Module 1 Assignment: Case Study Analysis

An understanding of cells and cell behavior is a critically important component of disease diagnosis and treatment. But some diseases can be complex in nature, with a variety of factors and circumstances impacting their emergence and severity.

Effective disease analysis often requires an understanding that goes beyond isolated cell behavior. Genes, the environments in which cell processes operate, the impact of patient characteristics, and racial and ethnic variables all can have an important impact.

An understanding of the signals and symptoms of alterations in cellular processes is a critical step in the diagnosis and treatment of many diseases. For APRNs, this understanding can also help educate patients and guide them through their treatment plans.

In this Assignment, you examine a case study and analyze the symptoms presented. You identify cell, gene, and/or process elements that may be factors in the diagnosis, and you explain the implications to patient health.

To prepare:

By Day 1 of this week, you will be assigned to a specific case study for this Case Study Assignment. Please see the “Course Announcements” section of the classroom for your assignment from your Instructor.

The Assignment (1- to 2-page case study analysis)

Develop a 1- to 2-page case study analysis in which you:

  • Explain why you think the patient presented the symptoms described.
  • Identify the genes that may be associated with the development of the disease.
  • Explain the process of immunosuppression and the effect it has on body systems.
By Day 7 of Week 2

Submit your Case Study Analysis Assignment by Day 7 of Week 2.

Reminder: The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The sample paper provided at the Walden Writing Center provides an example of those required elements (available at All papers submitted must use this formatting.

Scenario for Case Study Week 2: A 65-year-old obese African American male patient presents to his HCP with crampy left lower quadrant pain, constipation, and fevers to 101˚ F. He has had multiple episodes like this one over the past 15 years and they always responded to bowel rest and oral antibiotics. He has refused to have the recommended colonoscopy even with his history of chronic inflammatory bowel disease (diverticulitis), sedentary lifestyle, and diet lacking in fiber. His paternal grandfather died of colon cancer back in the 1950s as well. He finally underwent colonoscopy after his acute diverticulitis resolved. Colonoscopy revealed multiple polyps that were retrieved, and the pathology was positive for adenocarcinoma of the colon. 

Here is the introduction to the directions. I cannot copy and paste the directions from Week 2 into the same box as the case study as the site does not save if I go to another site to copy. So I am asking you to go into the Week 2 directions yourself for full details, please. 

Please go in to Week 2 for further instructions on writing this case study. This is due on the final day of Module 1, Week 2, which is a Sunday at 11:59 pm MT, as usual. The instructions are very clearly spelled out and like with the discussion, there are several points for you to include in your case study analysis. Since cancer is one of the topics in Module 1, this will be a good case. Please note the instructions specific to the page count, and the fact that you need a Title page, introduction, summary and references per Walden requirements. You may use your textbook as one resource (or another text) but please use at least 2 other scholarly articles that are 5 years old or less in your references. You may use more and you may also use very high-level websites (Walden discourages use of lower level websites, that are more accessible to the public). I hope this helps guide you in next week’s work. Please focus, though, on quality peer responses for this week’s work first. Thank you

Short paragraph 200 words

Assignment: Reducing Potential Conflicts

Instructions:  Visit the website: to familiarize yourself with health information privacy regulations.

Write a short paragraph (200 words or more) of one thing you learned. 

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Maternal-Child Nursing Module 01 Discussion – Nursing Law Module 01 Discussion – Nursing Law


Read the two case summaries provided here. The case summaries are on page 2. Once you read the two case summaries, follow the instructions below.

Initial Post

Compare the appropriate nursing interventions by the nurse completed in Mississippi to the inappropriate nursing interventions by the nurse in the Texas case. Provide rationale supporting your comparison citing at least two scholarly sources.

Response Posts

  • Explain why you agree or disagree with at least two other classmates’ responses
  • Provide at least two examples and one credible resource to support each response



 Complete the following case studies and submit your answers in a WORD DOCUMENT.This assignment must be submitted to Canvas on time for you to get credit. Please answer every question- Not answering all questions will result in a reduction of your grade.

 Case Study, Chapter 8, Anti-infective AgentsA student nurse has to administer a broad-spectrum anti-infective medication to a patient. The patient develops nausea, vomiting, and diarrhea while taking the medication. The student nurse has to teach the patient about the anti-infective medication. a.  The faculty member asks the student nurse to identify the difference between a broad-spectrum and narrow-spectrum anti-infective medication.b.  The patient asks the student nurse what it means to develop resistance to anti-infectives. When the student nurse is teaching the patient about the anti-infective agent, it is important to include what general points to minimize bacterial resistance?c.  The faculty member asks the student nurse to identify the three common adverse reactions associated with the use of anti-infectives. This patient is complaining of what common adverse reaction?

Case Study, Chapter 10, Antiviral AgentsA patient is being treated with combination antiviral drugs for HIV and locally active antiviral drugs that include zidovudine and acyclovir. The student is preparing a 5-minute presentation on antiviral agents for clinical preconference. The student has to prepare medication information about the antiviral medications that are being administered to the client.  

 .a  What are the key characteristics of common viral infections?

b.  What are the common adverse effects of zidovudine?

c.  What key nursing considerations should the nurse focus on for the patient receiving a locally active antiviral agent? 

reflecto 12vo


Reflect on the focus area or system(s) for the week. Genitourinary/Neurological System

  • What challenges might you anticipate in completing this assessment?
  • What differences might you anticipate when assessing patients across the lifespan?
  • Share findings from scholarly resources that help in the performance of this assessment.

100 word reply due tomorrow at 9 am


Case: An elderly widow who just lost her spouse. 

Subjective:  A patient presents to your primary care office today with chief  complaint of insomnia. Patient is 75 YO with PMH of DM, HTN, and MDD.  Her husband of 41 years passed away 10 months ago. Since then, she  states her depression has gotten worse as well as her sleep habits. The  patient has no previous history of depression prior to her husband’s  death. She is awake, alert, and oriented x3. Patient normally sees PCP  once or twice a year. Patient denies any suicidal ideations. Patient  arrived at the office today by private vehicle. Patient currently takes  the following medications: 

•           Metformin 500mg BID 

•           Januvia 100mg daily 

•           Losartan 100mg daily 

•           HCTZ 25mg daily 

•           Sertraline 100mg daily 

 Current weight: 88 kg

Current height: 64 inches

Temp: 98.6 degrees F

BP: 132/86 

             Insomnia is a disorder linked with difficulty in sleep quality,  initiating or maintaining sleep, along with substantial distress and  impairments of daytime functioning. Its prevalence ranges from 10 to 15%  among the general population, with higher rates seen among females,  divorced or separated individuals, those with loss of loved ones, and  older people (Bollu & Kaur, 2019). Insomnia can simply be defined as  a sleep disorder where the patient has trouble falling asleep or  staying asleep. According to Krystal et al (2019), it is a common  condition that is linked with noticeable deterioration in function and  quality of life, mental and physical morbidity. The complaints of  insomnia are present in 60–90% of patients with major depression,  Complaints of disrupted sleep are very common in patients suffering from  depression, (Wichniak, etal., 2017).

Questions you might ask the patient and rationale

             The diagnosis and treatment of insomnia rely mainly on a thorough sleep  history to address the precipitating factors as well as maladaptive  behaviors resulting in poor sleep (Bollu & Kaur, 2019).

What  is your sleep pattern including how many hours of sleep do you get at  night prior to your husband’s demise and what it has been in the 10  months since his death? Does she perform certain rituals or do something  special before she sleeps. This assesses if the insomnia started before  or after the husband’s death. This provides a clue to insomnia that may  be related to bereavement.

What  time do you go to bed every night and what is your normal routine  before going to bed? This is to check if the patient is doing something  differently which has disrupted her normal routine and caused insomnia. 

How  often do you wake up to urinate at night? This question is asked to  assess for nocturia due to diabetes that may lead to insomnia. Nocturia  can prevent the patient from having a good night’s sleep. ,  changes in  blood glucose levels at night causesto hypoglycemic and hyperglycemic  episodes, nocturia and associated depression and insomnia ( Khandelwal  et al., 2017).

Do  you sleep during the day time. This provides information that evaluates  if day time sleeping may be affecting her ability to sleep at night.

Are  you  taking your medications as prescribed? This patient takes  sertraline for depression. Did the insomnia start after the pt started  taking sertraline or after the death of her husband.   

Identify people in the patient’s life you would need to speak to or get feedback from to further assess the patient’s situation


Are  there are things that disrupts her sleep?  for example, music/TV noise  or crying/playing children. This is important to ascertain that her  condition is not caused by environmental factors. Epidemiologic research  according to Johnson et al (2018) has shown that social features of  environments, family, social cohesion, safety, noise, and neighborhood  disorder can cause changes in sleep patterns; and other factors like  light, noise, traffic, etc., can also affect sleep and is attributed to  sleep disorders among adults and children.

What  does she do when she wakes up at night? does she eat, drink coffee or  smoke. This is to determine if midnight activities may hinder her from  falling asleep.

Does  she complain of having a hard time falling asleep or sleeping for a  short period and waking up, unable to go back to sleep? This assesses  how sleep and rest she may be getting.

Who  caters to the needs of this patient? This is to assess if she is well  cared for or if the patient is concerned about her self care.


Has the patient complained to you about difficulty falling asleep?

Does the patient complain about waking up in the middle of the night and finding it hard to go back to sleep?

Who does the patient leave with?


Does she complain of feeling tired because of not sleeping?

 Does this patient communicate appropriately or is she withdrawn when you see her?

When did you see the patient last?

Primary care physician

Has  this patient complained about any sleep problems in the past? This  provides collaboration between health care providers to ensure proper  management and delivery of patient-centered care.

Physical Exams

Psychiatric evaluation: A  mental health evaluation should be done to assess the patient’s overall  mental state including presenting symptoms, thoughts, feelings, or  behavior. PMHNP’s can use the Geriatric Depression Scale (GDS) which is a  self-reported measure of depression in the older adult. Cornell Scale  for Depression in Dementia (CSDD). The CSDD focuses on an interview with  a family member or caregiver as well as with the patient and is  confirmed for use in patients with or without dementia. Also, the   Zung  Self-Rating Depression Scale (SDS) which is used as a screening tool,  covering affective, psychological and somatic symptoms associated with  depression.

Polysomnogram ( sleep study):  can be performed  to diagnose sleep disorders such as insomnia

Sleep diary:  Evaluating the patient’s sleep patterns through a sleep diary provides  information on the patient’s sleep pattern and a diagnosis of insomnia.

Epworth Sleepiness Scale: This a questionnaire used to evaluate  daytime sleepiness.

Thyroid function test: Production of little or much thyroid hormone, can affect  sleep.

HBA1C:  The patient has a history of diabetes, monitoring her HbA1C is  important. This is because Individuals with a diagnosis of diabetes  report higher rates of insomnia, poor sleep quality, excessive daytime  sleepiness ( Khandelwal et al., 2017).

Actigraphy:  is an objective measurement of  sleep schedule,  rest-activity patterns used to help confirm insomnia.

Lab test: such as random glucose test,  liver function test, complete blood count, Erythrocyte Sedimentation Rate, kidney function test.

Differential diagnosis

 Late-life spousal bereavement : bereavement is known to cause  depression and complicated grief ( Holm etal., 2019).

Late  life depression (LLD) Predisposing factors include previous clinical  depression, persistent sleep difficulties, female gender,  being widowed  or divorced ( Blackburn etal., 2017). Complicated grief

Medicated-related insomnia

 Sleep apnea. Sleep apnea is considered to be prevalent  in more in persons with diabetes ( Khandelwal et al., 2017).

             The most likely differential diagnosis, in my opinion, would be  late-life spousal bereavement. (LLSB). The patient was diagnosed with  MDD, she lost her husband (died) ten months ago, and she is still  suffering from depression and insomnia.  Being widowed causes  impairments in sleep (Monk et al., 2008).

Pharmacologic Agents

Sertraline  (SSRI) causes insomnia as a side effect. Augmenting sertraline with a  different medication in the elderly may lead to polypharmacy. Therefore,  switching sertraline with a medication to help with MDD and insomnia  will be more helpful. I would choose to stop sertraline and start  trazadone. sedative antidepressants (such as trazadone 25-50mg) are a  safe  when given in low doses and are given in patient groups where  hypnotics are contraindicated, e.g., in the elderly and patients with  sleep apnea (Wichniaketal., etal., 2017). Trazodone is an antidepressant  that functions by inhibiting serotonin transporter and serotonin type 2  receptors. Trazodone in low doses provides a sedative effect for sleep  through antagonism of 5-HT-2A receptor, H1 receptor, and  alpha-1-adrenergic receptors ( Shin & Saadabadi., 2020). Trazodone  also improves apnea and hypopnea episodes in patients known to have   with obstructive sleep apnea (OSA), and it  does not worsen hypoxemic  episodes. This patient can be started on trazadone 25- 50mg at bedtime.

             A second drug choice is an antidepressant mirtazapine. It is effective  in managing major depressive disorder and has sedative properties which  is helpful in relieving sleep problems like insomnia and can be used in  the elderly. Mirtazapine is known as an atypical antidepressant with an  off label use for insomnia. It works by exerting antagonist effects on  the central presynaptic alpha-2-adrenergic receptors, causing an  elevated release of serotonin and norepinephrine. Mirtazapine is also  sometimes called a noradrenergic and specific serotonergic  antidepressant (NaSSA). I would recommend starting the patient on 15 mg  of mirtazapine at bedtime. Mirtazapine is known to treat MDD in patients  that were no unresponsive to SSRIs. I prefer to start this patient on  trazadone, rather than mirtazapine. Mirtazapine has side effects of  increased appetite, increased weight gain and this patient is already  obese with weigh 88kg, height 64 inches (bmi 34.4), increased  cholesterol. Further increase in weight would increase risk for  cardiovascular problems. Trazadone is quickly absorbed and has a faster  onset with hypnotic properties. This makes it more appropriate for this  patient.

Identify any contraindications to / Ethnicities

             A consideration for administration of trazadone is the age of this  patient. The dose in the elderly should not be more than 100 mg/day.  There is a  risk for orthostatic hypotension is in the elderly,  especially in the elderly with with pre-existing heart conditions  (hypertension) ( ( Shin & Saadabadi., 2020). The metabolism of  trazadone should also be considered in different ethnicities as poor  CYP2D6 metabolizers are known to have therapeutic response.  In the  Asian ethnicity, medications that metabolized by CYP2D6 should not be  prescribed (Kitada, 2003). Therefore, if this patient is Asian  increasing the dose of trazadone will be considered or choosing a  different medication to enable the patient get a full effect of the  drug. If the patient were of Asian descent, I would have to decide on  increasing the dose of Trazadone if they were a poor metabolizer or  choosing another medication that was not affected by CYP2D6.

Check Points

Monitor  the patient closely after changing her drug therapy. Side effects of  the medication should be clearly explained to the patient and family  importantly if hallucination is noted, immediate report to the PMHNP for  discontinuation of the medication. The patient should be   be monitored  for suicide ideation, especially at the beginning of the treatment or  when the dose is modified (Shin & Saadabadi., 2020).  I would  observe how this patient will adjust to trazadone 25-50mg in 4 weeks to  determine dose adjustment. 


Blackburn, P., Wilkins-Ho, M., Wiese, B. (2017). Depression in older adults: Adults and management. BCMJ, 59 (3).


Bollu, P., Kaur, H. ( 2019). Sleep Medicine: Insomnia and Sleep. The Journal of Missouri State   Medication Association, 116(1), 68–75.


Khandelwal, D., Dutta, D., Chittawar, S., Kalra, S. (2017). Sleep disorders in type 2 diabetes.       Indian Journal of Endocrinology and Metabolism,  21(5), 758–761. doi:    10.4103/ijem.IJEM_156_17

Kitada M. (2003) Genetic polymorphism of cytochrome P450 enzymes in Asian populations:

            Focus on CYP2D6. International Journal of Clinical Pharmacological


Holm,  N. Severinsson, E., Berland, A. (2019). The meaning of bereavement  following spousal     loss: A qualitative study of the experiences of  older adults.


Monk, T. H., Germain, A., & Reynolds, C. F. (2008). Sleep disturbance in bereavement.

            Psychiatric Annals, 38(10), 671–675.

Shin, J., Saadabadi., A. (2020). Trazodone. StatPearls.

Wichniak, A., Wierzbicka, A., Walęcka, M., Jernajczyk, W. (2017). Effects of Antidepressants    on sleep. Current Psychiatry Reports, 19 (9), 63. doi: 10.1007/s11920-017-0816-4


Discussion Question


A nurse manager is attending a national convention and is attending a concurrent session on staffing ratios. Minimum staffing ratios are being discussed in the nurse manager’s own state. The nurse manager has a number of questions about staffing ratios that the session is covering. The nurse manager knows that evidence exists that increasing the number of RNs in the staffing mix leads to safer workplaces for nurses and higher quality of care for patients.

1. What are the three general approaches recommended by the American Nurses Association (2017) to maintain sufficient staffing?

2. Summarize the findings that are often cited as the seminal work in support of establishing minimum staffing ratio legislation at the federal or state level.

3. Analyze what proponents and critics say about whether mandatory minimum staffing ratios are needed.




Eco 4

Data can be qualitative or quantitative. Qualitative data is helpful to generate a hypothesis and gather information if little is known about an expected association. Focus groups, key informant interviews, and case studies are types of qualitative data collection methods used to identify common themes from which to build a hypothesis. Quantitative data collection and analysis is used to test a hypothesis and make comparisons to determine the direction and strength of a potential association. The Behavioral Risk Factor Surveillance System (BRFSS) is cross-sectional panel survey used to collect quantitative data on adult behaviors and risk factors. It is one of the largest U.S. health data collection efforts. The data can be used to analyze associations on a state or country level. Follow the steps to obtain a 2×2 contingency table (also known as a “cross tabulation”) crossing binge drinking with depression.

  1. Retrieve the “BRFSS Web-Enabled Analysis Tool” resource provided in the Topic Materials.
  2. Select “Cross Tabulation.”
  3. Select “2015” for the year.
  4. Select “Arizona” for the state.
  5. Select “Alcohol Consumption: Binge drinkers (males having five or more drinks on one occasion, females having four or more drinks on one occasion)” for Step 2 Select Row.
  6. Select “Chronic Health Conditions: Ever diagnosed with a depressive disorder, including depression, major depression, dysthymia, or minor depression” for Step 3 Select Column.
  7. Skip Steps 4 and 5.
  8. Select “Sample Size” for Step 6 Select Statistics and run the report for the cross tabulation.

Part 1

Using the data from the cross tabulation results, calculate the odds ratio for depression among those exposed to binge drinking. Interpret the odds ratio and discuss if the odds ratio is a good estimate of the relative risk in this situation. Why or why not? Show your 2×2 table and all calculations. Present or describe the formula you used to arrive at your answer.

Part 2

Use the Topic Material, “BRFSS Web-Enabled Analysis Tool,” located on the CDC website, and run a report for two variables of interest to you. Create a 2×2 table and calculate the odds ratio for this association. Interpret the odds ratio and discuss the public health importance of the association. Show your 2×2 table. Present or describe the formula you used to arrive at your answer.

Refer to the “Creating a 2×2 Contingency Table” resource for guidance in creating 2×2 contingency tables.

General Requirements

APA style is not required, but solid academic writing is expected.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. Refer to the LopesWrite Technical Support articles for assistance.