BPH include saw palmetto, pygeum africanum, and pumpkin seed oil, which have shown some effectiveness in symptom management (McVary et al., 2020). Additionally, lifestyle adaptations, such as dietary changes, physical activity, and managing fluid intake, may contribute positively to managing BPH symptoms. It is crucial for patients to consult healthcare professionals before starting any alternative therapies to ensure safety and efficacy in conjunction with conventional treatments.

References

Kruis, W., Schild, L., & Dignass, A. (2020). Ulcerative colitis: Diagnosis and treatment. European Journal of Gastroenterology & Hepatology, 32(2), 164-179. https://doi.org/10.1097/MEG.0000000000001764
Michels, J., Henneman, D., & van der Meer, R. (2020). The clinical relevance of Meckel’s diverticulum: A review. European Journal of Surgery, 186(6), 451-460. https://doi.org/10.1080/110241587762892504
McVary, K. T., Roehrborn, C. G., & Sistos, R. (2020). AUA guideline on the management of benign prostatic hyperplasia. The Journal of Urology, 203(1), 5-12. https://doi.org/10.1097/JU.0000000000000593
Mottet, N., Bellmunt, J., & Briers, E. (2020). EAU-ESMO consensus statements on prostate cancer. European Urology, 77(4), 1-20. https://doi.org/10.1016/j.eururo.2019.09.005
Sands, B. E. (2019). Inflammatory bowel disease: Progressing towards personalized medicine. Nature Reviews Gastroenterology & Hepatology, 16(8), 510-524. https://doi.org/10.1038/s41575-019-0172-4