7.12 Learning Activity: Case Study
Case Study
Read each case study carefully. Use the information provided in the scenario, along with the course content and any required resources, to answer the questions.
Kinsey Valdez, age 26, is brought to the urgent care clinic by her roommate, Sara, who reports a recent change in Kinsey’s behavior and difficulty concentrating. Kinsey states that she allowed her roommate to bring her to the outpatient clinic because she was not feeling well, adding, “I just do not know what’s wrong.” During the initial visit, the nurse notes that Kinsey turns away, does not make eye contact, and speaks quietly.
Sara reports that Kinsey has had a lack of energy for several weeks. She explains that Kinsey frequently talks about her life being “hopeless,” does not get out of bed in the morning, and has little interest in sleeping or eating.
Sara further explains that when Kinsey was 16, her best friend died in a car accident, and Kinsey experienced severe depression at that time. She received family support but did not take medication or participate in traditional counseling services. Additionally, Kinsey recently discovered that she is HIV positive. She received this news around the anniversary of her best friend’s death.
Kinsey has lived with Sara for three years in an apartment. They also work together as nurses on the night shift in the medical-telemetry unit at a local hospital. Kinsey’s closest family member, her younger brother, lives three hours away, and they rarely speak. Kinsey admits that she has few friends and states, “I’m usually not much fun to hang out with, but I’m okay with that.” She has also been picking up many extra shifts at work because of short staffing in recent weeks.
Kinsey states, “I’m worried that this positive HIV test will cause me to no longer be able to work as a nurse.”
Kinsey is instructed to go to the nearest emergency department (ED) for further assessment and follow-up. Sara takes her to the ED. The urgent care nurse calls the ED nurse and provides a brief report. When Kinsey and Sara arrive, they are immediately placed in a private ED room.
Reflective Questions
- What cues do you recognize as relevant when planning and providing care for Kinsey?
- What is Kinsey’s priority nursing problem?
- What are your first steps when caring for Kinsey?
Assessment
The ED nurse performs an assessment and collects the following data.
Vital Signs
- Blood pressure: 110/64 mm Hg
- Pulse: 48 beats/minute
- Temperature: 35.8°C
- Oxygen saturation: 97% on room air
- Respiratory rate: 16 breaths/minute
Pain Assessment Using PQRST
- Location: Knees and ankles bilaterally
- Provocation or palliation: “Always there, does feel a bit better after sleeping for a while.”
- Quality: “Achy.”
- Radiation: None
- Severity: 3/10
- Timing: Started approximately three weeks ago after falling on the ice at work while leaving after a night shift.
Focused Assessment Findings
Neurological
Kinsey reports a history of migraine headaches but has not experienced any in recent years. She wears contact lenses most of the time but sometimes wears glasses. She denies dizziness, changes in vision, or numbness in her limbs.
Respiratory
Breathing is unlabored and regular but occasionally shallow when resting.
Cardiac
Kinsey denies any cardiac complaints.
Gastrointestinal
- Weight: 52.3 kg, representing a 3-kg decrease since her previous hospital visit one year ago
- Eats approximately one meal daily, but only when her roommate prepares food and brings it to her in bed
- States, “I’m just too tired to eat most of the time.”
- Nibbles on snacks and drinks Gatorade and protein shakes while at work
- Reports that her last bowel movement was yesterday and that her bowel pattern is regular
- Denies nausea or vomiting
Genitourinary
Kinsey denies any genitourinary complaints.
Integumentary
- Three small, evenly spaced, superficial scratches are present on her left forearm.
- No redness, tenderness, or warmth is noted around the scratches.
- Her face appears pale.
- A small, nonraised, light-pink rash is present across her chest. The rash is not warm or pruritic.
Psychosocial Assessment Findings
General Appearance and Behavior
Kinsey is wearing pajamas. Her hair is in a loose bun, and she is not wearing makeup. She appears apprehensive and detached and avoids eye contact. She is slouched in the chair with her feet elevated in a modified fetal position. She is cooperative but passive.
Affect and Mood
Kinsey has a sad facial expression and blunted affect. Her movements are slow, and she speaks in a quiet, monotone voice.
Speech Pattern
Kinsey’s speech is slow, quiet, and minimal. Her sentences are logical.
Thought Content
Kinsey demonstrates depressive thought content without evidence of delusions or hallucinations.
Cognition
Kinsey is alert and oriented to person, place, and time. She has a bachelor’s degree in nursing, holds an RN license, and is articulate and intelligent.
Judgment
There is no evidence of changes in Kinsey’s judgment.
Laboratory Results
- Laboratory results are unremarkable.
- Tests are negative for alcohol and cannabis.
- CD4 count: 641 cells/µL
Additional Reflective Questions
- What additional cues are relevant when planning Kinsey’s care based on the nursing assessment?
- What is your hypothesis regarding Kinsey’s condition after analyzing the nursing assessment data?
- Write a SMART goal for Kinsey’s care based on the priority nursing problem or problems.
- What priority nursing interventions should be implemented when caring for Kinsey?
Answers to the Case Study are found in the “Answer Key” at the end of the book.
