Case Studies - June

1.
A group of elders living in a senior center are concerned about their risk for
stroke. They have asked you, as their community health nurse, to address their
concerns
Questions for this Scenario:

What are the signs and symptoms of a stroke? Sudden numbness or weakness in the face,
arm, or leg, especially on one side of the body. Sudden confusion, trouble speaking,
difficulty understanding speech, nausea/vomiting
What causes these signs and symptoms? Lack of blood flow caused by blood clot
What happens in the body physiologically?
What are the risk factors? Age, gender, ethnicity, hypertension, family history, having
TIA’s, atherosclerosis, obesity, diabetes and atrial fibrillation
Using each of the three levels of prevention, identify an appropriate educational
topic that would address these elders’ prevention needs.
Primary prevention exercise, eating healthy and other lifestyle modifications,
control blood pressure, cholesterol levels
Secondary prevention Use of antihypertensives, anti-aggregants, statins and
lifestyle interventions
Tertiary prevention
Think about the intervention you will do in terms of “CHNAC’ standards. How will
this fit?
How about the Principals of primary health care?
2.A nurse is assigned to a new role as a school nurse for three elementary
schools in a rural county. She knows that a community assessment should be
conducted first in order to identify community needs and appropriate resources.
Who should the nurse involve in the initial stages of the community assessment?
The population, individual, noted leaders such as leaders.
How would you go about getting people interested? Explaining how this will
benefit them.
What are your ideas to be successful? Windshield survey, research literature and
statistics (the demographics), found out
3. A high school in a rural farm community has a disproportionately high number
of pregnant students. Most of these young mothers choose to keep the baby
rather than terminate the pregnancy or give the baby up for adoption. Some have
assistance from their families or the fathers of the babies. In many of these cases,
the young mothers are unable or unwilling to complete their high school
education. This often leads to isolation, depression, and financial dependency on
others. The school nurse determines that a combination learning and support
group for these young mothers may alleviate some of the isolation and depression
and provide them with incentive to finish school.

What are the first steps the nurse must take to establish this group?
Who are the key people the nurse must work with to make this group work?
Which SDOH affected? How?
How can you as a nurse help?
How can you encourage them to finish school?
What would they need in order to be able to do so?
3. The nurse working in an inner-city neighborhood clinic observes that many

clients are coming to the clinic with complaints of vomiting and severe diarrhea.
Through reviewing the clinic records and interviewing the clients the nurse learns
that most of the ill clients live within a 6-block radius. The electric power has been
off at least six times in the last 3 weeks for between 4 and 8 hours each time.
Clients have also complained that their tap water “smells and tastes funny” but
they cannot afford to buy bottled water. Many of the clients are boiling their water
before drinking it but for most of them when the power is out the stove does not
work.

What other kinds of assessment might the nurse do to identify the potential
problem?
How can the nurse involve the community in the assessment and planning
process?
How do you need to involve?
4. Ms Smith, age 58, and Ms. White, age 67, are sisters who live together in a
small rural town. They are both retired high school teachers. Ms. Smith has retired
early due to advanced osteoporosis. Ms. White has osteoarthritis. The two sisters
have requested information from the community health center about managing
their mobility concerns and have expressed interest in increasing their exercise.
They are both being seen by a local family physician and managed with a
pharmacological treatment plan. The physician has advised them to exercise
more and increase their flexibility through weight training. Both sisters are
optimistic and enthusiastic about gaining greater control in their lives through self
management.
What are the signs and symptoms of OA? Pain, stiffness, tenderness, loss of flexibility,
swelling of joints, grating sensation
What are the Symptoms of osteoporosis? Height loss over time, fractures from standing
decreased grip strength, back pain,
What can happen to people with osteoporosis?causes bone to become way and brittle
resulting in the patient being at risk for falls and fractures, also deformities, bone cancer
What should the nurse keep in mind as he/she develops a plan of care with these
clients? Slowing down or preventing further bone loss, controlling pain, stressing
careful positioning, prescribing certain exercises, educating the patient, improving
bowel elimination (high fibre diet, increased fluids, stool softeners etc.)
What aspects of chronic illness influence the health goals of these clients? The
patients mindset and view towards osteoporosis, sometimes they
5.A 16-year-old female high school student is being treated for gonorrhea and chlamydia for the
second time in six months. While counseling the young woman the nurse learns that she has only
one sexual partner, but she suspects that her boyfriend might not consider their relationship
monogamous. He refuses to wear a condom because he says he wants to really enjoy having sex
with her and a condom would interfere with that. The client does not want to confront her boyfriend
because she is afraid of losing him. She states, “What’s the big deal anyway? Gonorrhea and
chlamydia are curable.” Later, when preparing the clinic’s report of infectious diseases for the state
health department, the nurse notes that there is a high incidence of gonorrhea and chlamydia in
the clinic’s adolescent population.

What nursing interventions are appropriate with this client?
What actions should be taken at the community level?
6.When visiting an elderly client at home, the client’s daughter tells the nurse that several
members of the family have had abdominal pain, diarrhea, and severe vomiting. While washing
her hands in the kitchen, the nurse notices that the client’s granddaughter has begun preparing
the evening meal. There are frozen chicken breasts thawing on the counter next to the raw
vegetables for the salad. The nurse notices that the granddaughter has not washed her hands
after returning from the bathroom.
What is the appropriate response of the nurse regarding the treatment of the vomiting and
diarrhea of the family members?
How should the nurse approach the client’s granddaughter regarding food preparation and the
importance of proper hand washing?
7.A group of parents in a community health nurse’s assigned schools have voiced concerns that
“...more students in this school are using drugs and alcohol than ever before and we need to know
what to look for.”, The nurse offered to speak at the next PTA meeting about the ways parents can
identify possible substance abuse.
Questions for this Scenario

What symptoms may these students display?
What is the danger of substance abuse?
What should the nurse use as a guide to plan the educational offering?
Who should she involve?
8.A nurse working in an inner-city public health department clinic notices that the clients served by
the clinic have many health problems related to their poor living conditions, including: recurrent
respiratory infections, high blood lead levels in children, and skin rashes due to inadequate
personal hygiene. There are unusually high rates of skin and lung cancer, particularly among the
adolescents and young adults. In assessing the neighborhood, the nurse finds that the housing is
inadequate and overcrowded with poor ventilation and heating systems. The buildings are in
disrepair with peeling paint and broken windows. Garbage is piled in the streets next to
overflowing dumpsters and there is a chemical processing plant at the edge of the neighborhood
with smokestacks that emit a foul-smelling gas that hangs in the air over the neighborhood. In her
role as an advocate for her clients, the nurse decides to form a neighborhood coalition to address
these issues.

Who are the people and agencies that need to be included in the coalition?
What kind of policy changes would be needed to effect change in this neighborhood?
9.A nurse is making home visits to several elderly clients in a Haitian immigrant community. When
she visits the home of one of her clients, the client tells the nurse that her faith voodoo priest has
told her that she can no longer take her medication because it causes her to sleep during the day.
The client believes that while she is sleeping the caplata (sorcerer) will steal her soul and make
her into a zombie. The client states that her daughter is angry with her for listening to her priest.
She is afraid to mention this to her physician because he will not understand.

What must be taken into consideration?
What is the best way for the nurse to address this client’s situation?
Who needs to be included on the care team when developing a plan of care for this client?
10.The leader of the local Girl Scout troop has asked a community health nurse to come to one of
the troop meetings to talk to the girls (ages 12-14) about eating disorders. The troop leaders have
noticed that several of the girls have lost weight lately and have been greatly admired by the
others. Every conversation lately seems to be centered on weight loss and body image. The troop
leader has talked to several of the parents and they share her concern.

What does eating disorder mean?
What types?
Who does it affect?
What are some of the things the nurse might want to assess regarding the learners?
What educational theories or models might be useful in working with this learner population?

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1.

Questions for this Scenario:

Questions for this Scenario:

Which SDOH affected? How?

How can you as a nurse help?

How can you encourage them to finish school?

What would they need in order to be able to do so?

3. The nurse working in an inner-city neighborhood clinic observes that many

Questions for this Scenario:

How do you need to involve?

Questions for this Scenario:

Questions for this Scenario

Questions for this Scenario:

Questions for this Scenario:

Questions for this Scenario:

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