case study

1. Type 1 Diabetes Mellitus

Case: 14-year-old boy, polyuria, weight loss, fruity breath, BGL 28, ketones +.

  • A–E: Clear airway, Kussmaul breathing, tachycardia, drowsy, fruity odour.

  • Patho: Autoimmune β-cell destruction → no insulin → fat breakdown → ketones → DKA.

  • Nursing: IV fluids, insulin infusion, monitor K+, family education on insulin & sick-day rules.

2. Type 2 Diabetes Mellitus

Case: 55-year-old overweight woman with fatigue, foot ulcer, recurrent infections, HbA1c 9%.

  • A–E: Stable, ulcer noted, sluggish cap refill.

  • Patho: Insulin resistance → hyperglycemia → impaired healing & infection risk.

  • Nursing: Wound care, glycemic control (meds, diet), foot care teaching, podiatry referral.

3. Diabetic Ketoacidosis (DKA)

Case: 22-year-old with T1DM missed insulin, now tachypnoeic, confused, pH 7.1.

  • A–E: Deep rapid breaths, fruity odour, tachycardia, lethargy.

  • Patho: No insulin → fat metabolism → ketones → metabolic acidosis.

  • Nursing: Oxygen, IV fluids, insulin, monitor K+, hourly BGLs.

4. Hyperosmolar Hyperglycemic State (HHS)

Case: 70-year-old T2DM with dehydration, confusion, BGL 45, no ketones.

  • A–E: Confused, dry mucous membranes, weak pulse.

  • Patho: Severe hyperglycemia → osmotic diuresis → dehydration, hyperosmolarity, no ketosis.

  • Nursing: IV fluids (aggressive), insulin infusion, monitor electrolytes & neuro status.

5. Hypoglycemia

Case: 35-year-old insulin-dependent diabetic, sweating, tremors, confused, BGL 2.8.

  • A–E: Tachycardia, sweating, disoriented, risk of collapse.

  • Patho: Excess insulin or insufficient intake → low BGL → brain deprived of glucose.

  • Nursing: Fast-acting carbs if conscious, IV dextrose/IM glucagon if unconscious, recheck BGL.

6. Chronic DM Complications

Case: 65-year-old man with blurred vision, neuropathy, necrotic toe ulcer.

  • A–E: Ulcer noted, reduced pedal pulses, decreased sensation.

  • Patho: Long-term hyperglycemia → microvascular + macrovascular damage.

  • Nursing: Wound care, glycemic control, foot care education, ophthalmology referral.

7. Hyperthyroidism (Graves’)

Case: 30-year-old woman with weight loss, heat intolerance, tremors, HR 120, exophthalmos.

  • A–E: Tachycardic, anxious, sweaty, tremor present.

  • Patho: TSI antibodies stimulate thyroid → ↑T3/T4 → hypermetabolism.

  • Nursing: Antithyroid meds, β-blockers, thyroidectomy prep, education on stress avoidance.

8. Hypothyroidism (Hashimoto’s)

Case: 55-year-old woman with fatigue, weight gain, cold intolerance, bradycardia, dry skin.

  • A–E: Slow HR, pale dry skin, lethargic.

  • Patho: Autoimmune destruction → ↓T3/T4 → hypometabolism.

  • Nursing: Levothyroxine, constipation care, monitor cardiac function.

9. Addison’s Disease

Case: 35-year-old with fatigue, weight loss, hypotension, hyperpigmented skin, Na+ 128, K+ 6.0.

  • A–E: Hypotensive, weak pulses, dark skin patches.

  • Patho: Adrenal insufficiency → ↓cortisol + ↓aldosterone → Na+ loss, K+ retention, hypoglycemia.

  • Nursing: Hydrocortisone replacement, IV fluids, stress dosing education.

10. Cushing’s Syndrome

Case: 45-year-old woman with central obesity, moon face, purple striae, HTN, hyperglycemia.

  • A–E: High BP, truncal obesity, thin skin, striae noted.

  • Patho: ↑Cortisol → protein breakdown, fat redistribution, immunosuppression.

  • Nursing: Monitor for infection, skin care, emotional support, treat underlying cause.

🔹 Female Reproductive Disorders (9)

11. Ovarian Cysts

Case: 28-year-old woman with pelvic pain after exercise, ultrasound shows fluid-filled cyst.

  • Patho: Follicle fails to rupture → fluid accumulation.

  • Nursing: Pain relief, monitor for rupture, education (often self-resolve).

12. PCOS

Case: 25-year-old with irregular periods, hirsutism, acne, infertility.

  • Patho: Insulin resistance + ↑androgens → anovulation + cysts.

  • Nursing: Lifestyle modification, metformin, OCP, education on long-term risks.

13. Ovarian Cancer

Case: 52-year-old with bloating, pelvic pain, early satiety.

  • Patho: Epithelial cell proliferation → late diagnosis.

  • Nursing: Symptom awareness, surgical prep, chemo support.

14. Endometritis

Case: 26-year-old post C-section, fever, pelvic pain, foul discharge.

  • Patho: Infection of endometrium → inflammation.

  • Nursing: Antibiotics, pain relief, monitor for sepsis.

15. Endometriosis

Case: 32-year-old with severe dysmenorrhea, dyspareunia, infertility.

  • Patho: Endometrial tissue outside uterus → cyclical bleeding → scarring.

  • Nursing: NSAIDs, hormonal therapy, surgical referral.

16. Endometrial Hyperplasia

Case: 48-year-old with heavy irregular bleeding, thickened endometrium.

  • Patho: Unopposed estrogen → overgrowth → precancer.

  • Nursing: Progesterone therapy, weight loss education, cancer screening.

17. Endometrial Cancer

Case: 60-year-old postmenopausal woman with vaginal bleeding.

  • Patho: Malignant endometrial cells (often from hyperplasia).

  • Nursing: Education on screening, surgical prep, psychosocial support.

18. Fibroids (Leiomyomas)

Case: 40-year-old woman with heavy menses, pelvic pressure, anemia.

  • Patho: Benign estrogen-dependent smooth muscle tumors.

  • Nursing: Manage anemia, pain control, surgery if severe, fertility counseling.

19. Cervical Cancer

Case: 42-year-old woman with post-coital bleeding, HPV+.

  • Patho: HPV infection → dysplasia → carcinoma.

  • Nursing: Pap smear education, surgical/radiation prep, psychosocial support.

🔹 Breast Disorders (3)

20. Fibroadenoma

Case: 22-year-old with a painless, mobile, firm breast lump.

  • Patho: Benign tumour, estrogen-driven.

  • Nursing: Reassurance, biopsy if suspicious, monitoring.

21. Carcinoma in Situ (CIS)

Case: 45-year-old, mammogram shows suspicious localized lesion.

  • Patho: Malignant cells confined, no spread.

  • Nursing: Education, biopsy, surgery/radiation plan.

22. Invasive Carcinoma

Case: 55-year-old with hard fixed lump, nipple retraction, peau d’orange.

  • Patho: Malignant cells infiltrate breast tissue → possible metastasis.

  • Nursing: Oncology referral, treatment support, emotional care.

🔹 Male Reproductive Disorders (4)

23. BPH

Case: 70-year-old man with nocturia, weak stream, incomplete emptying.

  • Patho: Age-related prostate enlargement → urethral compression.

  • Nursing: Monitor urinary retention, meds (tamsulosin/finasteride), TURP education.

24. Prostate Cancer

Case: 68-year-old with hesitancy, dribbling, hematuria, bone pain.

  • Patho: Malignant prostate tumour (often adenocarcinoma).

  • Nursing: PSA monitoring, biopsy support, surgical/chemo education.

25. Testicular Cancer

Case: 26-year-old with painless testicular mass.

  • Patho: Germ cell tumour, often curable.

  • Nursing: Orchiectomy prep, chemo/radiation support, fertility discussion.

26. Epididymitis

Case: 30-year-old with painful swollen scrotum, dysuria, STI history.

  • Patho: Infection of epididymis (STI or bacterial).

  • Nursing: Antibiotics, scrotal support, partner STI treatment, analgesia.

🔹 Sensory Disorders (7)

27. Cataracts

Case: 72-year-old with blurred vision, glare, cloudy lens.

  • Patho: Protein breakdown → lens opacity.

  • Nursing: Surgery prep, post-op care education, fall prevention.

28. Open-Angle Glaucoma

Case: 65-year-old with gradual peripheral vision loss, halos.

  • Patho: Blocked outflow → ↑ IOP → optic nerve damage.

  • Nursing: Eye drops adherence, lifelong follow-up, safety teaching.

29. Angle-Closure Glaucoma

Case: 58-year-old with sudden severe eye pain, N/V, fixed pupil.

  • Patho: Sudden blocked drainage → ↑ IOP → optic nerve ischemia.

  • Nursing: Emergency referral, IV mannitol/acetazolamide, surgical prep.

30. Macular Degeneration (AMD)

Case: 70-year-old with central vision loss, distorted lines.

  • Patho: Macula degeneration (dry = drusen, wet = neovascular).

  • Nursing: AREDS vitamins, laser/anti-VEGF for wet, vision aids.

31. Diabetic Retinopathy

Case: 62-year-old diabetic with floaters, vision loss, retinal hemorrhages.

  • Patho: Hyperglycemia damages retinal vessels.

  • Nursing: Glycemic control, laser therapy referral, annual eye exams.

32. Otitis Media

Case: 6-year-old with fever, ear pain, red bulging eardrum.

  • Patho: Bacterial/viral infection of middle ear.

  • Nursing: Antibiotics (if bacterial), analgesia, warm compresses, teaching.

33. Meniere’s Disease

Case: 45-year-old man with recurrent vertigo, tinnitus, hearing loss.

  • Patho: Excess endolymph → pressure imbalance → vertigo.

  • Nursing: Low-salt diet, diuretics, antivertigo meds, safety teaching.