The case study approach


case study journal article

Apr 06,  · How to review a case report. There are some journals dedicated purely to case reports, such as the Journal of Medical Case Reports, emphasizing their importance in modern literature. In the past, isolated case reports have led to significant advancements in patient care. IRBs can waive the need for consent if a study is conducted Cited by: 3. Jul 26,  · Journal articles are articles for publications in journals, generally following a fairly strict format. A case study is generally an examination of a specific "case" in business and can be prepared to inform, but can also be prepared for others to. Journal of Case Studies (formerly Annual Advances in Business Cases) was established by the Society for Case Research ( to provide a continual flow of effective up-to-date cases to promote excellence in case research, writing, and process for publishing in this journal is to email the case and teaching note to [email protected]

Pediatric Sepsis: A Case Study | Article | NursingCenter

Join NursingCenter to get uninterrupted access to this Article. Abdominal pain with vomiting is a common pediatric complaint in the emergency department setting that can lead to a more insidious disease state.

The article depicts a case study of a month-old male child presenting with these signs and symptoms that ultimately resulted in a diagnosis of septic shock. The importance of physical assessment, rapid response to findings with time-constrained empirical interventions, the relevance of pediatric sepsis to the provider, the consideration of access to health care, and a case study journal article approach case study journal article treatment of the patient and the family are highlighted.

The application and explanation of evidence-based guidelines is also depicted in the management of the patient. IN THE emergency department ED environment, abdominal pain and vomiting are some of the most common pediatric complaints. These presentations are the principal complaint of 6.

The differential diagnoses can be expansive with a wide variation of severity of illness and injury. The case study presented herein illustrates the importance of initial assessment, meticulous investigation, case study journal article, rapid empiric treatment, and using evidence-based guidelines for children presenting with sepsis, case study journal article.

The mother stated that she was concerned that her son "had the flu. She indicated that her son vomited green fluid once that morning and was complaining of abdominal pain. The mother explained that she had responsibility for T. It was Saturday morning, case study journal article. The mother reported that she and T. The initial visual assessment, also referred to as the pediatric assessment triangle PATperformed by the triage nurse, case study journal article, quickly determined that this child was unstable.

See Table 1. Once in the treatment room, the mother denied any past medical history or surgical procedures. There were no known complications at birth, the delivery was a normal spontaneous vaginal delivery, and birth occurred at 39 weeks of gestation. The patient was up to date on his required childhood immunizations but had not received a flu vaccination within the last year.

His mother denied alcohol or drug use during pregnancy or currently. She was a single mother, unemployed, uninsured, and a poor historian. She had case study journal article given him anything for the present illness because "it just came on this morning.

Initial vital signs were as follows: Temperature: The immediate general impression of the patient was that he appeared poorly cared for as evidenced by soiled clothes and lack of cleanliness. He was well developed and well nourished but, case study journal article, more importantly, appeared toxic as evidenced by his poor response to interaction and listlessness.

Upon further examination, the patient's skin was dry, dusky, and appeared ashen. His face was symmetrical, the anterior fontanel was soft and sunken, and the posterior fontanel was closed. The head was normocephalic without deformity, the neck was supple, the trachea was midline, and no cervical lymphadenopathy or thyromegaly was palpated.

He was unable to follow objects with his gaze, and his pupils were dilated with sluggish response to light. He did not produce tears, even when agitated. The nares were crusted and inflamed, the nasal airway was patent, and his oral mucosa was dry with cracked lips. The neck was supple with a full range of motion and no meningismus or nuchal rigidity. Lung sounds were clear and equal bilaterally, and no respiratory distress was noted. The patient's pulse was rapid, regular, case study journal article, and symmetrical when centrally palpated in the femoral region.

The heart tones were normal with no murmurs or gallops. There was no cyanosis, and his capillary refill time was less than 2 s.

The abdomen was distended and rigid with hypoactive case study journal article sounds, case study journal article. There was no bruising or signs of obvious trauma, and the mother could not recall the last bowel movement. Upon palpation, there was involuntary guarding, with no masses or peristaltic movements noted.

Upon inspection of his back, there was no spinal or costovertebral tenderness. His diaper was dry and did not appear to have been changed for some time. The external genitalia were normal, with no rash or hernia noted. The patient moved all four extremities against gravity but not resistance and had a flaccid muscle tone with weak bilateral grasps.

The neurological assessment was limited to observation of a weak cry and minimal response to pain when peripheral intravenous PIV access was obtained. See Table 2. When obtaining vital signs, the triage nurse noticed that the child had not made any verbal sounds and asked the mother whether the child speaks.

The mother stated, "You know, it is the weirdest thing Upon completing the triage information, T. The physical examination was completed by the primary ED nurse while T. A pediatric crash cart was also brought to the treatment room upon recognition of the severity of this child's illness. A pulse oximeter, a heart monitor, and a blood pressure cuff were placed upon disrobing the patient. A gauge PIV catheter was placed in the left antecubital area, blood was drawn for laboratory analysis, and the site was secured with an arm board.

Urinary case study journal article was carried out with 6 ml of urine initially collected. A complete blood cell count, complete metabolic panel, blood type and screen, blood cultures, and a urine toxicology panel to rule out possible drug ingestion as the cause of lethargy and altered mental status were ordered STAT.

Fluid resuscitation with 0. Antibiotic treatment was begun immediately following collection of blood culture specimens. As bacterial meningitis, antibiotic-resistant infection strains, case study journal article, and septicemia were not yet ruled out, ceftriaxone 1.

These antibiotics were used as broad-spectrum, empirical coverage for gram-positive vancomycin and gram-negative ceftriaxone organisms. The results of the laboratory tests began to arrive while empirical treatment was carried out, case study journal article. Results of the urine toxicology panel were negative, and no salicylate or acetaminophen levels were detected.

The complete blood cell count reported a white blood cell count of 4. His hemoglobin was The rapid influenza screen was positive for influenza A. An abdominal computed tomographic CT scan was ordered to evaluate the rigid abdomen with involuntary guarding, a head CT scan was ordered to evaluate the altered mental status and flaccid tone, and a chest radiograph was ordered to rule out pneumonia or other cardiopulmonary causative factors.

The radiologist read the chest radiograph and the head CT scan as normal. The radiologist's impression of the abdominal CT scan was case study journal article distended stomach, with mildly distended multiple segments of small bowel suggestive of small bowel obstruction or ileus and distal esophageal mild dilation and fluid content consistent with vomiting.

All of these results were supportive of a diagnosis of sepsis with leukopenia, neutropenia, and metabolic acidosis with respiratory compensation. The diagnosis of sepsis was not solely based on laboratory findings. Serwint, Dias, Chang, case study journal article, Sharkey, and Walker found that leukopenia or neutropenia alone in the febrile child is not associated with sepsis. Rather, it is the culmination of the clinical judgment, physical findings, and review of the complete blood cell count that identifies significant disease Serwint et al.

Then, abruptly, T. Placement was verified by two confirmatory methods: chest radiograph and positive colorimetric change identified on the end-tidal CO 2 detector immediately following intubation. Atropine 7. A second intravenous fluid bolus was begun ml. Atropine is indicated when the bradycardia is associated with increased vagal tone.

Intubation may also stimulate a vagal response, with atropine recommended as an adjunct during intubation. The resuscitation efforts continued for 4 min until T. A surgeon from a pediatric tertiary care facility was consulted for this critically ill child, case study journal article, because of an abnormal abdominal CT and possible sepsis.

He agreed to accept T. The critical care pediatric transport team arrived within 15 min, case study journal article. A total fluid resuscitation of approximately ml had been delivered at the time of departure. See Figure 1. Differential diagnoses considered at the time of transfer included sepsis of unknown origin, intussusception with obstruction, volvulus, case study journal article, strangulated hernia, appendicitis, trauma, and meningitis.

Although acute abdominal pain in children can be benign in cases such as acute gastroenteritis or mesenteric lymphadenopathy, these were excluded, given the patient's septic presentation. Pediatric patients who present with intractable pain, uncontrolled vomiting, unstable vital signs, altered mental status, and suspicion of an acute abdomen require an emergent surgical consult. The timeliness of consultation and transfer was the result of an established relationship between the community hospital and the pediatric tertiary care facility.

The total time of the patient's length of stay in the ED was approximately 1 hr. Although this is the treatment goal for sepsis, the transportation time to the pediatric tertiary care facility was approximately 17 min. The initiation of empirical treatment of sepsis before transfer was an essential component of this child's care.

This case presented a pediatric patient with possible septic shock. Multiple professional groups have created evidence-based guidelines that are continuously being reviewed and revised on pediatric sepsis. Suspicion of septic shock case study journal article arise from the "triad of inflammation" with a mental status change Brierley et al. The "triad of inflammation" refers to the common signs of benign infection in children: tachycardia, fever, and vasodilation.

Sepsis is added to the differential diagnoses when these signs are coupled with irritability, drowsiness, confusion, poor interaction with caregivers, lethargy, or decreased arousal in the pediatric patient Brierley et al. These can be difficult to detect in the case study journal article patient, but may manifest in a number of behaviors. In this case, the patient had little interaction with caregivers, did not respond to name, was difficult to arouse, and, perhaps most importantly, did not respond appropriately to pain when a PIV catheter was placed.

Clinical diagnosis of sepsis is made when a suspected infection is characterized by hypothermia or hyperthermia, and there are clinical signs of inadequate tissue perfusion.

This requires either temperature or leukocytic abnormality. Once this has been determined, a child must also have cardiovascular dysfunction, acute respiratory distress syndrome ARDSor two or more other organ dysfunctions to be considered in severe sepsis Dellinger et al.


Case studies | Journals | Oxford Academic


case study journal article


Jun 27,  · The case study approach allows in-depth, multi-faceted explorations of complex issues in their real-life settings. The value of the case study approach is well recognised in the fields of business, law and policy, but somewhat less so in health services research. Based on our experiences of Cited by: Abdominal pain with vomiting is a common pediatric complaint in the emergency department setting that can lead to a more insidious disease state. The article depicts a case study of a month-old male child presenting with these signs and symptoms that ultimately resulted in a diagnosis of septic shock. About this journal. Clinical Case Studies (CCS), peer-reviewed & published bi-monthly electronic only, is the only journal devoted entirely to case studies & presents cases involving individual, couples, & family easy-to-follow case presentation format allows you to learn how interesting & challenging cases were assessed & conceptualized, & how treatment followed such.