KAITLYN'S CASE
INTERACTIVE CASE #2
Case Introduction
Kaitlyn is a 27-year-old computer programmer who complains of 3 days of abdominal pain and diarrhea. For the first 2 days, the pain was in the mid-abdomen, near the belly button. The pain has been in the right lower abdomen for the last day. She has no appetite and a low-grade fever. SEE HER SYMPTOMS BELOW.
RIGHT SIDE ABDOMINAL PAIN
ANATOMY OF THE GASTROINTENSTINAL TRACT
FEELING HOT
WHAT IS THE DIAGNOSIS?
Kaitlyn decides to see the doctor.
Licensed Practical Nurse
STEP ONE
PART 1
Think about it:
How is Blood Pressure Taken?
Licensed practical nurses complete a blood pressure test as a routine part of taking vitals in all cases. Blood pressure is the force of blood pumped from the heart against the walls of arteries. The instruments used depend on whether the measurement is automated or manual, though regardless of method, the unit of millimeters of mercury (mm Hg) remains constant in all readings. The results of blood pressure tests contain two numbers: systolic and diastolic. Systolic is the pressure of blood flow as the heart beats or contracts, while diastolic is the pressure in arteries between beats.
SOURCE: Mayo Clinic
Several machines may be used for automated measurement of blood pressure depending on the clinic/hospital.
SOURCE: News - Medical and Life Sciences
SOURCE: Healthline
A depiction of manual measurement of blood pressure using a stethoscope and sphygmomanometer (blood pressure cuff). The stethoscope is placed over the brachial artery in the arm, and pulse is measured as pressure from the cuff is released in short intervals.
PART 2
Answer questions related to the video and receive a key that you can use to open the vault. Good luck!
Ultrasound Technologist
STEP TWO
PART 1
Think about it:
What is ultrasound?
An ultrasound, also referred to as a sonogram, is a non-invasive diagnostic technique used to create images of the inside of the body. Ultrasound scans, common in many healthcare facilities, function by transmitting high-frequency sound waves into the body, and recording the waves that bounce back. The shading of the image is dependent on the type of matter the sound waves travel through, and how each area absorbs the vibrations. Based on density, body structures including fluids, tissue, and bone are able to be differentiated because of contrast in shape and color. In Kaitlyn's case, her inflamed appendix can be observed by an increased diameter or thickening of the organ wall in ultrasound imaging.
Figure 2
Figure 1
This image is from Kaitlyn’s ultrasound exam. Can you see the appendix? Her appendix measures 15mm in diameter. The normal appendix should not measure more than 6mm. The wall of the appendix is dark grey while the surrounding fat is light grey in
color.
By using a probe referred to as a transducer, a computer can interpret the reflected waves to form 2D images on the screen. This process is shown in the image above of a woman having a pelvic ultrasound,
Figure 3
The image to the right depicts a fetal ultrasound in which the form of a developing fetus inside the uterus is visible on an imaging screen.
PART 2
Answer questions related to the video and receive a key that you can use to open the vault. Good luck!
Physician Assistant
STEP THREE
PART 1
Think about it:
What tests can be done to determine a diagnosis?
Possible causes of right lower quadrant pain include appendicitis, obstructive kidney stone, ruptured ovarian cyst, and inflammation or infection of the small intestines or colon.
In most cases, there cannot be a definitive diagnosis of appendicitis upon the initial description of symptoms. The doctor, physician assistant, or nurse will run a series of tests. Other than physical examination, tests range from blood and urine labs to CT scans and ultrasounds. Tests for appendicitis vary depending on the situation and health care provider, but a combination of test results allows for a more accurate diagnosis. Labs are done first to rule out similar-presenting conditions (see Figures 1 and 2).
Figure 1
In urine tests, a sample of urine is assessed for the presence of white blood cells and bacteria, which can suggest a urinary tract infection, as well as minerals and red blood cells, which can suggest kidney stones.
Figure 2
In blood tests, a blood sample is searched for signs of an infection or inflammation by the presence of an elevated white blood cell count or c-reactive protein level. Patients with appendicitis typically demonstrate elevations of both. However, other causes of inflammation or infection (i.e., urinary tract infection or an infection of the colon) can produce similar findings. Therefore, imaging exams such as a CT scan or an ultrasound are done to try to distinguish between the various possibilities.
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PART 2
Answer questions related to the video and receive a key that you can use to open the vault. Good luck!
General Surgeon
STEP SIX
STEP FIVE
PART 1:
Kaitlyn sees the general surgeon.
Think about it:
How is appendicitis treated?
Acute appendicitis occurs when the appendix–a 3.5-inch finger-shaped tissue arising from the beginning of the large intestines in the right lower abdomen–becomes infected and inflamed due to a blockage. Physicians can treat acute appendicitis by surgically removing the appendix. Patients can either undergo an open appendectomy or a laparoscopic appendectomy. Open appendectomies utilize a much larger incision right above the belly button, while laparoscopic appendectomies use various small incisions and a fiber-optic instrument called a laparoscope.
PART 2
Answer questions related to the video and receive a key that you can use to open the vault. Good luck!
OR Nurse
STEP FIVE
PART 1
Think about it:
How is skin prepped for surgery?
Preparing the skin before any surgery is essential to minimize risk of infection. Pre-surgery procedure may include hair removal depending on the anatomical location and type of surgery. In general, skin preparation products are applied to the marked surgical site in the operating room. Commonly used products to sterilize the area include ChloraPrep and Betadine, both of which are applied as liquid directly onto the skin, then allowed to dry. ChloraPrep is an alcohol and chlorhexidine based solution applied by swab to kill bacteria.
Once the product is dried, sterile surgical drapes are placed over unprepared areas of the body. Separation of sterile from non-sterile areas is key during surgery to ensure a safe procedure and recovery of the patient.
PART 2
Answer questions related to the video and receive a key that you can use to open the vault. Good luck!
