Appendix: Classroom Activities

Please utilize the “Suite of Patients” and suggested prompt activities below to engage your students in knowledge application associated with the various learning units throughout the text.

Unit Patients

1. 56 year old female, admitted yesterday afternoon with nausea/vomiting, right sided upper abdominal pain, increases after eating. Has had two stools since admit and vomiting stopped after dose of Zofran in ER. Had ERCP yesterday afternoon for dilated biliary duct. She is scheduled for OR this morning for cholecystectomy. Only medical history is depression, surgical history of C-section x2. She does not take any medications routinely at home. She is accompanied by her 17-year-old daughter.
2. 65-year-old male hospitalized three days prior with malaise, cough, cachexia, 30 lbs unintentional weight loss over past six weeks. He has a remote history of alcohol and drug abuse but has been sober for more than 10 years. He was diagnosed with acquired immunodeficiency syndrome (AIDS), pneumocystis pneumonia (PCP), oral candidiasis. He is being treated with IV fluids, IV Bactrim, IV fluconazole. He is divorced and has one daughter. His ex-wife came to the hospital yesterday to visit. No visitors currently. Patient is very quiet and withdrawn.
3. 32-year-old non-binary person, who was transferred from the ICU this morning after being extubated. Patient was admitted five days prior with COVID. Patient cannot have visitors due to COVID status. Continues four liters nasal cannula oxygen.
4. 29-year-old female with cellulitis on right arm from infiltration from heroine injection. Her wife is present along with their 4-year-old son. She had and I&D yesterday and may need to have repeat procedure tomorrow. Currently on IV antibiotics.
5. 52-year-old male with gangrene of fourth toe from having a nail through sole of shoe. Patient has a history of uncontrolled diabetes, hypertension (HTN), peripheral vascular disease (PVD), chronic kidney disease (CKD) stage 2, and peripheral neuropathy. Receiving IV antibiotics, scheduled for toe amputation tomorrow. He has no visitors.
6. 82-year-old female who had elective right hip replacement for uncontrolled hip pain and degenerative joint disease (DJD). She has a history of type 2 diabetes mellitus on metformin and dietary restrictions, previous hysterectomy, osteoporosis, carpal tunnel repair and rheumatoid arthritis which she takes oral methotrexate to control. She has a son who is visiting. Expected to be discharged today.
7. 68-year-old male, awaiting nursing home placement following admission for hepatic encephalopathy from alcoholism. He was medically cleared last week but is a registered sex offender and have yet to find placement. He has an activated power of attorney, who is a state appointed guardian. He continues to get up without calling, makes inappropriate remarks to staff and had a fall three days prior. Other history is bipolar, alcohol abuse, type 2 diabetic, chronic kidney disease stage 3 and hypertension.
8. 19-year-old female admitted for what is presumed Benadryl overdose last evening. On room air, needs to have 1:1 sitter present. Patient is not responding to questions, does not know if this accidental overdose or intentional. History of previous intentional overdose, depression, and anxiety. Dad is present and demanding to know if a toxicology screen was completed and what it showed.
9. 61-year-old male admitted six days prior confusion. Was found by a neighbor wandering. Works at the local gas station. Initial work up shows what appears to be lung cancer with brain metastasis. Patient does not have a power of attorney. He is not married and is estranged from his son. Neighbor that found him is a friend and is willing to become guardian. Between history from neighbor and review of medical records shows a history of smoking. Neighbor says it does appear he has lost weight recently but hadn’t mentioned other concerns when he had talked to him about two weeks ago. In the process of paperwork to be completed for guardianship. Patient had been aspirating when eating, decision to start nasal gastric feed was made yesterday by ethics committee. Awaiting guardianship for further decision on biopsy for confirmed diagnoses and decision to proceed with treatment or switch to hospice care.
10. 45-year-old female admitted last evening short of breath, dizzy, lightheaded with gastrointestinal bleed. Esophagogastroduodenoscopy (EGD) scheduled for this morning. If negative with need prep for colonoscopy then colonoscopy tomorrow. Patient has little medical history except had recently returned from and overseas trip and had chest and back pain about 2 days after returning. Had been found to have a saddle PE and was hospitalized for 5 days on heparin drip and discharged home with coumadin about a week prior. Patient continued to have back and intermittent chest pain and had been taking ibuprofen 1-2 times daily since discharge. Husband brought her in last night when she was found to have a hgb of 6.2. Husband is furious that no one told them she should not be taking Ibuprofen on previous discharge.
11. 64-year-old male with BKA for non-healing diabetic ulcer, scheduled to go to rehab today if bed becomes available. Lives alone in a second floor, low-income apartment without an elevator. Does not have any visitors.
12. 32-year-old male, admitted 15 days prior for newly diagnosed AML. Received induction therapy starting 13 days ago. Patient is at nadir, will need 1 unit of PRBCs for a hgb of 6.2 today and a unit of platelets for a platelet count of 8. Patient has had fevers for the past 2 days and is currently receiving vancomycin and cefepime. Also, on prophylactic acyclovir and fluconazole. Patient has mucositis is on PCA pump and receiving TPN and diet as tolerated (which magic mouth wash before meals).
13. Cachexic, 25-year-old female with history of cystic fibrosis. Admitted for CF exacerbation overnight.  Eats during the day and is tube fed overnight. Admitted for extensive pulmonary toileting, IV antibiotics (tobramycin and cefuroxime), continued home respiratory treatments. Patient also needs to have nutrition recommendations reviewed during this hospitalization. She is here with her boyfriend. The boyfriend also has 2 school aged children that would like to visit.
14. 78-year-old male with a history of HTN, hypothyroid. Admitted 2 days prior to abdominal pain, nausea/vomiting. Had a colectomy yesterday for perforated diverticulitis. Patient is NPO, has NG tube in place. Had nausea overnight. His wife is expected to visit later today, went home after return from OR yesterday.
15. 89-year-old female admitted from nursing home yesterday with increased confusion. Has a history of dementia, HTN, type 2 diabetes, dysphagia. Was found to have a UTI. Started on IV Levaquin, awaiting urine cultures. Expected discharge tomorrow. She has been trying to get up frequently overnight. No family present. Needs 1:1 supervision for all feedings.
16. 82-year-old man admitted with COPD exacerbation, is on 2 L of home oxygen baseline. Oxygen saturation was 78% on arrival, has not been able to do ADLs because of shortness of breath. Has CAD, HTN, PAD. Lives in a duplex with his granddaughter that lives on the other side. His granddaughter called yesterday.
17. 68-year-old male who is morbidly obsess, admitted 2 days prior shortness of breath with CHF. Patient is on IV bumex and is down 25 lbs since admit. He has a history of HTN, CAD, post CABG, CKD stage 2. Expected discharge today.
18. 36-year-old female admitted for excessive uterine bleeding 4 days prior. Newly diagnosed with uterine cancer. Patient had open hysterectomy, oophorectomy, salpingotomy and lymph node biopsy. Had diagnostics, port placement and staging over the past 3 days. Expected discharge today. Her husband is here with their 16-month-old daughter. The husband has been very inattentive during this hospitalization and has expected her to watch their daughter over the last couple days and even left to go for lunch yesterday leaving daughter in room.
19. 68-year-old male with history of stage 3 CKD, admitted with AKI on CKD yesterday. Patient has had nausea and vomiting for past 36 hours, baseline creatinine 0f 1.8, was 4.6 on admit. Has been given fluid hydration, is down to 3.2 this morning.
20. Bed open.
21. It is “ortho day” in the OR. There are 3 patients scheduled. 1 is a 54-year-old male with bilateral knee replacement (0800 surgery time), scheduled for observation admit. 68-year-old women with right knee (1100 surgery time), expect to be discharged. And 78-year-old male with hip replacement (1300 OR time), scheduled for observation admit.
22. 72-year-old female waiting for a bed in the emergency room. Arrived overnight with hypoxia, cough, SOB. Positive for influenza.