Liver PBL
Patient Chart:
Gloria Stone 1/21/1970
PMH: HTN, Hyperlipidemia
Meds: HCTZ 25 mg daily, Acetaminophen 650mg every 4-6 hours as needed, Garlic 200mg
TID
Allergies: NKDA
FH: Dad: Deceased age 70 from MI, HTN, Hyperlipidemia
Mom: 74 yrs., alive, breast cancer at age 45
Sister: 45 yrs., alive, ETOH abuse
SH: Works at daycare center, separated from spouse, 2 children, 1 year college completed, No
routine physical activity, Drinks 20 oz. of soda daily, 2 glasses of ETOH daily, Smokes ½ PPD,
Previous experimentation with marijuana and meth.
Past Clinic Visit Information:
03/11: BP 160/90 HR 80 Re-establish care. Dx: HTN, Hyperlipidemia, On Garlic currently and
restarted on HCTZ
11/08: BP 150/86 HR 70. New patient- establish care On Garlic currently and HCTZ started,
treat Lipid panel with diet and activity
Past Diagnostics:
03/11: Fasting glucose 122, Na 139 K+4.3 Chloride 102 Co2 27.5 BUN 13 Creatinine 0.9 AST
150 ALT 60, Hgb 12 Hct 37 MCV 105 Total Cholesterol 230 HDL 40 LDL 160 Triglyceride 150
11/08: Fasting glucose 120, Na 138 K+3.8 Chloride 102 Co2 28.5 BUN 16 Creatinine 1.1 AST
90, ALT 40, Hgb 12 Hct 37 MCV 100 Total Cholesterol 227 HDL 49 LDL 150 Triglyceride 140
Liver/Hepatitis PBL
Assignment:
References: 2 journal articles and 2 textbooks within the last five years (2pts)
1. Prior to class, students should review the Hepatitis and Liver Function Test Powerpoints
as well as recommended readings for this topic. Students should also review the various
causes of elevation of hepatic enzymes in detail using current journal articles pertinent to
this topic.
2. A “patient chart” will be posted in the Liver/Hepatitis content section in the course prior to
the session.
3. One student will be selected to be the designated spokesperson for the class.
Students in class and online will interview the patient. The session will be recorded;
therefore if a student is not able to be present in class or online, they are responsible for
listening to the recorded session.
4. After class is complete, as a group, students will have an on-line discussion in the
discussion section under Liver PBL. Students need to discuss the mostly likely three
differentials with rationale and references, with the mostly likely listed as number one. All
students should submit their answers and a consensus will need to be decided. Include
also the diagnostics, with rationale, that should be done at this visit. The results of the
diagnostics requested by the spokesperson will be posted in the Liver/Hepatitis content
section within 24 hours of the diagnostic request. (2.5points)
5. After you have received the diagnostic results, individually, select your final diagnosis for
today’s visit. Explain the rationale, references and the pathophysiology of the diagnosis.
(2.5 points) Write your plan in detail. This should be written as if you are the NP writing
the prescriptions and talking with the patient—everything that you would actually discuss
in the office visit. Points will be deducted if this is not clear to the patient. (9 points)
6. In your plan, address any other medical issues that are pertinent to this patient and
changes in the medical plan, if any, which should be considered at today’s visit or at
future visits. Please be specific. (9 points)
Please save the final document as a word file. Save with your last name and case
name (i.e. SmithRenalPBL). The document must use 12 point font. No more than 5
pages with the reference page as an additional page. Be sure your name is on
each page of the document.
Liver PBL Rubric
Section
Diagnostics with
differentials and
rationales (group work)
(2.5 pts.)
Final Diagnosis for
today’s visit with rationale
and pathophysiology
(individual work) (2.5 pts.)
Detailed plan including
pharmacological and non-
Points Obtained/Points
Earned
Comments
pharmacological
interventions, including
patient education
(individual work) (9 pts.)
Additional medical issues
or follow-up (individual
work) (9 pts.)
Professional References
with appropriate in –text
citation and reference list
using APA format. All
citations/reference list
needs to be complete. (2
pts.)
Total Points (25 pts.)
Liver PBL case
CC: Here because you told me my liver labs were bad.
HPI: Taking medication as prescribed. No HA, dizziness, vision changes, CP, SOB, Abd pain,
pain or swelling in legs. No N/V/D. No yellowing of skin or eyes. No change in stools or urine.
Not routinely exercising- Just don’t have time with 2 kids and no husband to help and working
full time. Just anxious and depressed at times. Cries for no reason. Unable to sleep or eat at
times. Uses ETOH to help sleep. No SI or thoughts of self harm. Gets teary at work. Little
interest in hobbies. Fatigued, occasionally feels worthless. Sometimes think should cut down
ETOH. Husband left due to drinking- annoyed me. Feels guilty at times because not with kids
when drinking, Never needed an eye-opener. Drinks 1-2 20 ounces of pop daily. 2-3 ETOH
drinks. Smoke ½ PPD.
PMH: No surgery, HTN, hyperlipidemia- no treatment other than diet. No blood transfusions. No
liver, gall bladder or bleeding disorder
Immunizations- no idea- had flu shot but not sure if others.
Meds- HCTZ, Garlic, Tylenol
NKDA
Family history- no gall bladder disease, liver disease or bleeding problems
Social: ½ PPD, ETOH as above- hard liquor, beer, wine. Married but separated, 12 partners
lifetime 3 in past month. Occasionally uses condoms- if I remember. 2 children. Used IV meth
and marijuana before. No foreign travel. Works in child care.
ROS: general- no fever, chills, or night sweats, Fatigued at times. Feels well overall
HEENT: no vision changes, yellow eyes, or sore throat
CV: no CP, lightheadedness, or palpitations, no edema
Resp: No SOB, cough, or wheezing
Abd: no abd pain or N/V/D, no constipation, Appetite decreased lately- from stress, no abd
edema
Renal: No urgency, burning or hematuria
Genitalia: No STI testing, no discharge, no sores or lesions
MS- no muscle aches or pains, no decreased strength
Neuro- no HA, dizziness, dec sensation, seizures or tremors
Endo- no heat/cold intolerance, polyuria, polydipsia, or polyphagia
Skin- no rashes, hair loss, brittle nails, or yellow skin, no dryness
Lymph- no tender lymph nodes
Ext- no decreased sensation
Psych- feeling anxious and sad- depression after birth of child on Zoloft- quit 3 months after
started.
PA: 97 F, 160/88, HR 70, Ht 5 ft 10” Weight 210 pounds
Eyes: PERRLA, 3mm bilat, optic disc crisp- no AV nicking, sclera white, conjunctiva clear
Neck: supple, no thyroid enlargement or masses, no carotid bruits
Lymph: no lymph node enlargement
CV: S1S2 no S3S4 or murmurs, no heaves lifts or thrills
Resp: clear
Abd: BS + no renal, iliac, or femoral bruits, soft, mild right upper quadrant tenderness, no
rebound tenderness, neg Murphy’s sign, liver span 16 cm , no spleen enlargement, no dullness
to percussion, no hepatojugular reflex
Gentiallia: no sores or lesions
Ext: no edema
MS- 5+ strength bilat, full ROM, no redness or swelling of joints
Neuro: CN II to XII intact, reflexes 2+ bilat, neg Romberg, gait normal, finger to nose normal, no
tremors
Psych- tearful at times.