How to Write a Case Study

How to Write a Case Study

Case studies are important teaching and learning tools in colleges and universities. They provide real-life examples that can help students know how to apply the information taught in class. In addition, case studies can help students to organize their thoughts and learn how to deal with some of the problems that they are likely to experience in real-life settings. Therefore, they are considered to be important tools that educators can use to help students to become effective decision-makers and problem solvers. Case studies usually present facts regarding a given issue, organization, problem, event, or experience. The students are then asked to analyze the case and focus on the most important facts. In addition, they are supposed to carefully examine the issues raised and find ways of solving any problem that may arise. The process entails looking at different alternatives and making a decision on the best course of action.

How to Write a Case Study

As a student, you need to know that case studies are not just about summarizing a case. Instead, it should revolve around identifying the key issues, outlining alternatives, assessing the possible actions, and making the most appropriate conclusions. Therefore, case studies should be approached and addressed systematically.  As a student, there are five major points that you should think about when analyzing a case study. First, you need to understand the most critical issues in the case. Next, highlight the issues and how they affect different stakeholders. The next step is to identify the alternative course of action that is relevant to the next. The fourth point is to evaluate the course of action. Finally, draw a conclusion based on the analysis that you have done. The conclusion should relate to the facts of the case and the issues that are being addressed.

Sample Case Study

Primary Diagnosis and ICD-10 Code:

Primary Diagnosis

Lt. Colonel Brenda James is suffering from acute cholecystitis. Acute cholecystitis refers to a clinical syndrome characterized by gallbladder wall inflammation, which causes right-upper-quadrant (RUQ) abdominal pain, nausea, vomiting, fever, and leukocytosis (Jones et al., 2020). Abdominal pain remains the most common or predominant sign of acute cholecystitis. Typically, this pain can be described as sharp, crampy, excruciating, and tends to last for several hours. Additionally, RUQ pain in acute cholecystitis patients either occurs in the right side or the middle of the upper abdomen, but spreads to the right shoulder as in the case of Miss James. Other symptoms of the condition that the patient presents include: light or clay-colored stool, pain that exacerbates with fatty foods or after meals, chills, and weight loss (Ahmed, 2018). Equally important, Miss James is in her late 40’s, the age that serves as one of the risk factors for acute cholecystitis.

Differentials  

Wide-ranging conditions can cause RUQ, which means it is not unusual for patients and healthcare professionals (HCPs) to confuse acute cholecystitis with other illnesses. In particular, the diseases in question include: cardiac disease, peptic ulcer disease, acute appendicitis, acute cholangitis, as well as irritable bowel disease (Hafiz et al., 2017). In this context, three of these conditions have been chosen as the differential diagnoses for acute cholecystitis because they mimic gallbladder disease: appendicitis, acute cholangitis, and peptic ulcer disease (Jones et al., 2020).

Appendicitis. Acute appendicitis is a condition that involves the inflammation or swelling of the cystic duct. The swollen appendix looks like a finger-shaped pouch, projecting from the large intestine, especially on the lower right side of the abdomen (Cartwright & Knudson, 2015). Appendicitis pain becomes severe with the worsening of the inflammation. Unlike acute cholecystitis that radiates the right shoulder and occurs in the upper right side of the abdomen, appendicitis tends to cause pain on the patient’s lower right side of the abdomen. Moreover, appendicitis is common in children and youth aged between 10 and 30 years.

Acute cholangitis. A clinical syndrome that is associated with bacterial infection, as well as stasis, in the biliary tract, accompanied by abdominal pain, fever, whitening and yellowing of the eyes and skin, respectively. The condition results from the blockage of the bile duct by gallstones (Ahmed, 2018). Unlike acute cholecystitis, the leading predisposing factor for acute cholangitis is biliary obstruction.

Peptic ulcer disease. The condition involves the formation of wounds or ulcers either in the patient’s duodenal or gastric mucosa. In most cases, the main causes of peptic ulcer disease include Helicobacter pylori and excessive use of NSAID (Grans et al., 2015). The major symptoms of the condition include fever, a burning or excruciating epigastic pain. While the alleviation of duodenal ulcer pain occurs with food intake, gastric ulcers are exacerbated with eating (Grans et al., 2015). Other predisposing factors for peptic ulcer disease include: excessive alcohol consumption, smoking, and prolonged intubation. Although Miss James has presented with episodes of heartburn that is a key symptom of peptic ulcer disease, the condition has been ruled out because antacids have proved ineffective in alleviating the pain. Additionally, her stools are light-colored, not black or tarry as in the case of people with peptic ulcer disease.

Procedural Codes

The procedural code of cholecystitis is K81. In this context, the patient is suffering from acute cholecystitis, which is represented by the ICD-10-CM Code of K81.0. Other procedural codes for different types of cholecystitis may not be applicable here, but it is prudent to list them: K81.1, K81.2, and K81.9 for chronic cholecystitis, acute cholecystitis with chronic cholecystitis, and unspecified cholecystitis, respectively.

Additional Laboratory and Diagnostic Tests

Additional lab tests would include the following:

Abdominal ultrasounds: an imaging tests that creates the image on the target organ, appendix.

Hepatobiliary scintigraphy: works by creating images of upper portion of bile ducts, small intestine, gallbladder, as well as liver.

Cholangiography: involves the use of dye in the bile ducts as a way of showing both the bile ducts and the gallbladder.

CT scans: used to create and show images of the target internal organs.

Complete blood count (CBC) test

Liver function test (LFT).

Consults

A number of healthcare specialists would be involved in the management of Miss James’ condition: the cardiologist, the preoperative nurse, surgeon, and pharmacist. In particular, the cardiologist helps with the evaluation of comorbid factors, while the preoperative nurse oversees the patient’s requisite clearance prior to the surgery. For example, the nurse will communicate any deficiencies and other concerns to the surgeon. The pharmacist will play a central in accessing the medications for interactions and the likelihood of withdrawal.

Therapeutic Modalities:

Pharmacological: The main pharmacological modalities for acute cholecystitis are the use of ursodiol and other antibiotics and pain relievers to treat gallstones and abdominal, percutaneous drainage of the gallbladder, and laparoscopic cholecystectomy. The first two pharmacological interventions are suitable for the acutely ill and milder cases that are considered to be poor surgical candidates (Jones et al., 2020).

Nonpharmacological: Asking the patient to fast, which relieves the gallbladder. Other therapies include low-fat diet, consuming low-spicy foods, and preventing dehydration through intravenous IV fluids.

Health Promotion: The main risk factors for cholecystitis comprise age, fatty or spicy foods, and weight. Acute cholecystitis is common in the older population, overweight and obese people, and individuals who live in unhealthy diets. For instance, food intolerances initiate nausea, heartburn, bloating, and nausea in cholecystitis patients.

Patient Education: The patient and her family members will be advised to prioritize reducing the risk of cholecystitis by losing weight gradually and avoiding spicy and fatty foods. This is because high cholesterol and fat foods contributes to the development of gallstones.

Disposition/Follow-Up Instructions: The recommended therapeutic modality for Miss James is the removal of her gallbladder. After the surgical procedure, follow-up time will be 3-4 weeks. During this period, the patient will us counter analgesics to manage the minimal pain. Most importantly, laparoscopic insufflation causes the CO2 to be retained in the shoulder, which tends to cause severe pain that area (Jones et al., 2020). The patient will be reminded that the retention of CO2 is common and that the pain will undergo dissipation.

References

Ahmed, M. (2018). Acute cholangitis – an update.  World Journal of Gastrointestinal Pathophysiology, 15(1), 1-7.

Cartwright, S. & Knudson, M. (2015). Diagnostic imaging of acute abdominal pain in adults. American Family Physician, 191(7), 452-9.

Hafiz, N., Greene, K., & Crockett, S. (2017). An unusual cause of right upper quadrant pain. Gastroenterology, 153(2), e10-e11.

Grock, A., Chan, W., deSouza, I. (2016). A curious case of right upper quadrant abdominal pain. Western Journal of Emergency Medicine, 17(5), 630-3.

Grans, S., Pols, M., & Stoker, J. (2015). Guideline for the diagnostic pathway in patients with acute abdominal pain. Digestive surgery, 32(1), 23-31.

Jones, M., Genova, R., & O’Rourke, M. (2020). Acute cholecystitis. StatsPearls Publishing.