The concept behind the case studies presented in Lab 12 used to illustrate the Enterobacteriaceae and Pseudomonas is for you and your lab partners as a group to:
1. First come up with a valid diagnosis of the type of infectious disease seen in your case study and then identify the bacterium causing that infectious disease, and
2. Support your groups diagnose based on:
a. Any relevant facts in the patient’s history.(A reliable on-line source will be used to support this.)
b. The patient’s signs and symptoms. (A reliable on-line source will be used to support this.)
c. Each of the individual lab tests given in your case study.
d. All microbiological lab tests you performed as part of the project.
The due date for this report can be found on the class calendar. Remember, you are working as a group to solve a problem. Your grade for this lab is based on the completeness of your report and written evidence of the critical thinking process that went into making and supporting your diagnosis, therefore, it is critical that all members of the group participate, question any conclusions being made by the group, and contribute to the report. Remember, you are trying to convince your instructor that you understand how the diagnosis was made by supporting that diagnosis with data. Your group will work together to write the report and submit one hard copy of that report for your group. Part of your grade will be based on evaluation of your work by your team members.
Be sure to handle all the bacterial cultures you are using in lab today as if they are pathogens! Be sure to wash and sanitize your hands well at the completion of today’s lab.
Also, make sure you observe several MacConkey agar plates and the Cetrimide agar plate used by others in your lab so that you can answer practical questions from Lab 12 and Lab 13. The Performance Objectives for Lab 13 tell you what you are expected to be able to do on the practical.
Case Study Lab Report for Labs 12 and 13:
The Enterobacteriaceae and Pseudomonas
Your Name:
Others in your group:
Unknown number (1-6): 4(CASE STUDY 1B)
Lab section: CRW
Date:
Case Study #1B from Lab 12
A 90-year-old woman resides at an area nursing home. She shows signs of mild dementia, and because of severe arthritis and requiring a walker for ambulation, sits in a chair most of the day. She has not used any form of estrogen in at least 30 years. She also has a history of 4-5 confirmed urinary tract infections per year. This morning, her caregiver is unable to coax the patient out of her bed. She seems confused and disoriented. Vital signs reveal tachycardia in the 120’s, respirations at 24/min, and a blood pressure of 78/49. She is immediately taken to an ER for evaluation. A CT of the abdomen and a chest x-ray appear normal. She has a WBC count of 2300/µL. She continues to exhibit marked confusion compared to her baseline and is exhibiting anxiety. Urine and blood samples are taken and sent for culture and sensitivity.
Assume your unknown is from both a urine sample and a blood sample.
Did you have Case Study 1A, 1B, or 1C? ___1B___
1. Patient’s history and predisposing factors
Read the case study. Explain how any relevant parts of the patient’s history contributed to your diagnosis of the type of infectious disease that is present here. The patient’s history refers to anything given in the case study prior to that patient seeking medical attention for the current medical condition.
You are urged to use the computers in lab to search reliable medically oriented Internet sources to support this. Reliable sources you might consider are Medscape (http://emedicine.medscape.com/infectious_diseases) and The Centers for Disease Control and Prevention (CDC) at http://www.cdc.gov/. Cite any sources you use at the end of this Patient’s History section in APA style (http://www.apastyle.org/).
The patient’s history should suggest a general type of infectious disease that is present, such as a urinary tract infection, a wound infection, gastroenteritis, pharyngitis, pneumonia, septicemia, etc. Do not look up the bacterium you eventually identify as the cause of this infectious disease. You don’t know the causative bacterium at this point. You need to determine the general type of infection to determine what microbiological tests to perform in order to identify the bacterium causing the infection. Search at least one medically oriented reference article from a reliable site such as Medscape and use this article to support your diagnosis the type of infectious disease seen here. Don’t forget to cite any sources you used in APA style directly under this Patient’s History and Patient’s Symptoms sections of this Lab Report.
2. Patient’s signs and symptoms
Read the case study. Explain how the patient’s signs and symptoms contributed to your diagnosis of the type of infectious disease that is present here. Signs refer to anything being measured by a medical professional during a physical exam such as blood pressure, respiration rate, heart rate, oxygen saturation, and temperature. Symptoms refer to symptoms being reported by the patient.
You are urged to use the computers in lab to search reliable Internet sources to support this. Reliable sources you might consider are Medscape (http://emedicine.medscape.com/infectious_diseases) and the Centers for Disease Control and Prevention (CDC) at http://www.cdc.gov/. Also see appendix F (SIRS and Sepsis) in your lab manual for an indication of whether or not the patient has SIRS. Cite any sources you use at the end of this Patient’s History section in APA style (http://www.apastyle.org/). Also refer to appendix F (SIRS and Sepsis) in your lab manual for an indication as to whether or not the patient has SIRS.
The patient’s signs and symptoms should suggest a general type of infectious disease that is present, such as a urinary tract infection, a wound infection, gastroenteritis, strep throat, pneumonia, septicemia, etc. Do not look up the bacterium you eventually identify as the cause of this infectious disease. You don’t know the causative bacterium at this point. You need to determine the general type of infectious disease present in order to determine what microbiological tests to perform to identify the bacterium causing the infection. Search at least one medically oriented reference article from a reliable site such as Medscape and use this article to support your diagnosis the type of infectious disease seen here. Don’t forget to cite any sources you used in APA style under this Patient’s History and Patient’s Symptoms sections of this Lab Report.
3. Vocabulary list for medical terms used in the case study under signs and symptoms
List and define any medical terms used in your case study that describe the patients’ signs and symptoms that the average person not in the medical profession might not know.
4. Results of laboratory test given in the case study
List each lab test given in the case study that would be done in a lab, such as a total white blood cell count, differential white blood cell count, urinalysis, and X-ray, and explain how the result of that test helps to contribute to your diagnosis. The CBC and urinalysis tests are described in Appendix C and Appendix D of this lab manual.
5. Microbiological lab tests you performed in Lab 12
a. Gram stain
Give the Gram reaction (Gram-positive or Gram negative and how you reached this conclusion) and the shape and arrangement of the unknown you were given. State how these Gram stain results contributed to your decision of what microbiological test to perform next. The Gram stain is discussed in Lab 6.
Gram negative Bacillus/Bacilli-Rod Shape. Pink in color. Bacteria – Streptococcus -How it determines what test is next.
b. Oxidase test
Give the results of the oxidase test (positive or negative) you performed on the unknown you were given, and how you reached this conclusion. State how these oxidase results contributed to your decision as to what microbiological media to use next. The oxidase test is discussed in Lab 12 under C. Lab Tests Used in Today’s Lab.
Oxidase negative , no color change after 10 seconds rubbing to uchiry Gibson oxidase test swab to the colony of unknown what test are do next & why base on this result.
c. Maconkey agar (if used)
Describe the results of the MacConkey agar plate you inoculated with the unknown you were given. State how this contributed to narrowing down your identification of the bacterium causing the infectious disease. MacConkey agar is discussed in Lab 12 under C. Lab Tests Used in Today’s Lab.
Weak fermentation of lactose pink but not cloudy color colonies
c. Cetrimide agar (if used)
Describe the results of the Cetrimide agar plate you inoculated with the unknown you were given. State how this contributed to your identification of the bacterium causing the infectious disease. Cetrimide agar is discussed in Lab 12 under C. Lab Tests Used in Today’s Lab.
Oxidase positive swab/ purple- green water-soluble pigment. Pseudomonas aeruginosa growing on cetrimide agar.
d. EnteroPluri-Test.
Using your EnterPluri-Test, identify the unknown you were given. The EnteroPluri-Test and its use are described in Lab 12 under C. Lab Tests Used in Today’s Lab.
1. In the table below, put a (+) or a (-) in the Result row for each test.
2. Add up the value of each positive test in a group and put that number in the code for each group.
3. The 5-digit number is the CODICE number. Look that number up in the Codebook and identify your unknown.
| Group 1 | Group 2 | Group 3 | Group 4 | Group 5 | |||||||||||
| Test | Glucose | Gas | Lysine | Ornithine | H2S | Indole | Adonitol | Lactose | Arabinose | Sorbitol | VP | Dulcitol | PA | Urea | Citrate |
| Value | 4 | 2 | 1 | 4 | 2 | 1 | 4 | 2 | 1 | 4 | 2 | 1 | 4 | 2 | 1 |
| Result | + | + | + | + | – | – | + | + | + | + | + | _ | _ | _ | + |
| Code | 7 | 4 | 7 | 6 | 1 | ||||||||||
| CODICE NUMBER: Identification: | |||||||||||||||
Genus and species of bacterium: Klebsiella Aerogenes -Called Now ____________________________________________
Final diagnosis:
What infectious disease does the patient have?
What is the genus and species of the bacterium causing this infectious disease?
Rubric Name: Lab 12, Case Study 1 Report_2022
| Criteria | Level 4 3 points | Level 3 2 points | Level 2 1 point | Level 1 0 points | Criterion Score |
| Patient’s history | The significance of all of the points in the patient’s history in making the final diagnosis was well explained. A good outside source was used and cited correctly. (Minus 1 point if cited incorrectly.) | The significance of most of the points in the patient’s history in making the final diagnosis was well explained. A good outside source was used and cited correctly. (Minus 1 point if cited incorrectly.) | The significance of a few of the points in the patient’s history in making the final diagnosis was well explained. A good outside source was used and cited correctly. (Minus 1 point if cited incorrectly.) | The significance of the patient’s history in making the final diagnosis was not well explained and/or outside sources were not used. | Score of Patient’s history, / 3 |
| Patient’s signs and symptoms | The significance of each of the patient’s signs and symptoms in making the final diagnosis was well explained. A good outside source was used and cited correctly. (Minus 1 point if cited incorrectly.) | The significance of most of the patient’s signs and symptoms in making the final diagnosis was well explained. A good outside source was used and cited correctly. (Minus 1 point if cited incorrectly.) | The significance of a few of the patient’s signs and symptoms in making the final diagnosis was well explained. A good outside source was used and cited correctly. (Minus 1 point if cited incorrectly.) | The significance of the patient’s signs and symptoms in making the final diagnosis was not well explained and/or outside sources were not used. | Score of Patient’s signs and symptoms, / 3 |
| Vocabulary list | All important medical terms were defined. | Most important medical terms were defined. | Some important medical terms were defined. | Important medical terms were not defined. | Score of Vocabulary list, / 3 |
| Results of lab tests given in the case study | The significance of the results of each of the lab tests given in the case study in making the final diagnosis was well explained. | The significance of most of the results of the lab tests given in the case study in making the final diagnosis was well explained. | The significance of a few of the results of the lab tests given in the case study in making the final diagnosis was well explained. | The results of the lab tests given in the case study were stated but their significance in making the final diagnosis was not explained. | Score of Results of lab tests given in the case study, / 3 |
| Following Correct Lab Report Instructions | All of the patient’s history, patient’s signs and symptoms, and lab tests given in the case study were put in the correct place. | Most of the patient’s history, patient’s signs and symptoms, and lab tests given in the case study were put in the correct place. | Some of the patient’s history, patient’s signs and symptoms, and lab tests given in the case study were put in the correct place. | An incorrect format was used in writing the lab report. | Score of Following Correct Lab Report Instructions, / 3 |
| Gram stain | The Gram reaction, shape, and arrangement of the bacterium are all correct and were used correctly in determining what medium and/or test to use next with an explanation as to why. | The Gram reaction, shape, and arrangement of the bacterium are all correct and were used correctly in determining what medium and/or test to use next but there is no explanation as to why | The Gram reaction, the shape and/or the arrangement were not used in determining what medium and/or test to use next. | Either the Gram reaction, the shape, and/or the arrangement was incorrect. | Score of Gram stain, / 3 |
| Oxidase test | The result of the oxidase test is correct and was used correctly in determining which agar to use in the next step with an explanation as to why. | The result of the oxidase test is correct and was used correctly in determining which agar to use in the next step but no explanation as to why. | The result of the oxidase test is incorrect resulting in the wrong agar being used in the next step and contributing to a wrong final diagnosis. | The result of the oxidase test wasnot used in making the final diagnosis. | Score of Oxidase test, / 3 |
| Macconkey agar (if used) | The results of the Macconkey agar are correct and were used correctly in making the final diagnosis. Organisms showing these results are included. | The results of some of the Macconkey agar are correct and were used correctly in making the final diagnosis. Organisms showing these results are included. | The results of the Macconkey agar are correct. However, organisms showing these results are not included. | Macconkey agar should not have been used in making the final diagnosis. | Score of Macconkey agar (if used), / 3 |
| Cetrimide agar (if used) | All of the results of the Cetrimide agar are correct and were used correctly (which possible organism or organisms it could be) in making the final diagnosis. | Some of the results of the Cetrimide agar are correct but the significance of the results (which possible organism or organisms it could be) was not stated. | The results of the Cetrimide agar are incorrect and contributed to a wrong final diagnosis. | Cetrimide agar should not have been used in making the final diagnosis. | Score of Cetrimide agar (if used), / 3 |
| EnteroPluri Test (if used) | The results of the EnteroPluri Test tests are correct and were used correctly in making the final diagnosis. | The results of the EnteroPluri Test are correct but were used incorrectly in making the final diagnosis. | The results of one or more of the EnteroPluri Test are incorrect and contributed to a wrong final diagnosis. | The EnteroPluri Test should have been used in making the final diagnosis but was not. | Score of EnteroPluri Test (if used), / 3 |
| Final diagnosis | The genus and species of the bacterium and the infection it is causing are all correct. The infection that leads to sepsis, if applicable, is explained. | The genus and species of the bacterium and the infection it is causing are all correct. The infection that leads to sepsis, if applicable, is not explained. | Either the genus, or the species of the bacterium is incorrect, or the infection it is causing is incorrect. The infection that leads to sepsis, if applicable, is not explained. | The genus and species of the bacterium and the infection it is causing are all incorrect. | Score of Final diagnosis, / 3 |
