Purpose 

Problem-based learning is a methodology designed to help students develop the reasoning process used in clinical practice through problem solving actual patient problems in the same manner as they occur in practice.  The purpose of this activity is to develop students’ clinical reasoning skills using a case-based learning exercise. Through participation in an online discussion forum, students identify learning issues in a self-directed manner which facilitates learning for the entire group. 

Activity Learning Outcomes 

Through this discussion, the student will demonstrate the ability to:

1. Synthesize clinical knowledge, didactic learning and research findings to provide appropriate primary care to patients with common acute and stable chronic conditions. (WO6.1) (CO 1, 2, 4 & 5) 

Due Date:  

Student enters initial post to part one by 11:59 p.m. MT on THURSDAY; responds substantively to at least one topic-related post of a peer including evidence from appropriate sources AND all direct faculty questions in parts one by Sunday, 11:59 p.m. MT. 

 A 10% late penalty will be imposed for discussions posted after the deadline on THURSDAY 11:59pm MT, regardless of the number of days late. NOTHING will be accepted after 11:59pm MT on Sunday (i.e. student will receive an automatic 0). Week 8 discussion closes on Saturday at 11:59pm MT. 

Total Points Possible:  50 

Requirements:

1. What is your primary (one) diagnosis for this patient at this time? (support the decision for your diagnosis with pertinent positives and negatives from the case)
2. Identify the corresponding ICD-10 code.
3. Provide a treatment plan for this patient’s primary diagnosis which includes:
   • Medication*
   • Any additional testing necessary for this particular diagnosis*
   • Patient education
   • Referral
4. Provide an active problem list for this patient based on the information given in the case.
5. Are there any changes that you would also make to this patient’s overall treatment plan at this time? Must provide an EBM argument for each treatment or testing decision.
6. Provide an appropriate F/U plan. 

*If part of the plan does not warrant an action, you must explain why. ALL medication and testing decisions (or decisions not to treat with medication or additional testing) MUST be supported with an evidence-based medicine (EBM) argument. Over-the-counter (OTC) and RXs must be written in full as if handing a script to the patient in the office. 

 

Case Study

Now, assume that you sent your patient for labs and she returns the following day, as instructed, to review the results.

CBC with differential

TSH with Reflex to FT4

PHQ-9 Depression Score=10 (previous was 5 at last visit 6 months ago)

 

**To see view the grading criteria/rubric, please click on the 3 dots in the box at the end of the solid gray bar above the discussion board title and then Show Rubric.

DISCUSSION CONTENT  Category  Points  %  Description  Application of Course Knowledge  15  30%  Student chooses one appropriate diagnosis for the patient; AND  Diagnosis is supported with strong pertinent positive and negative subjective and objective data from parts 1 & 2; AND  The ICD code for the diagnosis is correct; AND  Treatment plan for primary diagnosis includes medication, additional testing, patient education, and referral; AND  Prescription and OTC medications are written appropriately as a RX and all components are correct; AND   Treatment decisions (medication, additional testing, referrals) are supported with appropriate EBM arguments; AND   An accurate problem list is presented based on case information; AND   Student discusses changes (or not) to the overall treatment plan for the patient for pertinent issues; AND   An appropriate F/U plan is provided  (9 critical elements)  Support from Evidence-Based Practice (EBP)  15  30%  Discussion post is supported with appropriate, scholarly sources AND  Sources are published within the last 5 years (unless the most current CPG is used) AND  A reference list is provided with in-text citations that match AND  All treatment and testing decisions are fully supported with an appropriate EBM argument  (4 critical elements)  Interactive Dialogue  10  20%  Student provides a substantive* response to at least one topic-related post of a peer AND  Includes evidence from appropriate scholarly sources AND  Provides a reference list which match in-text citations AND  Student responds to all direct faculty questions  (4 critical elements)        Total CONTENT Points= 40 pts  DISCUSSION FORMAT  Category  Points  %  Description  Organization  5  10%  Case study response is presented in a logical format, AND  Responses are in sequence with the numbered questions AND  The case study response is understandable and easy to follow AND  All responses are relevant to the case topic  (4 critical elements)  Grammar, Syntax, Spelling & Punctuation  5  10%  Discussion post has minimal grammar, syntax, spelling, punctuation, or APA format errors*          Total FORMAT Points= 10 pts        DISCUSSION TOTAL= 50 pts

 

 

 

Solution

Week 6 Clinical Case Study Part Two Discussion

• Diagnosis

My primary diagnosis for this patient based on the HPI, physical exam, and diagnostic testing

results will be primary hypothyroidism. The patient presented with common signs and symptoms

of hypothyroidism which include, fatigue, generalized weakness, depression, constipation, cold

intolerance, coarse or dry hair, dry skin, weight gain, muscle cramps, and thickened nails (Dubbs

& Spangler, 2014). In addition, the patient also has an elevated TSH level of 6.770 and a T4 of

0.62, which are indicative of hypothyroidism with a confirmation made on TSH with values

greater than 4.0 (Epocrates, 2019). T4 is used in determining whether a patient has either primary

or secondary hypothyroidism. The patient has an elevated TSH and a low free T4, which confirm

the primary hypothyroidism in the patient (Epocrates, 2019).…………………please follow the link below to purchase the solution at $5

 

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