Topic 1—Preparing to understand our patients
Each piece of information tells you about the patient, their pathophysiology and the pharmacology used to manage this case. By using the signs and symptoms we begin a process of elimination and confirmation.
Case studies are mainly not straightforward ‘textbook’ answers. Sometimes we have to ask lots of questions and explore each fact before we really understand the case.
Understanding pathophysiology and pharmacology can be simple by using the following 10 steps:
1. Underline/identify key words.
2. Define the disease or condition. Do you understand these terms? If you don’t understand, begin reading around these terms. You may also need to look at or revise your old anatomy and physiology notes to really understand how ‘normal’ bodies work before you can explore your patient in the case study.
3. List the common signs and symptoms associated with the disease or condition. Again if you are unsure look them up in a text book. Can you explain why each of these signs and symptoms manifest?
4. List the signs and symptoms your patient in the case study has presented with. Ask yourself do these signs and symptoms match those listed in the text book?
5. Are there signs and symptoms that don’t match or don’t make sense? What are some possible reasons for this (we could call this an hypothesis)? Begin exploring and eliminating possible reasons based on further reading.
6. Now ask yourself: are there any reasons this case could be complicated? Is it the condition/disease, the patient’s management of the condition, are there investigations missing or does the patient have other co-morbidities?
7. How would you investigate this case study? What might a doctor order to better understand this case study, e.g. blood tests or x-rays?
8. How is this condition treated/managed?
9. What pharmacotherapy is used to manage the disease/signs/symptoms?
10. When looking at pharmacotherapy: look at mode of action, therapeutic use, pharmacokinetics, side effects, drug interactions and nursing considerations.

Often on clinical you see a more simplified example of this 10 step process called ISBAR. ISBAR (or introduction, situation, background, assessment and recommendations) is a tool or framework that can be used to assist health professionals to communicate critical information to each other. As you explore the case study ask yourself the following questions:
• What is the situation at the moment with this case study?
• What is the background to this condition(s)?
• What is your assessment of the situation or the patient?
• What action do you recommend now (to make a recommendation you need to have a hunch, a hypothesis or a nursing diagnosis).
• Use the 10 steps or ISBAR to assist unpacking the many aspects of each case study. The more you do this the quicker, easier and more detailed your analysis of the case study will be. This is good news for your assignment.
Topic 2—Renal failure and diabetes
1. List the differences between acute and chronic renal failure.
2. List the signs and symptoms of diabetes type 2.
3. Outline focal points of connections of renal functions and the complexity of diabetes type 2.
Patient case study