CHAPTER 23

CASE STUDY 1: VITAL SIGNS ASSESSMENT IN AN ELDERLY PATIENT 

Scenario:
Mrs. Kemi, a 70-year-old woman, arrives at the clinic feeling weak and dizzy. You are assigned to check her vital signs. Her blood pressure is 90/60 mmHg, her temperature is 36.2°C, and her pulse is 50 bpm. 

Questions and Answer Spaces: 

1. What are the normal ranges for vital signs?
   Answer:___________________________________________________ 

2. What do the findings suggest in this case?
   Answer:___________________________________________________ 

3. What could be possible causes of low blood pressure in an elderly patient?
   Answer:___________________________________________________ 

4. What actions should you take next as an auxiliary nurse?
   Answer:___________________________________________________ 

5. When should you report to the nurse or doctor?
   Answer:___________________________________________________ 

✅ Case Study 2: A Young Girl with Malaria Symptoms 

Scenario:
Fatima, a 10-year-old girl, is brought in by her father. She has high fever, chills, vomiting, and complains of joint pain. She lives in an area known for malaria. 

Questions and Answer Spaces: 

1. What are the signs and symptoms of malaria?
   Answer:___________________________________________________ 

2. How is malaria transmitted?
   Answer:___________________________________________________ 

3. What immediate care should you provide?
   Answer:___________________________________________________ 

4. What prevention measures can be discussed with the father?
   Answer:___________________________________________________ 

5. When should the patient be referred for testing or further treatment?
   Answer:___________________________________________________ 

✅ Case Study 3: Suspected Typhoid Fever in a Teenager 

Scenario:
James, a 17-year-old boy, visits the health post with complaints of persistent fever, abdominal pain, weakness, and poor appetite. He admits to drinking untreated water from a stream. 

Questions and Answer Spaces: 

1. What are common signs and symptoms of typhoid fever?
   Answer:___________________________________________________ 

2. What are the risk factors for typhoid?
   Answer:___________________________________________________ 

3. What should be your first steps in caring for James?
   Answer:___________________________________________________ 

4. What health advice would you give James and his family?
   Answer:___________________________________________________ 

5. When should you escalate care to a higher facility?
   Answer:___________________________________________________ 

✅ Case Study 4: Pregnant Woman with Suspected Miscarriage 

Scenario:
Mrs. Amina, a 32-year-old woman, comes in with lower abdominal pain and vaginal bleeding. She says she is 10 weeks pregnant and has experienced no trauma. She looks worried and pale. 

Questions and Answer Spaces: 

1. What could be the possible causes of bleeding in early pregnancy?
   Answer:___________________________________________________ 

2. What signs may indicate a miscarriage?
   Answer:___________________________________________________ 

3. What immediate actions should you take as an auxiliary nurse?
   Answer:___________________________________________________ 

4. What advice should be given to the patient?
   Answer:___________________________________________________ 

5. What information should be recorded before referring?
   Answer:___________________________________________________ 

✅ Case Study 5: First Aid for Road Traffic Accident Victim 

Scenario:
A motorcyclist is brought into the clinic after a road traffic accident. He is bleeding from a cut on his forehead, his arm is swollen, and he appears to be in pain. He is conscious but confused. 

Questions and Answer Spaces: 

1. What are the first steps in handling a trauma victim?
   Answer:___________________________________________________ 

2. How do you control external bleeding?
   Answer:___________________________________________________ 

3. What are signs of possible fracture?
   Answer:___________________________________________________ 

4. What precautions should be taken during first aid?
   Answer:___________________________________________________ 

5. What information is important when referring this patient?
   Answer:___________________________________________________ 

✅ Case Study 6: Fever and Rash in a Child 

Scenario:
A 6-year-old child, Musa, presents to the clinic with a high fever, red spots on his skin, and swollen lymph nodes. He has not been vaccinated against measles and was recently in contact with other children in the neighborhood who were sick. 

Questions and Answer Spaces: 

1. What are the common causes of fever and rash in children?
   Answer:___________________________________________________ 

2. What are the key signs of measles?
   Answer:___________________________________________________ 

3. What are the complications associated with measles?
   Answer:___________________________________________________ 

4. What immediate actions should you take as an auxiliary nurse?
   Answer:___________________________________________________ 

5. What prevention measures should be discussed with the family?
   Answer:___________________________________________________ 

✅ Case Study 7: Suspected Appendicitis in a Young Adult 

Scenario:
A 20-year-old male, Tunde, comes to the clinic with sharp pain in his lower right abdomen. The pain started mildly but has become more intense over the past 6 hours. He is feeling nauseous and has not eaten since the pain started. 

Questions and Answer Spaces: 

1. What are the typical symptoms of appendicitis?
   Answer:___________________________________________________ 

2. How should you assess the patient for appendicitis?
   Answer:___________________________________________________ 

3. What are the common complications of untreated appendicitis?
   Answer:___________________________________________________ 

4. What steps should you take to manage this patient?
   Answer:___________________________________________________ 

5. When should you escalate to a healthcare professional for further management?
   Answer:___________________________________________________ 

✅ Case Study 8: Asthma Attack in a 15-Year-Old 

Scenario:
A 15-year-old girl, Chidinma, is brought in by her mother after experiencing difficulty breathing, wheezing, and tightness in her chest. Chidinma has a history of asthma but has not used her inhaler for a few days. 

Questions and Answer Spaces: 

1. What are the signs of an asthma attack?
   Answer:___________________________________________________ 

2. How should you manage Chidinma during an asthma attack?
   Answer:___________________________________________________ 

3. What advice should be given to Chidinma and her mother about asthma management?
   Answer:___________________________________________________ 

4. What are the common triggers for asthma attacks?
   Answer:___________________________________________________ 

5. When should Chidinma be referred to the hospital?
   Answer:___________________________________________________ 

✅ Case Study 9: Dehydration in an Elderly Patient 

Scenario:
Mr. Johnson, a 75-year-old male, presents with dry mouth, sunken eyes, and confusion. He has not been drinking enough water, especially after a bout of diarrhea that lasted for two days. 

Questions and Answer Spaces: 

1. What are the signs of dehydration in elderly patients?
   Answer:___________________________________________________ 

2. What are the potential complications of dehydration?
   Answer:___________________________________________________ 

3. What initial treatment should you provide for Mr. Johnson?
   Answer:___________________________________________________ 

4. How can dehydration be prevented in elderly patients?
   Answer:___________________________________________________ 

5. When should Mr. Johnson be referred for further medical attention?
   Answer:___________________________________________________ 

✅ Case Study 10: Sepsis in a Post-Operative Patient 

Scenario:
A 40-year-old woman, Mrs. Olufunke, is recovering after an appendectomy. She develops a fever, increased heart rate, and a wound that appears red, swollen, and has foul-smelling discharge. She also complains of feeling very weak. 

Questions and Answer Spaces: 

1. What are the signs and symptoms of sepsis?
   Answer:___________________________________________________ 

2. What are the common causes of sepsis in post-operative patients?
   Answer:___________________________________________________ 

3. What immediate actions should be taken to manage sepsis?
   Answer:___________________________________________________ 

4. How can sepsis be prevented in post-operative patients?
   Answer:___________________________________________________ 

5. When should the patient be referred to the hospital for further treatment?
   Answer:___________________________________________________ 

✅ Case Study 11: Anemia in a 25-Year-Old Woman 

Scenario:
Mary, a 25-year-old woman, complains of feeling fatigued, dizzy, and pale. She has a history of heavy menstrual periods and has been experiencing weakness for the past two weeks. 

Questions and Answer Spaces: 

1. What are the signs and symptoms of anemia?
   Answer:___________________________________________________ 

2. What are the common causes of anemia in women?
   Answer:___________________________________________________ 

3. What immediate steps should you take in caring for Mary?
   Answer:___________________________________________________ 

4. What tests can be recommended to confirm anemia?
   Answer:___________________________________________________ 

5. What dietary advice should be given to prevent iron-deficiency anemia?
   Answer:___________________________________________________ 

 ✅ Case Study 12: Diabetic Ketoacidosis (DKA) in a Diabetic Patient 

Scenario:
John, a 35-year-old male with type 1 diabetes, presents to the clinic with nausea, vomiting, excessive thirst, and confusion. His blood sugar is elevated at 350 mg/dL. He has not been taking his insulin regularly. 

Questions and Answer Spaces: 

1. What is diabetic ketoacidosis (DKA), and how does it develop?
   Answer:___________________________________________________ 

2. What are the key symptoms and signs of DKA?
   Answer:___________________________________________________ 

3. What immediate treatment should be provided for John?
   Answer:___________________________________________________ 

4. What is the role of insulin in managing DKA?
   Answer:___________________________________________________ 

5. When should John be referred to the hospital for further treatment?
   Answer:___________________________________________________ 

✅ Case Study 13: Stroke in a Middle-Aged Man 

Scenario:
Mr. Emmanuel, a 50-year-old man, arrives at the clinic after suddenly feeling weakness on his right side and slurring his speech. He is conscious but appears confused and unable to move his right arm and leg. 

Questions and Answer Spaces: 

1. What are the common signs and symptoms of a stroke?
   Answer:___________________________________________________ 

2. What are the primary causes of stroke?
   Answer:___________________________________________________ 

3. How should you manage this patient while awaiting emergency help?
   Answer:___________________________________________________ 

4. What should be recorded and communicated when referring this patient to the hospital?
   Answer:___________________________________________________ 

5. What preventive measures can be discussed to reduce the risk of stroke?
   Answer:___________________________________________________ 

✅ Case Study 14: A 6-Month-Old Baby with Respiratory Distress 

Scenario:
Olumide, a 6-month-old baby, is brought in by his mother after showing signs of difficulty breathing, coughing, and wheezing. His skin appears slightly bluish around the lips, and his breathing is rapid. 

Questions and Answer Spaces: 

1. What are the signs of respiratory distress in infants?
   Answer:___________________________________________________ 

2. What is the likely cause of these symptoms in an infant?
   Answer:___________________________________________________ 

3. What immediate actions should be taken to help the infant?
   Answer:___________________________________________________ 

4. What are the potential complications of respiratory distress in infants?
   Answer:___________________________________________________ 

5. When should the infant be referred to a hospital for further care?
   Answer:___________________________________________________ 

✅ Case Study 15: Gastroenteritis in a 4-Year-Old 

Scenario:
Sarah, a 4-year-old child, has been vomiting and experiencing diarrhea for the past 24 hours. She looks lethargic, and her mother is concerned about her dehydration. Sarah also complains of stomach cramps. 

Questions and Answer Spaces: 

1. What are the main causes of gastroenteritis in children?
   Answer:___________________________________________________ 

2. What signs and symptoms should you look out for in dehydrated children?
   Answer:___________________________________________________ 

3. What measures can be taken to prevent dehydration in this case?
   Answer:___________________________________________________ 

4. What should be the immediate care plan for Sarah?
   Answer:___________________________________________________ 

5. When should Sarah be referred to a hospital for further treatment?
   Answer:___________________________________________________ 

✅ Case Study 16: Urinary Tract Infection (UTI) in a Female Patient 

Scenario:
A 29-year-old woman, Halima, visits the clinic complaining of burning sensation while urinating, lower abdominal discomfort, and frequent urge to urinate. Her urine appears cloudy with a strong odor. 

Questions and Answer Spaces: 

1. What are the common symptoms of a urinary tract infection (UTI)?
   Answer:___________________________________________________ 

2. What are the possible causes of UTI in women?
   Answer:___________________________________________________ 

3. What immediate steps can be taken to manage this case?
   Answer:___________________________________________________ 

4. What preventive advice should be given to Halima?
   Answer:___________________________________________________ 

5. When should a UTI be referred for further investigation or specialist care?
   Answer:___________________________________________________ 

✅ Case Study 17: Snake Bite in a Rural Setting 

Scenario:
A 40-year-old farmer, Mr. Yakubu, was bitten on the foot while working on his farm. He reports pain, swelling, and discoloration at the site. He is sweating and complains of dizziness and blurred vision. 

Questions and Answer Spaces: 

1. What are the first aid steps for managing a snake bite?
   Answer:___________________________________________________ 

2. What symptoms suggest that the bite may be from a venomous snake?
   Answer:___________________________________________________ 

3. What should you avoid doing after a snake bite?
   Answer:___________________________________________________ 

4. What is the role of antivenom, and when should it be administered?
   Answer:___________________________________________________ 

5. What should you do while preparing the patient for referral?
   Answer:___________________________________________________ 

✅ Case Study 18: Convulsion in a Child 

Scenario:
Chidera, a 3-year-old child, suddenly starts jerking her arms and legs, rolls her eyes, and becomes unconscious for a few seconds. This happens at home after she developed a high fever. 

Questions and Answer Spaces: 

1. What is a febrile convulsion?
   Answer:___________________________________________________ 

2. What steps should you take immediately during a convulsion?
   Answer:___________________________________________________ 

3. What should be done after the convulsion stops?
   Answer:___________________________________________________ 

4. What causes febrile convulsions in children?
   Answer:___________________________________________________ 

5. How can future convulsions be prevented?
   Answer:___________________________________________________ 

✅ Case Study 19: Postpartum Hemorrhage (PPH) 

Scenario:
A 28-year-old woman, Amaka, has just delivered her baby. About 30 minutes after delivery, she begins to bleed heavily. She is becoming weak and pale. Her blood pressure is dropping, and she appears anxious. 

Questions and Answer Spaces: 

1. What are the causes of postpartum hemorrhage (PPH)?
   Answer:___________________________________________________ 

2. What are the signs that a woman is experiencing PPH?
   Answer:___________________________________________________ 

3. What immediate actions should you take?
   Answer:___________________________________________________ 

4. How can PPH be prevented during delivery?
   Answer:___________________________________________________ 

5. When should the woman be referred urgently?
   Answer:___________________________________________________ 

✅ Case Study 20: Mental Health - Depression in a Teenager 

Scenario:
Blessing, a 17-year-old girl, has been withdrawn from her friends and family for several weeks. She sleeps excessively, has lost interest in school, and often says she feels hopeless. Her teacher reports that she no longer participates in class. 

Questions and Answer Spaces: 

1. What are the signs and symptoms of depression in teenagers?
   Answer:___________________________________________________ 

2. What are possible causes of depression in this age group?
   Answer:___________________________________________________ 

3. How should an auxiliary nurse approach and support a teenager showing signs of depression?
   Answer:___________________________________________________ 

4. What actions should be taken if a teenager expresses suicidal thoughts?
   Answer:___________________________________________________ 

5. What resources can be recommended to the family and school for support?
   Answer:___________________________________________________ 

✅ Case Study 21: High Fever in an Infant 

Scenario:
Samuel, an 11-month-old baby, is brought in with a temperature of 39.5°C. He is irritable, cries constantly, and refuses to feed. His mother says the fever started suddenly and has not responded to paracetamol. 

Questions and Answer Spaces: 

1. What could be the possible causes of high fever in infants?
   Answer:___________________________________________________ 

2. What danger signs should you look for in this case?
   Answer:___________________________________________________ 

3. What should be your immediate actions to manage the fever?
   Answer:___________________________________________________ 

4. When is it necessary to refer a child with fever to the hospital?
   Answer:___________________________________________________ 

5. What can parents do at home to manage fever safely?
   Answer:___________________________________________________ 

✅ Case Study 22: Labour Complications – Prolonged Labour 

Scenario:
A 32-year-old pregnant woman has been in labour for over 18 hours. Contractions are now irregular and weak. She is exhausted, and the fetal heart rate has dropped. 

Questions and Answer Spaces: 

1. What are the dangers of prolonged labour for the mother and baby?
   Answer:___________________________________________________ 

2. What are some possible causes of prolonged labour?
   Answer:___________________________________________________ 

3. What immediate steps should be taken while waiting for the doctor?
   Answer:___________________________________________________ 

4. How can auxiliary nurses support women during labour?
   Answer:___________________________________________________ 

5. Why is it important to monitor fetal heart rate closely?
   Answer:___________________________________________________ 

✅ Case Study 23: Dehydration Due to Diarrhea 

Scenario:
Tosin, a 6-year-old boy, has had watery stools for three days. He is lethargic, has dry lips, sunken eyes, and a rapid pulse. His mother says he hasn’t eaten or drunk much. 

Questions and Answer Spaces: 

1. What are the signs of severe dehydration in children?
   Answer:___________________________________________________ 

2. What are the common causes of diarrhea in children?
   Answer:___________________________________________________ 

3. What is the best initial treatment for dehydration?
   Answer:___________________________________________________ 

4. How can Oral Rehydration Solution (ORS) be prepared and given?
   Answer:___________________________________________________ 

5. When should a dehydrated child be urgently referred?
   Answer:___________________________________________________ 

✅ Case Study 24: Burn Injury in a Child 

Scenario:
A 3-year-old girl accidentally pulls a hot pot of water on herself. She suffers burns on her left arm and chest. The skin appears red and blistered. She is crying uncontrollably. 

Questions and Answer Spaces: 

1. What type of burn injury is described in this scenario?
   Answer:___________________________________________________ 

2. What are the immediate first aid steps for burns?
   Answer:___________________________________________________ 

3. What should not be applied to burns at home?
   Answer:___________________________________________________ 

4. When should this child be referred to a hospital?
   Answer:___________________________________________________ 

5. What advice can be given to prevent burn injuries in children?
   Answer:___________________________________________________ 

✅ Case Study 25: Miscarriage in Early Pregnancy 

Scenario:
Fatima, a 24-year-old woman who is 8 weeks pregnant, presents with lower abdominal pain and heavy bleeding. She says she passed some clots and is feeling dizzy and weak. 

Questions and Answer Spaces: 

1. What are the signs and symptoms of a miscarriage?
   Answer:___________________________________________________ 

2. What should be done immediately when a woman presents with these symptoms?
   Answer:___________________________________________________ 

3. What are the potential causes of early pregnancy loss?
   Answer:___________________________________________________ 

4. What should you monitor closely in this patient?
   Answer:___________________________________________________ 

5. What emotional support should be offered to the woman?
   Answer:___________________________________________________ 

✅ Case Study 26: Appendicitis in a Teenager 

Scenario:
A 16-year-old boy, Joseph, comes to the clinic with severe pain in the lower right side of his abdomen. He says the pain started around his navel and moved to the right. He also has nausea, vomiting, and a mild fever. 

Questions and Answer Spaces: 

1. What are the classic symptoms of appendicitis?
   Answer:___________________________________________________ 

2. Why is early diagnosis and treatment important?
   Answer:___________________________________________________ 

3. What should you avoid giving a suspected appendicitis patient?
   Answer:___________________________________________________ 

4. How should this patient be managed before referral?
   Answer:___________________________________________________ 

5. What complications can arise if appendicitis is untreated?
   Answer:___________________________________________________ 

✅ Case Study 27: D&C After Incomplete Miscarriage 

Scenario:
A 30-year-old woman was admitted with retained products of conception following an incomplete miscarriage at 10 weeks. She complains of heavy vaginal bleeding and abdominal cramps. She has been scheduled for a dilation and curettage (D&C). 

Questions and Answer Spaces: 

1. What is a D&C and when is it indicated?
   Answer:___________________________________________________ 

2. What are the risks of delaying D&C in this situation?
   Answer:___________________________________________________ 

3. What are the signs that indicate a complication post-procedure?
   Answer:___________________________________________________ 

4. What emotional support should be offered to the patient?
   Answer:___________________________________________________ 

5. What advice should be given on recovery and prevention of infection?
   Answer:___________________________________________________ 

✅ Case Study 28: Abdominal Pain – Pelvic Inflammatory Disease 

Scenario:
Zainab, a 25-year-old woman, reports lower abdominal pain, fever, and foul-smelling vaginal discharge. She also complains of pain during urination and intercourse. Her menstrual cycle has also become irregular. 

Questions and Answer Spaces: 

1. What is Pelvic Inflammatory Disease (PID)?
   Answer:___________________________________________________ 

2. What are common causes and risk factors for PID?
   Answer:___________________________________________________ 

3. What are key signs and symptoms to assess?
   Answer:___________________________________________________ 

4. What is the primary treatment for PID?
   Answer:___________________________________________________ 

5. How can PID be prevented?
   Answer:___________________________________________________ 

✅ Case Study 30: Insomnia and Anxiety in an Elderly Patient 

Scenario:
Mr. Musa, a 68-year-old man, complains of difficulty sleeping, restlessness at night, and loss of appetite. He says he worries constantly and cannot concentrate. He recently lost his wife and has been isolated at home. 

Questions and Answer Spaces: 

1. What are the possible causes of insomnia in the elderly?
   Answer:___________________________________________________ 

2. What factors may contribute to anxiety in older adults?
   Answer:___________________________________________________ 

3. What simple strategies can help improve sleep?
   Answer:___________________________________________________ 

4. When should this patient be referred for psychological support?
   Answer:___________________________________________________ 

5. What non-drug options can help reduce anxiety?
   Answer:___________________________________________________