2020 Nursing Page Update

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York College Graduate Presents Case Study on Mystery Illness as Part of Graduate Student Research Day

A Graduate student sitting in the simulation lab with a patient in a bed behind her. She is sitting on the edge of the bed smiling for a photograph.

Jessi Graves ’13/’21 studied acute jaundice in a patient who didn’t show any other symptoms. Her research was presented in Graduate Student Research Day on April 22, 2021.

Jessi Graves ’21 remembers speaking to the 64-year-old woman in front of her and noting the severity of her jaundice. A medical condition that causes the yellowing of the skin and eyes, jaundice can often present with many other symptoms, including pain or fever. This woman had neither.

“I hadn’t seen jaundice that bad since I used to work in intensive care,” says Graves, who received her Nursing degree from York College of Pennsylvania in 2013 and is currently in the Adult Gerontology Nurse Practitioner program.

The patient’s case was so intriguing to Graves that she decided to do a case study on acute jaundice, which examines why someone may present the physical yellowing commonly seen with jaundice, but has no other symptoms. The study was recently submitted in the inaugural Graduate Student Research Day at York College.

“I’ve always enjoyed learning,” Graves says. “Continuing my education as a nurse is incredibly important, and this is a great opportunity to share what I’ve learned with my peers.”

About the case

Graves’s patient was four-weeks post-operative from surgery to repair a femur she broke in a fall. The woman was otherwise healthy, Graves says, and had chosen not to see a primary care doctor for about four years prior to her accident.

When she had a follow-up appointment with her orthopedic surgeon, the doctor noticed the discoloration of her skin. Neither she nor her husband had paid much attention to it. She was then referred to a primary care doctor, where Graves encountered her.

Sometimes, Graves says, painless jaundice can be a sign of pancreatic cancer, so they got to work right away in ordering labs to determine what was causing the jaundice. Lab results showed the woman had hemolytic anemia, a disorder in which red blood cells are destroyed faster than they can be made. The condition was caused by the aspirin the woman was prescribed after her surgery.

“It’s interesting that drugs we prescribe all the time can sometimes cause people harm,” Graves says. “We often don’t think of those common, over-the-counter medications as something we should watch out for, but it’s a great reminder that everyone reacts differently to certain medications.”

Moving forward

Part of the woman’s ongoing care includes seeing a gastrointestinal (GI) specialist, who can further assess her needs and reactions to medications. Graves saw the woman later on when she was suffering from allergies, but she could not prescribe her any new medications until it’s approved by her GI physician.

“It makes it challenging for her to know she has this physical reaction to certain medications and has to be extra careful going forward,” Graves says. “It can be tough for someone in that situation, but I hope this helps her live a healthier life.”

The case study helped Graves examine the impact that primary care can have on someone’s life. It also feeds into her desire to keep learning and improving her practice. She often comes home from clinical or work to research symptoms she witnessed in patients throughout the week.

“There are little wins you can find in primary care each day,” Graves says. “It can change someone’s life, and that’s what I want to do.”