NIU NURS 308 Danielle’s Difficulty Case Study
NIU NURS 308 Danielle’s Difficulty Case Study
Danielle’s Difficulty: Risks, Treatments, and Prevention of Clostridium difficile
Part I – A Difficult Disease
What an awful holiday season it had been for Danielle, an 11th grader at Ithaca High School. It all started right before Thanksgiving when she had to have her wisdom teeth removed. Her mouth hurt so much she couldn’t enjoy most of the Thanksgiving meal. That and the antibiotic she was taking, clindamycin, gave her a metallic taste in her mouth, and so even the mashed potatoes she could eat didn’t taste right. On Thanksgiving, her 83-year-old grandmother had fallen and broken her thumb and elbow. She had been in the hospital for a few days and then in a rehab center for a week. When Danielle had visited her grandmother in the rehab center, she had seemed to be in good spirits and was looking forward to getting ready for the Christmas holiday. Danielle had promised her grandmother she would come and help decorate her Christmas tree.
Shortly before Christmas, Danielle’s grandmother developed watery diarrhea. Her doctor told her to take Imodium® A-D, an anti-diarrhea medicine that works by slowing down intestinal motility. The next day she had terrible abdominal cramping and Danielle’s father took her grandmother to the urgent care center. As soon as they took her vital signs and heard her history, they sent her to the emergency room. From there Danielle’s grandmother was admitted to the intensive care unit with a diagnosis of kidney failure due to dehydration induced by diarrhea caused by infection with Clostridium difficile. Within days, in spite of aggressive antibiotic therapy with metronidazole and vancomycin as well as heroic medical care, Danielle’s grandmother’s condition worsened and on December 30th she died of sepsis.
Now it was New Year’s Eve day and Danielle was starting to experience severe abdominal pain. Danielle was hoping it was just stress and not that she had “C. diff” like her grandmother.
NIU NURS 308 Danielle’s Difficulty Case Study Questions
1. What are the risk factors for developing Clostridium difficile disease?
2. Which of these risk factors did Danielle’s grandmother probably have?
3. What, if any, risk factors did Danielle have for developing C. difficile disease?
4. What is the role of spores in the development of C. difficile disease?
5. How do the toxins of C. difficile contribute to the signs of disease?
NATIONAL CENTER FOR CASE STUDY TEACHING IN SCIENCE
Part II – Relapse
When Danielle mentioned her stomachache to her father, he immediately took her to the emergency room. There they confirmed Danielle had C. diff. Danielle was given a three-week course of metronidazole, by the end of which she was feeling better. Once she went off the drugs, however, her abdominal pain returned.
1. Does the reappearance of Danielle’s symptoms suggest another bout of C. difficile disease?
2. What factors could cause a relapse in C. difficile disease?
3. If Danielle’s symptoms are due to a relapse of C. difficile, what alternative treatments might you suggest for her?
Image in title block is a micrograph depicting Gram-positive C. difficile bacteria from a stool sample culture obtained using a .1?m filter. Photo by Janice Carr, provided courtesy of CDC/ Lois S. Wiggs, public domain,
Case copyright held by the National Center for Case Study Teaching in Science, University at Buffalo, State University of New York. Originally published October 17, 2013. Please see our usage guidelines, which outline our policy concerning permissible reproduction of this work. NIU NURS 308 Danielle’s Difficulty Case Study.
NIU NURS 308 Cystic Fibrosis Case Study
Part I – The Meeting
Sarah stared blankly at the blue paisley wallpaper. Her husband Mike sat by her side, bending and unbending a small paper clip. “Sarah and Michael, it’s good to meet you,” welcomed the genetic counselor, as she entered the room. “I apologize for being late, but I was just meeting with another couple. Let’s see, you’d like to have a child, but you’re concerned because of your family history of cystic fibrosis.”
“Yes,” Sarah replied softly. “Mike and I met at a CF support group meeting a few years ago. He had a younger brother who died of cystic fibrosis, and I had a younger sister. We saw the painful lives they had—difficulty breathing, the constant respiratory infections. Although the treatments for CF are better now, we just don’t know if we can…” she trailed off.
“I can certainly understand your concern,” the genetic counselor responded sympathetically. “That’s where I hope to help, by providing as much information and advice as I can. I’m glad that you came to see me before you became pregnant so I can fully advise you of all options beforehand.”
“To start, let’s go over what we know about your case so far,” continued the genetic counselor. She pulled out a pad of paper, which she placed on the table in front of Sarah and Michael, and began to draw a series of circles and squares connected by lines.
“As I recall, both sets of parents did not display any of the symptoms of cystic fibrosis, right?” “Yes,” said Sarah and Michael in unison. The genetic counselor replied, “Ok, well that means….”
Consult your textbook and trustworthy Internet sites to answer the following questions:
See H & M pp. 718-720
University of Utah Health Sciences. (201_). Cystic fibrosis. Learn.Genetics—Genetic Science Learning Center. Retrieved from http://learn.genetics.utah.edu/content/disorders/singlegene/cf/
US National Library of Medicine. (2012). Cystic fibrosis. Genetics home reference—your guide to understanding genetic conditions. Retrieved from https://ghr.nlm.nih.gov/condition/cystic-fibrosis
1. Which organs are affected by cystic fibrosis?
2. What are the disease symptoms?
“So, what’s next?” asked Mike. “First, we’ll collect DNA samples from both of you. We’ll then analyze your CF genes for the most common mutations to see if you are carriers for this recessive genetic disease” the genetic counselor replied.
A few weeks later, the genetic counselor welcomed back Sarah and Mike. “We’ve received the results of your genetic tests for common CF mutations. Michael, you’re a carrier of the most common disease allele, delta-F508, and Sarah, you tested negative for the most common CF mutations.” “Thank goodness,” Sarah replied with relief. “That means it’s safe for us to have a child, right?” “Not exactly,” cautioned the genetic counselor. “Since Sarah tested negative for CF, it seems we don’t have much to worry about, right?” said Michael, pointing to the pedigree in which Sarah is not a carrier. “So, what did you mean when you said not exactly?”
The genetic counselor grabbed her laptop computer and positioned it in front of the three of them. Her fingers quickly typed out a web address and the words “OMIM – Online Mendelian Inheritance of Man” stretched across the browser window. “We can learn a lot more about this disease from this site. It will begin to explain why I said not exactly when Sarah asked if it was safe to conceive a child.”
The Online Mendelian Inheritance of Man (OMIM) is a catalog of known human genetic diseases. Go to OMIM at and search with the keyword “cystic fibrosis.” Examine the OMIM record entitled “602421 cystic fibrosis transmembrane conductance regulator.”
5. Scroll down the webpage and look closely at the section on “Allelic Variants.” Is the delta-F508 mutation the only known alteration of the CFTR gene or are there additional variants associated with cystic fibrosis?
NIU NURS 308 Quiz 3
Antibodies are produced by:
Mast cell degranulation decreases:
histamine, neutrophil chemotactic factor, and leukotrienes.
histamine and prostaglandins.
histamine and platelet-activating factor.
histamine, IL-4, and eosinophil chemotactic factor of anaphylaxis.
Antibody is effective against:
expression of MHC molecules.
viral protein synthesis.
CD4 markers are associated with:
cytotoxic T cells.
suppressor T cells.
helper T cells.
The sequence of inflammatory events within the vasculature is:
slower blood flow, arteriolar vasoconstriction, increased capillary permeabilty, edema.
blood becoming more viscous, vasodilation, increased capillary permeability, edema.
vasodilation, vasoconstriction, decreased local blood flow to injured site, edema.
arteriolar vasoconstriction, vasodilation, increased capillary permeability, plasma leakage, edema
The inflammatory response:
minimizes injury and promotes healing.
elevates body temperature to prevent spread of infection.
prevents the formation of abscesses.
prevents blood from entering the injured tissue.
Cytotoxic T cells:
inhibit virus-infected cells.
inhibit viral protein synthesis.
inhibit intracellular viruses.
decrease expression of MHC molecules.
Characteristic systemic manifestations of acute inflammation include:
fever caused by the release of IL-1 by neutrophils and macrophages.
reduced host susceptibility to the effects of endotoxins.
a “right shift” in the ratio of immature to mature neutrophils.
Innate resistance or immunity
Is a development of an individual’s later yearsc.
Is a relatively slow and specific process
Depends on physical, mechanical, and biochemical barriers
Cytokines and their receptors function:
as negative regulators of acquired immune responses.
as intracellular chemical signals.
aschemical signals between cells.
to decrease the production of proteins.