Initial commit: Nursing Case Study Builder (Tool #5)

- 10 detailed clinical case studies (STEMI, Asthma, DKA, Stroke,
Sepsis, NOF fracture, Preeclampsia, Febrile convulsion,
Paracetamol OD, AKI prerenal)
- 5-tab Streamlit UI: Case Library, Full Case, ADPIE Reasoning,
Quiz Questions, Care Plan Builder
- NCLEX-style MCQs with rationales and scoring per case
- Downloadable NANDA care plan export
- GitHub Actions workflow for HF Space auto-deploy

Co-Authored-By: Claude Sonnet 4.6 <noreply@anthropic.com>

.github/workflows/sync-to-hf.yml

@@ -0,0 +1,26 @@
+name: Sync to Hugging Face Space
+
+on:
+  push:
+    branches:
+      - main
+
+jobs:
+  sync-to-hub:
+    runs-on: ubuntu-latest
+    steps:
+      - name: Checkout repository
+        uses: actions/checkout@v4
+        with:
+          fetch-depth: 0
+          lfs: true
+
+      - name: Push to Hugging Face Space
+        env:
+          HF_TOKEN: ${{ secrets.HF_TOKEN }}
+        run: |
+          git config --global user.email "action@github.com"
+          git config --global user.name "GitHub Action"
+          git push \
+            https://NurseCitizenDeveloper:${HF_TOKEN}@huggingface.co/spaces/NurseCitizenDeveloper/nursing-case-studies \
+            main

.gitignore

@@ -0,0 +1,33 @@
+# macOS
+.DS_Store
+.AppleDouble
+.LSOverride
+._*
+.Spotlight-V100
+.Trashes
+
+# Python
+__pycache__/
+*.py[cod]
+*$py.class
+*.egg-info/
+dist/
+build/
+.eggs/
+*.egg
+.env
+.venv
+venv/
+env/
+
+# Streamlit
+.streamlit/secrets.toml
+
+# IDE
+.vscode/
+.idea/
+*.swp
+*.swo
+
+# Logs
+*.log

README.md

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+---
+title: Nursing Case Studies
+emoji: 🏥
+colorFrom: blue
+colorTo: indigo
+sdk: streamlit
+sdk_version: 1.32.0
+app_file: streamlit_app.py
+pinned: false
+---
+
+# 🏥 Nursing Case Study Builder — Student Nurses
+
+An interactive, free clinical case study tool designed to help student nurses develop critical thinking and clinical reasoning skills using the **ADPIE nursing process**.
+
+## Features
+
+- **📚 Case Library** — 10 detailed, realistic clinical scenarios across major body systems
+- **🔍 Full Case View** — Complete patient demographics, vitals, physical exam, investigations, and medical diagnosis
+- **🧠 ADPIE Reasoning** — Guided Assessment → Diagnosis → Planning → Implementation → Evaluation framework with model answers
+- **❓ Quiz Questions** — 5 NCLEX-style case-based MCQs per scenario with rationales and scoring
+- **📝 Care Plan Builder** — Structured NANDA nursing diagnosis care plan with SMART goals and downloadable output
+
+## Case Scenarios
+
+| # | Case | Category | Difficulty |
+|---|------|----------|------------|
+| 1 | STEMI — Acute Chest Pain | ❤️ Cardiovascular | Intermediate |
+| 2 | Acute Severe Asthma | 🫁 Respiratory | Intermediate |
+| 3 | Diabetic Ketoacidosis (DKA) | 🩺 Endocrine | Intermediate |
+| 4 | Ischaemic Stroke | 🧠 Neurological | Advanced |
+| 5 | Septic Shock | 🦠 Multi-system | Advanced |
+| 6 | NOF Fracture — Post-op Day 1 | 🦴 Musculoskeletal | Intermediate |
+| 7 | Severe Preeclampsia | 🤰 Maternal | Advanced |
+| 8 | Paediatric Febrile Convulsion | 👶 Paediatric | Beginner |
+| 9 | Paracetamol Overdose (DSH) | 🧪 Toxicology / Mental Health | Intermediate |
+| 10 | Acute Kidney Injury (Prerenal AKI) | 🫘 Renal | Intermediate |
+
+## How to Use
+
+1. **Browse** the Case Library and click **Open →** on any scenario
+2. **Read** the Full Case to understand the clinical picture
+3. **Work through** ADPIE Reasoning — write your answers before revealing the model
+4. **Test yourself** with Quiz Questions and review rationales
+5. **Build** a structured Care Plan and download it as a text file
+
+## Tech Stack
+
+- [Streamlit](https://streamlit.io/) — frontend framework
+- Pure Python — no API keys or external services required
+- All case data is locally curated for nursing education
+
+## Part of the Student Nurse Toolkit
+
+This tool is part of a free suite of nursing education apps:
+- [EBP Research Tool](https://huggingface.co/spaces/NurseCitizenDeveloper/nursing-ebp-tool)
+- [Drug Card Generator](https://huggingface.co/spaces/NurseCitizenDeveloper/nursing-drug-cards)
+- [NCLEX Prep](https://huggingface.co/spaces/NurseCitizenDeveloper/nclex-prep)
+- [Medication Safety Checker](https://huggingface.co/spaces/NurseCitizenDeveloper/medication-safety)
+- **Case Study Builder** ← you are here
+
+---
+*Built for student nurses. Educational use only — not a substitute for clinical training or professional judgment.*

cases/bank.py

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+"""
+Nursing Case Study Bank
+10 detailed patient scenarios covering major body systems.
+For educational purposes only.
+"""
+
+CASE_BANK = [
+
+    # ── 1. CARDIOVASCULAR — STEMI ──────────────────────────────────────────
+    {
+        "id": "case_001",
+        "title": "Crushing Chest Pain: STEMI",
+        "category": "Cardiovascular",
+        "difficulty": "Intermediate",
+        "tags": ["MI", "STEMI", "chest pain", "cardiovascular", "emergency"],
+        "learning_objectives": [
+            "Recognise clinical presentation of STEMI",
+            "Prioritise immediate nursing interventions (MONA)",
+            "Understand reperfusion therapy urgency (door-to-balloon < 90 min)",
+            "Monitor for complications: arrhythmias, cardiogenic shock",
+            "Provide appropriate patient and family education",
+        ],
+        "patient": {
+            "name": "Mr. Robert Chen",
+            "age": 64,
+            "gender": "Male",
+            "weight_kg": 92,
+            "height_cm": 176,
+            "allergies": ["Penicillin (rash)"],
+            "pmhx": ["Hypertension (10 years)", "Type 2 Diabetes Mellitus", "Hyperlipidaemia", "Ex-smoker"],
+            "medications": [
+                "Metformin 1000 mg BD",
+                "Atorvastatin 40 mg nocte",
+                "Amlodipine 5 mg daily",
+                "Aspirin 100 mg daily",
+            ],
+            "social": "Retired teacher. Lives with wife. Smoked 20/day for 30 years, quit 5 years ago. Occasional alcohol.",
+            "family_hx": "Father died of MI at age 58. Mother has T2DM.",
+        },
+        "presentation": (
+            "Mr. Chen is brought to ED by ambulance at 14:30. He describes sudden onset crushing "
+            "central chest pain radiating to his left arm and jaw, rated 9/10, starting 90 minutes ago "
+            "while mowing the lawn. He is diaphoretic, pale, and nauseated. Wife confirms he took one "
+            "GTN tablet at home with no relief."
+        ),
+        "vitals": {
+            "BP": "158/96 mmHg",
+            "HR": "104 bpm (irregular)",
+            "RR": "22 breaths/min",
+            "SpO2": "93% on room air",
+            "Temp": "36.8°C",
+            "Pain": "9/10",
+            "GCS": "15",
+            "BSL": "14.2 mmol/L",
+        },
+        "physical_exam": (
+            "Patient appears anxious and diaphoretic. Skin pale and clammy. "
+            "Heart sounds: S1, S2 present; no murmurs. Crackles at lung bases bilaterally. "
+            "JVP mildly elevated. Peripheral pulses present. No peripheral oedema."
+        ),
+        "investigations": {
+            "ECG": "ST elevation in leads II, III, aVF (inferior STEMI). Reciprocal ST depression in I, aVL.",
+            "Troponin I": "3.8 ng/mL (↑↑ normal < 0.04)",
+            "CK-MB": "68 U/L (↑ normal < 25)",
+            "BNP": "420 pg/mL (↑)",
+            "FBC": "Hb 138 g/L, WCC 11.2 × 10⁹/L",
+            "UEC": "Na 138, K 4.1, Cr 102 μmol/L",
+            "Glucose": "14.2 mmol/L",
+            "Lipids": "Total cholesterol 6.8 mmol/L, LDL 4.2 mmol/L",
+            "CXR": "Mild cardiomegaly. Early pulmonary oedema.",
+        },
+        "medical_diagnosis": "Inferior ST-Elevation Myocardial Infarction (STEMI)",
+        "nursing_priorities": [
+            "Immediate 12-lead ECG and cardiac monitoring",
+            "Establish IV access × 2 large-bore",
+            "Administer O₂ if SpO₂ < 94% — target 94–98%",
+            "Administer MONA: Morphine, Oxygen, Nitrates, Aspirin (per protocol)",
+            "Prepare for urgent PCI (door-to-balloon < 90 minutes)",
+            "Continuous cardiac monitoring — watch for arrhythmias",
+            "Maintain patient rest — reduce myocardial O₂ demand",
+            "Monitor haemodynamic status — watch for cardiogenic shock",
+        ],
+        "nursing_diagnoses": [
+            {
+                "diagnosis": "Acute Pain related to myocardial ischaemia",
+                "evidence": "Patient reports 9/10 crushing chest pain, diaphoresis, facial grimacing",
+                "goal": "Patient reports pain ≤ 3/10 within 30 minutes of intervention",
+                "interventions": [
+                    "Administer GTN SL (if SBP > 90 mmHg) per protocol",
+                    "Administer IV morphine titrated to pain per medical order",
+                    "Position patient in semi-Fowler's to reduce preload",
+                    "Reassess pain score every 15 minutes",
+                    "Provide calm reassurance to reduce anxiety-induced sympathetic stimulation",
+                ],
+            },
+            {
+                "diagnosis": "Decreased Cardiac Output related to myocardial injury",
+                "evidence": "Tachycardia 104 bpm, SpO₂ 93%, elevated BNP, pulmonary oedema on CXR",
+                "goal": "Haemodynamic stability: MAP > 65 mmHg, HR 60–100 bpm, SpO₂ ≥ 94%",
+                "interventions": [
+                    "Continuous cardiac monitoring — 12-lead ECG on admission",
+                    "Monitor vital signs every 15 minutes",
+                    "Apply O₂ to target SpO₂ 94–98%",
+                    "Ensure IV access — prepare for urgent PCI",
+                    "Monitor for signs of cardiogenic shock: ↓ BP, ↓ UO, altered LOC",
+                    "Restrict fluids if signs of pulmonary oedema",
+                ],
+            },
+            {
+                "diagnosis": "Anxiety related to acute illness and fear of death",
+                "evidence": "Patient appears anxious; high-acuity cardiac event",
+                "goal": "Patient verbalises reduced anxiety and understands planned treatment",
+                "interventions": [
+                    "Explain all procedures clearly and calmly",
+                    "Allow family member to stay if appropriate",
+                    "Administer anxiolytic per protocol if needed",
+                    "Reassure patient that team is taking immediate action",
+                ],
+            },
+        ],
+        "adpie": {
+            "assessment": (
+                "Subjective: 9/10 crushing chest pain to left arm and jaw, nausea, diaphoresis. "
+                "Objective: HR 104 irregular, BP 158/96, SpO₂ 93%, ECG showing inferior ST elevation, "
+                "Troponin I 3.8 ng/mL (markedly elevated), crackles at lung bases."
+            ),
+            "diagnosis": (
+                "1. Acute Pain r/t myocardial ischaemia AEB 9/10 pain, diaphoresis.\n"
+                "2. Decreased Cardiac Output r/t myocardial injury AEB tachycardia, low SpO₂.\n"
+                "3. Anxiety r/t acute illness AEB restlessness and verbalised fear."
+            ),
+            "planning": (
+                "Short-term: Pain ≤ 3/10 within 30 min; SpO₂ ≥ 94%; HR < 100 bpm.\n"
+                "Long-term: Patient undergoes successful PCI; understands cardiac rehab; "
+                "modifies risk factors (diet, exercise, medication adherence)."
+            ),
+            "implementation": (
+                "• Applied O₂ via Hudson mask at 6 L/min — SpO₂ improved to 96%.\n"
+                "• IV access × 2 established — bloods taken, fluids connected.\n"
+                "• GTN 400 mcg SL given — partial relief; morphine 2.5 mg IV titrated to pain 4/10.\n"
+                "• Aspirin 300 mg PO loading dose given per protocol.\n"
+                "• Continuous cardiac monitoring applied — telemetry for PVCs noted.\n"
+                "• Catheterisation lab notified — door-to-balloon time tracking initiated.\n"
+                "• Family updated; patient's anxiety visibly reduced after explanation."
+            ),
+            "evaluation": (
+                "Pain reduced to 4/10 within 20 minutes. SpO₂ 96% on O₂. HR 98 bpm, BP 142/88. "
+                "Patient transferred to catheterisation lab at 15:08 — door-to-balloon time 38 minutes. "
+                "PCI performed successfully. Post-procedure: haemodynamically stable, pain free."
+            ),
+        },
+    },
+
+    # ── 2. RESPIRATORY — ACUTE ASTHMA ─────────────────────────────────────
+    {
+        "id": "case_002",
+        "title": "Acute Severe Asthma Exacerbation",
+        "category": "Respiratory",
+        "difficulty": "Intermediate",
+        "tags": ["asthma", "respiratory", "bronchospasm", "wheeze", "emergency"],
+        "learning_objectives": [
+            "Assess severity of asthma using PEFR and clinical signs",
+            "Administer stepwise bronchodilator therapy",
+            "Recognise life-threatening asthma (silent chest, cyanosis)",
+            "Monitor response to treatment and escalate appropriately",
+            "Provide asthma action plan education",
+        ],
+        "patient": {
+            "name": "Ms. Aisha Patel",
+            "age": 28,
+            "gender": "Female",
+            "weight_kg": 62,
+            "height_cm": 163,
+            "allergies": ["NSAIDs (bronchospasm)", "Cats"],
+            "pmhx": ["Asthma since childhood", "Eczema", "Allergic rhinitis"],
+            "medications": [
+                "Salbutamol 100 mcg puffer PRN",
+                "Fluticasone/salmeterol 250/25 mcg 1 puff BD",
+                "Cetirizine 10 mg nocte",
+            ],
+            "social": "Schoolteacher. Non-smoker. Lives in apartment with cat. Recently started new cleaning products at work.",
+            "family_hx": "Mother has asthma. Father has hay fever.",
+        },
+        "presentation": (
+            "Ms. Patel presents to ED at 22:15 unable to complete sentences. She has been wheezing "
+            "for 4 hours, progressively worsening since visiting a friend's home who has two cats. "
+            "Used salbutamol puffer 8 times in the last 2 hours with minimal relief. Appears frightened "
+            "and is leaning forward in tripod position."
+        ),
+        "vitals": {
+            "BP": "138/82 mmHg",
+            "HR": "118 bpm",
+            "RR": "28 breaths/min",
+            "SpO2": "89% on room air",
+            "Temp": "37.0°C",
+            "Pain": "0/10 (dyspnoea 8/10)",
+            "GCS": "15",
+            "PEFR": "38% of predicted",
+        },
+        "physical_exam": (
+            "Patient in obvious respiratory distress. Using accessory muscles (sternocleidomastoid, intercostals). "
+            "Tripod position. Unable to complete full sentences. Widespread bilateral expiratory and inspiratory wheeze. "
+            "Prolonged expiratory phase. No cyanosis. No stridor."
+        ),
+        "investigations": {
+            "PEFR": "38% of predicted (severe: < 50%)",
+            "ABG": "pH 7.48, pCO₂ 32 mmHg, pO₂ 58 mmHg, HCO₃ 24 — respiratory alkalosis + hypoxaemia",
+            "FBC": "WCC 13.2 × 10⁹/L (stress response), Eosinophils 0.8",
+            "CXR": "Hyperinflated lungs. No consolidation. No pneumothorax.",
+            "ECG": "Sinus tachycardia 118 bpm",
+            "Theophylline level": "Not applicable (not on theophylline)",
+        },
+        "medical_diagnosis": "Acute Severe Asthma Exacerbation",
+        "nursing_priorities": [
+            "High-flow O₂ immediately — target SpO₂ 93–95%",
+            "Back-to-back salbutamol nebulisers (2.5–5 mg) every 20 min × 3",
+            "Ipratropium bromide nebuliser added for severe exacerbation",
+            "Oral/IV prednisolone (or hydrocortisone IV) per protocol",
+            "Continuous SpO₂ monitoring and frequent PEFR reassessment",
+            "Keep patient upright (sitting forward) — optimise respiratory mechanics",
+            "Prepare for escalation: IV magnesium sulphate, HDU/ICU if no improvement",
+            "Reassess every 15–20 minutes",
+        ],
+        "nursing_diagnoses": [
+            {
+                "diagnosis": "Impaired Gas Exchange related to bronchospasm and mucus plugging",
+                "evidence": "SpO₂ 89%, RR 28, ABG shows hypoxaemia, widespread wheeze",
+                "goal": "SpO₂ ≥ 93%, RR < 20, PEFR > 50% predicted within 1 hour",
+                "interventions": [
+                    "Apply O₂ 6–8 L/min via face mask — titrate to SpO₂ 93–95%",
+                    "Administer salbutamol 5 mg + ipratropium 0.5 mg via nebuliser",
+                    "Position: high Fowler's or forward-leaning (tripod)",
+                    "Monitor SpO₂ continuously, PEFR every 20 minutes",
+                    "Prepare IV magnesium sulphate 2 g over 20 min if no improvement",
+                ],
+            },
+            {
+                "diagnosis": "Ineffective Breathing Pattern related to airway obstruction",
+                "evidence": "Accessory muscle use, prolonged expiratory phase, RR 28, PEFR 38%",
+                "goal": "RR 12–20, accessory muscle use reduced, patient able to speak in sentences",
+                "interventions": [
+                    "Coach pursed-lip breathing to prolong exhalation",
+                    "Ensure calm, quiet environment to reduce anxiety and O₂ demand",
+                    "Administer corticosteroids (prednisolone 50 mg PO / hydrocortisone 200 mg IV)",
+                    "Repeat PEFR 15–20 minutes post-bronchodilator",
+                ],
+            },
+        ],
+        "adpie": {
+            "assessment": (
+                "Subjective: 4-hour history of worsening wheeze, dyspnoea 8/10, unable to finish sentences, "
+                "8 × salbutamol puffs with no relief. Objective: SpO₂ 89%, RR 28, HR 118, "
+                "PEFR 38%, accessory muscles, bilateral wheeze."
+            ),
+            "diagnosis": (
+                "1. Impaired Gas Exchange r/t bronchospasm AEB SpO₂ 89%, ABG hypoxaemia.\n"
+                "2. Ineffective Breathing Pattern r/t airway obstruction AEB accessory muscles, RR 28.\n"
+                "3. Anxiety r/t breathing difficulty AEB frightened appearance."
+            ),
+            "planning": (
+                "SpO₂ ≥ 93% within 30 min; PEFR > 50% within 60 min; "
+                "RR < 20; patient able to speak in full sentences."
+            ),
+            "implementation": (
+                "• O₂ 8 L/min via face mask applied — SpO₂ improved to 94%.\n"
+                "• Salbutamol 5 mg + ipratropium 0.5 mg nebulised — 3 doses 20 min apart.\n"
+                "• Prednisolone 50 mg PO given.\n"
+                "• Reassurance provided, calm environment maintained.\n"
+                "• PEFR measured at 20 min intervals: 38% → 52% → 61%."
+            ),
+            "evaluation": (
+                "After 60 minutes: SpO₂ 96% on 4 L O₂, PEFR 61%, RR 18, HR 96. "
+                "Speaking in full sentences. Wheeze reduced. Admitted to ward for observation. "
+                "Asthma action plan discussed before discharge."
+            ),
+        },
+    },
+
+    # ── 3. ENDOCRINE — DKA ────────────────────────────────────────────────
+    {
+        "id": "case_003",
+        "title": "Diabetic Ketoacidosis (DKA)",
+        "category": "Endocrine",
+        "difficulty": "Advanced",
+        "tags": ["DKA", "diabetes", "endocrine", "ketoacidosis", "insulin"],
+        "learning_objectives": [
+            "Identify DKA diagnostic criteria (BSL, ketones, pH)",
+            "Manage IV fluid resuscitation protocol",
+            "Administer insulin infusion safely — monitor potassium closely",
+            "Monitor for DKA complications: cerebral oedema, hypokalaemia",
+            "Identify and address precipitating factors",
+        ],
+        "patient": {
+            "name": "Ms. Emily Thornton",
+            "age": 19,
+            "gender": "Female",
+            "weight_kg": 58,
+            "height_cm": 168,
+            "allergies": ["NKDA"],
+            "pmhx": ["Type 1 Diabetes Mellitus (since age 9)"],
+            "medications": [
+                "Insulin glargine 20 units nocte",
+                "Insulin aspart sliding scale with meals",
+            ],
+            "social": "First-year university student. Lives in student accommodation. Recently had gastroenteritis — unable to eat for 2 days. Forgot to take insulin.",
+            "family_hx": "Nil relevant.",
+        },
+        "presentation": (
+            "Emily is brought to ED by her roommate at 03:00. She has been vomiting for 36 hours "
+            "and is confused and lethargic. Her roommate reports she has been breathing strangely "
+            "('like she can't catch her breath') and there is a fruity smell on her breath. "
+            "She omitted her insulin for 2 days as she wasn't eating."
+        ),
+        "vitals": {
+            "BP": "98/62 mmHg (lying)",
+            "HR": "124 bpm",
+            "RR": "28 breaths/min (Kussmaul)",
+            "SpO2": "97% on room air",
+            "Temp": "37.4°C",
+            "Pain": "5/10 (abdominal)",
+            "GCS": "13 (E3 V4 M6)",
+            "BSL": "28.4 mmol/L",
+        },
+        "physical_exam": (
+            "Patient is drowsy and confused. Dry mucous membranes, sunken eyes, poor skin turgor — "
+            "estimated 10% dehydration. Tachycardic. Kussmaul respirations (deep and rapid). "
+            "Fruity/acetone breath. Diffuse abdominal tenderness. No peritonism."
+        ),
+        "investigations": {
+            "BSL": "28.4 mmol/L",
+            "Blood ketones": "5.8 mmol/L (↑↑ normal < 0.6)",
+            "ABG": "pH 7.18, pCO₂ 18 mmHg, pO₂ 98 mmHg, HCO₃ 8 mmol/L — severe metabolic acidosis",
+            "Anion Gap": "30 (↑ normal 8–12)",
+            "UEC": "Na 132, K 5.8 (↑ — due to acidosis shift), Cr 118 μmol/L",
+            "Urine ketones": "4+ (strongly positive)",
+            "FBC": "WCC 18.4 (stress leucocytosis), Hb 132",
+            "HbA1c": "11.2% (↑↑ poor glycaemic control)",
+            "Lipase": "Normal",
+            "ECG": "Sinus tachycardia. Peaked T waves (hyperkalaemia).",
+        },
+        "medical_diagnosis": "Diabetic Ketoacidosis (DKA) — severe (pH < 7.2)",
+        "nursing_priorities": [
+            "URGENT IV fluid resuscitation: 0.9% NaCl 1 L over 1 hour",
+            "Commence insulin infusion — DO NOT start until K⁺ ≥ 3.5 mmol/L",
+            "Hourly potassium monitoring — replace aggressively as insulin drives K⁺ into cells",
+            "Strict fluid balance — IDC for accurate urine output monitoring",
+            "Hourly BSL, 2-hourly blood ketones and ABG",
+            "Continuous cardiac monitoring — hyperkalaemia/hypokalaemia arrhythmia risk",
+            "Neurological observations — watch for cerebral oedema (↓GCS, headache, vomiting)",
+            "NG tube if GCS < 13 (airway protection, vomiting)",
+        ],
+        "nursing_diagnoses": [
+            {
+                "diagnosis": "Deficient Fluid Volume related to osmotic diuresis and vomiting",
+                "evidence": "BP 98/62, HR 124, dry mucous membranes, estimated 10% dehydration",
+                "goal": "BP > 100/60, HR < 100, urine output ≥ 0.5 mL/kg/hr within 2 hours",
+                "interventions": [
+                    "Administer 0.9% NaCl 1 L stat, then 1 L/hr × 2 hours per DKA protocol",
+                    "Insert IDC — monitor hourly urine output",
+                    "Monitor vital signs every 30 minutes",
+                    "Accurate intake/output chart",
+                    "Assess skin turgor, mucous membranes hourly",
+                ],
+            },
+            {
+                "diagnosis": "Imbalanced Nutrition / Risk for Electrolyte Imbalance",
+                "evidence": "K⁺ 5.8 (acidosis shift — will drop rapidly with insulin), HCO₃ 8",
+                "goal": "K⁺ maintained 3.5–5.5 mmol/L; pH > 7.3 within 12 hours",
+                "interventions": [
+                    "DO NOT start insulin until K⁺ ≥ 3.5 — risk of fatal hypokalaemia",
+                    "Commence KCl replacement as per DKA protocol once insulin started",
+                    "Hourly potassium levels while on insulin infusion",
+                    "Continuous ECG monitoring for arrhythmias",
+                    "Administer sodium bicarbonate only if pH < 7.0 per protocol",
+                ],
+            },
+            {
+                "diagnosis": "Acute Confusion related to cerebral effects of acidosis and dehydration",
+                "evidence": "GCS 13, confused, lethargic",
+                "goal": "GCS returns to 15 within 6 hours as metabolic derangement corrects",
+                "interventions": [
+                    "Neurological observations hourly (GCS, pupils)",
+                    "Reorient patient frequently",
+                    "Raise bed rails — fall prevention",
+                    "Alert medical team immediately if GCS drops ≥ 2 points — cerebral oedema risk",
+                    "Avoid rapid fluid correction (risk of cerebral oedema)",
+                ],
+            },
+        ],
+        "adpie": {
+            "assessment": (
+                "Subjective: 36-hour vomiting, omitted insulin 2 days, abdominal pain. "
+                "Objective: BSL 28.4, ketones 5.8, pH 7.18, BP 98/62, HR 124, GCS 13, "
+                "Kussmaul respirations, fruity breath, 10% dehydration."
+            ),
+            "diagnosis": (
+                "1. Deficient Fluid Volume r/t osmotic diuresis AEB hypotension, tachycardia, dry mucous membranes.\n"
+                "2. Risk for Electrolyte Imbalance r/t insulin-potassium shift AEB K⁺ 5.8 (will drop with insulin).\n"
+                "3. Acute Confusion r/t acidosis and dehydration AEB GCS 13."
+            ),
+            "planning": (
+                "Fluid resuscitation to restore haemodynamic stability within 2 hours. "
+                "Safe insulin infusion with hourly K⁺ monitoring. "
+                "Ketones < 0.5, pH > 7.3 within 12 hours. GCS 15 within 6 hours."
+            ),
+            "implementation": (
+                "• IV 0.9% NaCl 1 L over 1 hour commenced — BP improved to 108/70 after 1 hour.\n"
+                "• Insulin infusion commenced at 0.1 units/kg/hr after K⁺ confirmed ≥ 3.5.\n"
+                "• KCl replacement added to IV fluids as per DKA sliding scale.\n"
+                "• IDC inserted — urine output 40 mL/hr after fluid resuscitation.\n"
+                "• Hourly BSL, 2-hourly ketones, continuous ECG monitoring.\n"
+                "• Family updated; patient reoriented regularly."
+            ),
+            "evaluation": (
+                "At 6 hours: BSL 14.2 mmol/L, ketones 1.8 mmol/L, pH 7.28, K⁺ 3.9, BP 118/76, "
+                "HR 98, GCS 15. At 12 hours: ketones cleared, pH 7.36, patient eating. "
+                "Diabetes educator consulted. Sick-day management plan provided."
+            ),
+        },
+    },
+
+    # ── 4. NEUROLOGICAL — STROKE (CVA) ────────────────────────────────────
+    {
+        "id": "case_004",
+        "title": "Acute Ischaemic Stroke",
+        "category": "Neurological",
+        "difficulty": "Advanced",
+        "tags": ["stroke", "CVA", "neurological", "tPA", "FAST", "thrombolysis"],
+        "learning_objectives": [
+            "Apply FAST/BE-FAST stroke recognition tool",
+            "Understand time-critical thrombolysis window (< 4.5 hours)",
+            "Perform accurate neurological assessment (NIH Stroke Scale)",
+            "Monitor for post-tPA haemorrhagic transformation",
+            "Prevent aspiration — nil by mouth until formal swallow assessment",
+        ],
+        "patient": {
+            "name": "Mrs. Joan McAllister",
+            "age": 72,
+            "gender": "Female",
+            "weight_kg": 74,
+            "height_cm": 161,
+            "allergies": ["Sulfonamides"],
+            "pmhx": ["Atrial Fibrillation", "Hypertension", "Hyperlipidaemia", "Previous TIA 3 years ago"],
+            "medications": [
+                "Apixaban 5 mg BD",
+                "Perindopril 4 mg daily",
+                "Rosuvastatin 20 mg nocte",
+            ],
+            "social": "Retired nurse. Widowed. Lives alone. Independent ADLs. Last seen well 1.5 hours ago by neighbour.",
+            "family_hx": "Sister had stroke at age 68.",
+        },
+        "presentation": (
+            "Mrs. McAllister is brought to ED by ambulance at 09:45. Her neighbour found her on the "
+            "kitchen floor at 09:30. She has right-sided facial droop, right arm weakness (cannot raise "
+            "arm above shoulder), and slurred speech. She appears confused about the date but knows her name. "
+            "Last known well: 08:15 (spoke to neighbour on phone)."
+        ),
+        "vitals": {
+            "BP": "186/104 mmHg",
+            "HR": "88 bpm (irregular — AF)",
+            "RR": "18 breaths/min",
+            "SpO2": "96% on room air",
+            "Temp": "37.1°C",
+            "Pain": "0/10 (headache 3/10)",
+            "GCS": "13 (E4 V3 M6)",
+            "BSL": "8.6 mmol/L",
+        },
+        "physical_exam": (
+            "Right facial droop (lower face). Right arm drift positive — arm falls within 10 seconds. "
+            "Right leg mild weakness. Speech dysarthric. No aphasia — comprehension intact. "
+            "NIHSS score: 8 (moderate stroke). Pupils equal and reactive. No neck stiffness. "
+            "Irregular rhythm on auscultation (AF)."
+        ),
+        "investigations": {
+            "CT Brain (non-contrast)": "No haemorrhage. Early ischaemic changes in left MCA territory.",
+            "CT Angiography": "Partial occlusion left middle cerebral artery (MCA)",
+            "NIHSS": "8 — moderate stroke",
+            "ECG": "Atrial fibrillation. Rate 88 bpm.",
+            "FBC": "Hb 128 g/L, Platelets 224 × 10⁹/L",
+            "Coagulation": "INR 1.1 (apixaban — anti-Xa not routinely measured)",
+            "UEC": "Na 139, K 4.0, Cr 88 μmol/L",
+            "BSL": "8.6 mmol/L",
+            "Lipids": "LDL 3.4 mmol/L",
+        },
+        "medical_diagnosis": "Acute Ischaemic Stroke — Left MCA territory (NIHSS 8)",
+        "nursing_priorities": [
+            "TIME CRITICAL — establish onset-to-door time, activate stroke pathway",
+            "NIL BY MOUTH until formal swallow screen completed",
+            "Maintain BP 140–180 mmHg (do NOT lower aggressively pre-tPA)",
+            "Position: HOB 0° (flat) initially to maximise cerebral perfusion",
+            "Continuous neurological observations — NIHSS, GCS, pupils every 15 min",
+            "IV access × 2 — bloods per stroke protocol",
+            "BSL monitoring — target 4–11 mmol/L (hypo/hyperglycaemia worsen outcomes)",
+            "Prepare for thrombolysis (tPA) or endovascular thrombectomy — if eligible",
+        ],
+        "nursing_diagnoses": [
+            {
+                "diagnosis": "Ineffective Cerebral Tissue Perfusion related to MCA occlusion",
+                "evidence": "NIHSS 8, right-sided weakness, facial droop, dysarthria, BP 186/104",
+                "goal": "No neurological deterioration; NIHSS improves or stabilises within 24 hours",
+                "interventions": [
+                    "HOB flat (0°) to maintain cerebral perfusion pressure",
+                    "Do NOT lower BP aggressively unless > 220 mmHg (or > 185 if tPA candidate)",
+                    "15-minutely neuro obs: GCS, NIHSS, pupillary response",
+                    "Monitor for signs of haemorrhagic transformation post-tPA: ↓GCS, new headache, vomiting",
+                    "Maintain BSL 4–11 mmol/L",
+                ],
+            },
+            {
+                "diagnosis": "Risk for Aspiration related to dysphagia secondary to stroke",
+                "evidence": "Dysarthria, reduced GCS, neurological deficits — high aspiration risk",
+                "goal": "No aspiration event; formal swallow screen completed before any oral intake",
+                "interventions": [
+                    "NIL BY MOUTH until speech pathology swallow assessment",
+                    "Position: lateral/semi-prone if vomiting risk",
+                    "NG tube for medications and hydration if swallow impaired",
+                    "Oral suctioning available at bedside",
+                    "Head of bed 30° once haemodynamic goals met",
+                ],
+            },
+            {
+                "diagnosis": "Impaired Physical Mobility related to right-sided hemiparesis",
+                "evidence": "Right arm weakness, right leg weakness, right facial droop",
+                "goal": "No skin breakdown; commence physiotherapy within 24 hours",
+                "interventions": [
+                    "Pressure injury prevention: 2-hourly repositioning",
+                    "Heel protectors applied",
+                    "Limb positioning to prevent contractures",
+                    "VTE prophylaxis per protocol",
+                    "Early physiotherapy and occupational therapy referral",
+                ],
+            },
+        ],
+        "adpie": {
+            "assessment": (
+                "Subjective: Headache 3/10, confusion (knows name, not date). "
+                "Objective: Right facial droop, right arm/leg weakness, dysarthria, NIHSS 8, "
+                "BP 186/104, AF on ECG, CT — left MCA ischaemia, last known well 1.5 hours ago."
+            ),
+            "diagnosis": (
+                "1. Ineffective Cerebral Tissue Perfusion r/t MCA occlusion AEB NIHSS 8, hemiparesis.\n"
+                "2. Risk for Aspiration r/t dysphagia AEB dysarthria, reduced GCS.\n"
+                "3. Impaired Physical Mobility r/t hemiparesis AEB arm/leg weakness."
+            ),
+            "planning": (
+                "Activate stroke pathway — tPA within 4.5 hours of onset. "
+                "Prevent aspiration until swallow screen. "
+                "NIHSS monitoring every 15 min. Commence rehab within 24 hours."
+            ),
+            "implementation": (
+                "• Stroke pathway activated — neurology notified at 09:48.\n"
+                "• CT Brain completed at 10:02 — no haemorrhage confirmed.\n"
+                "• tPA (alteplase) administered at 10:18 — door-to-needle time 33 minutes.\n"
+                "• BP managed: avoided antihypertensives while tPA infusing.\n"
+                "• Nil by mouth — NG tube inserted for medications.\n"
+                "• Neurological observations every 15 minutes.\n"
+                "• Speech pathology, physiotherapy, OT referrals placed."
+            ),
+            "evaluation": (
+                "At 24 hours: NIHSS improved to 4. Right arm strength improving. "
+                "Speech clearer. Swallow screen passed (modified diet). "
+                "No haemorrhagic transformation on repeat CT. Transferred to stroke unit."
+            ),
+        },
+    },
+
+    # ── 5. SEPSIS ─────────────────────────────────────────────────────────
+    {
+        "id": "case_005",
+        "title": "Septic Shock — Urinary Source",
+        "category": "Multi-system / Infectious",
+        "difficulty": "Advanced",
+        "tags": ["sepsis", "septic shock", "infection", "qSOFA", "Sepsis-3", "antibiotics"],
+        "learning_objectives": [
+            "Apply Sepsis-3 criteria and qSOFA screening tool",
+            "Implement Sepsis 1-Hour Bundle (blood cultures, antibiotics, fluids)",
+            "Monitor haemodynamic response to resuscitation",
+            "Understand vasopressor use in septic shock",
+            "Prevent secondary complications: AKI, ventilator-associated pneumonia",
+        ],
+        "patient": {
+            "name": "Mr. Harold Stevens",
+            "age": 78,
+            "gender": "Male",
+            "weight_kg": 68,
+            "height_cm": 170,
+            "allergies": ["Cephalosporins (anaphylaxis)"],
+            "pmhx": ["Benign Prostatic Hyperplasia", "Chronic Kidney Disease (Stage 3)", "Hypertension", "Type 2 Diabetes"],
+            "medications": [
+                "Tamsulosin 0.4 mg nocte",
+                "Metformin 500 mg BD (held — CKD)",
+                "Ramipril 5 mg daily",
+                "Insulin glargine 14 units nocte",
+            ],
+            "social": "Retired farmer. Lives with wife. IDC in situ (inserted 4 days ago at GP for urinary retention).",
+            "family_hx": "Nil relevant.",
+        },
+        "presentation": (
+            "Mr. Stevens is brought to ED by his wife at 16:20. She reports he has been 'not himself' "
+            "for 24 hours — drowsy, confused, not eating. He developed rigors and fever this afternoon. "
+            "Urine from his IDC is cloudy and malodorous. Wife says he was well last week."
+        ),
+        "vitals": {
+            "BP": "82/50 mmHg",
+            "HR": "118 bpm",
+            "RR": "24 breaths/min",
+            "SpO2": "94% on room air",
+            "Temp": "39.4°C",
+            "Pain": "3/10 (suprapubic)",
+            "GCS": "12 (E3 V3 M6)",
+            "BSL": "18.6 mmol/L",
+            "UO": "20 mL over last 2 hours (oliguria)",
+        },
+        "physical_exam": (
+            "Patient appears unwell, flushed and diaphoretic. Confused — knows name only. "
+            "Warm, vasodilated peripheries. Capillary refill 3 seconds. Suprapubic tenderness. "
+            "IDC in situ — bag contains 100 mL cloudy, dark urine. "
+            "No crepitations. Abdomen soft. No rigidity."
+        ),
+        "investigations": {
+            "qSOFA score": "3/3 (↓BP, ↑RR, altered mentation) — HIGH RISK SEPSIS",
+            "SOFA score": "8 — organ dysfunction × 3 systems",
+            "Lactate": "4.8 mmol/L (↑↑ — > 4 = septic shock)",
+            "FBC": "WCC 24.6 × 10⁹/L, Neutrophils 22.1, Hb 106 g/L",
+            "CRP": "348 mg/L (↑↑)",
+            "Procalcitonin": "28.4 ng/mL (↑↑)",
+            "UEC": "Na 134, K 5.2, Cr 248 μmol/L (↑ — baseline Cr 132), Urea 22.4",
+            "LFTs": "ALT mildly elevated",
+            "Coagulation": "PT 16.2 s, APTT 42 s, Fibrinogen 1.8 g/L (↓)",
+            "Blood cultures × 2": "Pending (collected before antibiotics)",
+            "MSU/catheter urine": "WCC > 10⁸, Gram-negative rods (presumed E. coli)",
+            "CXR": "No consolidation. Mild cardiomegaly.",
+        },
+        "medical_diagnosis": "Septic Shock — catheter-associated urinary tract infection (CAUTI)",
+        "nursing_priorities": [
+            "SEPSIS PATHWAY — 1-HOUR BUNDLE",
+            "Blood cultures × 2 sets BEFORE antibiotics",
+            "IV fluid resuscitation: 30 mL/kg crystalloid (0.9% NaCl or Hartmann's) STAT",
+            "IV antibiotics WITHIN 1 HOUR — per allergy/local protocol (avoid cephalosporins)",
+            "Measure serial lactates — target < 2 mmol/L",
+            "IDC output — strict hourly urine output (target ≥ 0.5 mL/kg/hr)",
+            "Consider vasopressors (noradrenaline) if MAP < 65 mmHg despite fluids",
+            "Continuous cardiac monitoring, ICU review",
+        ],
+        "nursing_diagnoses": [
+            {
+                "diagnosis": "Ineffective Tissue Perfusion (multi-organ) related to septic shock",
+                "evidence": "BP 82/50, lactate 4.8, oliguria 10 mL/hr, GCS 12, Cr 248",
+                "goal": "MAP ≥ 65 mmHg, lactate < 2, UO ≥ 0.5 mL/kg/hr within 3 hours",
+                "interventions": [
+                    "IV 0.9% NaCl 30 mL/kg (2040 mL) over 3 hours — reassess after each 500 mL",
+                    "Noradrenaline infusion via central line if MAP < 65 after fluids",
+                    "2-hourly lactate clearance measurement",
+                    "Strict hourly urine output — target ≥ 34 mL/hr",
+                    "Continuous cardiac monitoring",
+                ],
+            },
+            {
+                "diagnosis": "Hyperthermia related to systemic infection",
+                "evidence": "Temp 39.4°C, rigors, WCC 24.6, CRP 348",
+                "goal": "Temperature < 38.5°C within 2 hours",
+                "interventions": [
+                    "Administer paracetamol 1 g IV/PO per protocol",
+                    "Cooling blanket or ice packs to axillae/groin",
+                    "Ensure adequate hydration",
+                    "Temperature monitoring every 1–2 hours",
+                    "Remove IDC and replace with new IDC or suprapubic catheter",
+                ],
+            },
+        ],
+        "adpie": {
+            "assessment": (
+                "Subjective: 24-hour confusion, anorexia, rigors, 4-day IDC for urinary retention. "
+                "Objective: BP 82/50, HR 118, Temp 39.4, GCS 12, lactate 4.8, qSOFA 3, "
+                "WCC 24.6, Cr 248 (AKI), cloudy malodorous urine."
+            ),
+            "diagnosis": (
+                "1. Ineffective Tissue Perfusion r/t septic shock AEB BP 82/50, lactate 4.8, oliguria.\n"
+                "2. Hyperthermia r/t systemic infection AEB Temp 39.4, rigors, WCC 24.6.\n"
+                "3. Acute Confusion r/t septic encephalopathy AEB GCS 12."
+            ),
+            "planning": (
+                "1-hour sepsis bundle. MAP ≥ 65 within 3 hours. Lactate clearance ≥ 10%. "
+                "Appropriate antibiotics within 1 hour. Source control (IDC review)."
+            ),
+            "implementation": (
+                "• Blood cultures × 2 collected immediately.\n"
+                "• Meropenem 1 g IV (avoiding cephalosporins per allergy) within 45 minutes.\n"
+                "• IV 0.9% NaCl 2000 mL over 3 hours commenced.\n"
+                "• Noradrenaline 0.05 mcg/kg/min commenced via central line — MAP improved to 68.\n"
+                "• IDC removed; new IDC inserted; urine sent for C&S.\n"
+                "• ICU team notified; patient transferred to ICU.\n"
+                "• Family updated and support provided."
+            ),
+            "evaluation": (
+                "At 3 hours: MAP 68, HR 102, lactate 2.8 (↓ — clearance 42%), UO 38 mL/hr. "
+                "At 12 hours: lactate 1.4, UO improving, GCS 14. "
+                "Blood cultures: E. coli — sensitive to meropenem. Antibiotics rationalised."
+            ),
+        },
+    },
+
+    # ── 6. SURGICAL — POST-OP HIP FRACTURE ────────────────────────────────
+    {
+        "id": "case_006",
+        "title": "Post-Operative Neck of Femur Fracture",
+        "category": "Musculoskeletal / Surgical",
+        "difficulty": "Beginner",
+        "tags": ["hip fracture", "NOF", "orthopaedic", "post-op", "elderly", "falls"],
+        "learning_objectives": [
+            "Perform post-operative assessment using ABCDE approach",
+            "Manage post-operative pain using multimodal analgesia",
+            "Implement VTE prophylaxis and pressure injury prevention",
+            "Promote early mobilisation — key to recovery",
+            "Prevent delirium in elderly post-operative patients",
+        ],
+        "patient": {
+            "name": "Mrs. Betty Kowalski",
+            "age": 83,
+            "gender": "Female",
+            "weight_kg": 56,
+            "height_cm": 154,
+            "allergies": ["Codeine (nausea/vomiting)", "Latex"],
+            "pmhx": ["Osteoporosis", "Hypertension", "Mild cognitive impairment", "Hypothyroidism", "Urinary incontinence"],
+            "medications": [
+                "Alendronate 70 mg weekly",
+                "Calcium carbonate 600 mg BD",
+                "Vitamin D 1000 IU daily",
+                "Perindopril 5 mg daily",
+                "Levothyroxine 50 mcg daily",
+            ],
+            "social": "Widow. Lives alone in home unit. Daughter visits daily. Independent with frame. 1 previous fall this year.",
+            "family_hx": "Mother had hip fracture at age 85.",
+        },
+        "presentation": (
+            "Mrs. Kowalski returned from theatre at 14:30 following right hemiarthroplasty (hip replacement) "
+            "for a right neck of femur fracture sustained in a fall at home yesterday. "
+            "The procedure was performed under spinal anaesthesia with sedation. She is now in the "
+            "orthopaedic ward. She appears drowsy but rousable, and complaining of hip pain."
+        ),
+        "vitals": {
+            "BP": "108/66 mmHg",
+            "HR": "88 bpm",
+            "RR": "16 breaths/min",
+            "SpO2": "94% on room air",
+            "Temp": "36.2°C",
+            "Pain": "7/10 (right hip)",
+            "GCS": "14 (drowsy but oriented to person and place)",
+            "UO": "IDC in situ — 40 mL since returning from theatre (2 hours)",
+        },
+        "physical_exam": (
+            "Patient drowsy but rousable — responds to voice. Right hip: dressing intact, "
+            "wound drain in situ with 80 mL haemoserous drainage. Right leg warm, cap refill 2 sec. "
+            "Pedal pulses present. No distal neurovascular deficit. "
+            "Left leg: normal. Abdomen soft. Bowel sounds present."
+        ),
+        "investigations": {
+            "Post-op FBC": "Hb 86 g/L (↓ from pre-op 112 g/L — surgical blood loss)",
+            "UEC": "Na 138, K 3.8, Cr 92 μmol/L",
+            "Coagulation": "INR 1.2",
+            "CXR": "Clear. No consolidation.",
+            "Right hip X-ray": "Right hemiarthroplasty in situ — satisfactory position",
+        },
+        "medical_diagnosis": "Post-operative Day 0 — Right hemiarthroplasty for right NOF fracture",
+        "nursing_priorities": [
+            "ABCDE post-operative assessment on return from theatre",
+            "Multimodal pain management (paracetamol + NSAID + opioid PRN) — avoid codeine",
+            "VTE prophylaxis: TEDS + enoxaparin (commence Day 1) + early mobilisation",
+            "Pressure injury prevention: 2-hourly repositioning, heel protectors",
+            "Delirium prevention: reorientation, familiar objects, glasses/hearing aids",
+            "Wound drain monitoring — notify if > 200 mL/hour",
+            "Neurovascular observations right leg every 2 hours × 12 hours",
+            "IDC output — may remove IDC at 24–48 hours to reduce UTI risk",
+        ],
+        "nursing_diagnoses": [
+            {
+                "diagnosis": "Acute Pain related to surgical trauma (right hip)",
+                "evidence": "Pain 7/10 right hip, facial grimacing, reluctance to move",
+                "goal": "Pain ≤ 3/10 at rest and ≤ 5/10 with movement within 1 hour",
+                "interventions": [
+                    "Administer paracetamol 1 g QID (if not already given intra-op)",
+                    "Administer opioid analgesia PRN per protocol (avoid codeine — allergy)",
+                    "Position: supine with pillow between knees (hip precautions)",
+                    "Apply ice pack wrapped in cloth to right hip",
+                    "Reassess pain 30–60 minutes after analgesia",
+                ],
+            },
+            {
+                "diagnosis": "Risk for Perioperative Positioning Injury / Neurovascular Compromise",
+                "evidence": "Post-surgical hip — at risk for dislocation, DVT, neurovascular compromise",
+                "goal": "No distal neurovascular deficit; no signs of DVT throughout admission",
+                "interventions": [
+                    "Neurovascular observations (5 Ps) right leg every 2 hours",
+                    "Maintain hip precautions: no hip flexion > 90°, no adduction, no internal rotation",
+                    "TEDS stockings (check for latex allergy — use non-latex TEDs)",
+                    "Enoxaparin per protocol starting Day 1",
+                    "Early mobilisation with physiotherapy Day 1",
+                ],
+            },
+            {
+                "diagnosis": "Risk for Acute Confusion (Delirium) related to anaesthesia, pain, unfamiliar environment",
+                "evidence": "Age 83, mild cognitive impairment, post-op drowsiness, pain",
+                "goal": "No delirium episode; patient remains oriented × 3",
+                "interventions": [
+                    "Ensure glasses and hearing aids are available",
+                    "Frequent reorientation — name, location, date, what happened",
+                    "Maintain normal sleep-wake cycle — avoid unnecessary night interventions",
+                    "Avoid benzodiazepines and anticholinergic medications",
+                    "Encourage family presence",
+                    "Adequate pain management — uncontrolled pain is a delirium trigger",
+                ],
+            },
+        ],
+        "adpie": {
+            "assessment": (
+                "Subjective: Pain 7/10 right hip. Drowsy post-op. "
+                "Objective: BP 108/66, SpO₂ 94%, Hb 86 (↓), wound drain 80 mL, "
+                "GCS 14, right hip dressing intact, no neurovascular deficit."
+            ),
+            "diagnosis": (
+                "1. Acute Pain r/t surgical trauma AEB pain 7/10, facial grimacing.\n"
+                "2. Risk for Neurovascular Compromise r/t post-op hip surgery.\n"
+                "3. Risk for Delirium r/t age, cognitive impairment, anaesthesia."
+            ),
+            "planning": (
+                "Pain ≤ 3/10 within 1 hour. No neurovascular compromise. "
+                "Mobilise with physio Day 1. Delirium prevention strategy in place."
+            ),
+            "implementation": (
+                "• O₂ 2 L/min via nasal prongs — SpO₂ improved to 97%.\n"
+                "• Paracetamol 1 g IV given; oxycodone 2.5 mg PO given — pain 4/10 at 60 min.\n"
+                "• Non-latex TEDS applied. Hip precautions explained.\n"
+                "• Glasses and hearing aid retrieved from bedside. Family contacted.\n"
+                "• Neurovascular obs every 2 hours — all normal.\n"
+                "• Wound drain output charted hourly."
+            ),
+            "evaluation": (
+                "Pain 4/10 at 1 hour, 3/10 at 2 hours. SpO₂ 97%. Neurovascular obs intact. "
+                "No delirium at 12 hours — patient oriented × 3. "
+                "Day 1: mobilised to chair with physio. Day 2: walking with frame."
+            ),
+        },
+    },
+
+    # ── 7. MATERNAL — PREECLAMPSIA ─────────────────────────────────────────
+    {
+        "id": "case_007",
+        "title": "Severe Preeclampsia",
+        "category": "Maternal / Obstetric",
+        "difficulty": "Advanced",
+        "tags": ["preeclampsia", "obstetric", "maternal", "eclampsia", "magnesium", "hypertension"],
+        "learning_objectives": [
+            "Distinguish preeclampsia from gestational hypertension",
+            "Recognise severe features: BP > 160/110, proteinuria, headache",
+            "Administer magnesium sulphate safely for seizure prophylaxis",
+            "Monitor fetal wellbeing: CTG interpretation basics",
+            "Know antihypertensive options in pregnancy (labetalol, hydralazine)",
+        ],
+        "patient": {
+            "name": "Ms. Yara Okafor",
+            "age": 32,
+            "gender": "Female",
+            "weight_kg": 82,
+            "height_cm": 167,
+            "allergies": ["NKDA"],
+            "pmhx": ["Primigravida", "No previous hypertension", "No pre-existing medical conditions"],
+            "medications": ["Folic acid 500 mcg daily (ceased at 12/40)", "Iron supplements"],
+            "social": "32-year-old G1P0, 36 weeks gestation. Works as a nurse. Lives with partner.",
+            "family_hx": "Mother had preeclampsia in both pregnancies.",
+        },
+        "presentation": (
+            "Ms. Okafor presents to the maternity assessment unit at 11:00 with a frontal headache "
+            "rated 7/10, visual disturbances ('flashing lights'), and epigastric pain since this morning. "
+            "She is 36+2 weeks gestation. Her midwife took her BP at home and it was 170/110. "
+            "Her ankles have been very swollen for the past week."
+        ),
+        "vitals": {
+            "BP": "172/114 mmHg (severe range — repeated × 2, 15 min apart)",
+            "HR": "96 bpm",
+            "RR": "18 breaths/min",
+            "SpO2": "98% on room air",
+            "Temp": "37.0°C",
+            "Pain": "7/10 (frontal headache + epigastric)",
+            "Reflexes": "Hyperreflexia 3+ bilaterally, clonus present (3 beats)",
+        },
+        "physical_exam": (
+            "Alert and distressed. Generalised oedema — face, hands, ankles. "
+            "Hyperreflexia with 3-beat clonus — eclampsia risk. "
+            "Epigastric tenderness on palpation. "
+            "Uterine fundus at 36 cm. Fetal heart rate: 148 bpm, reactive."
+        ),
+        "investigations": {
+            "Urine dipstick": "Protein 3+ (significant proteinuria)",
+            "Spot PCR": "450 mg/mmol (↑↑ severe, normal < 30)",
+            "BP trend": "Two readings ≥ 160/110, 15 min apart — SEVERE range",
+            "FBC": "Hb 112 g/L, Platelets 98 × 10⁹/L (↓ — HELLP concern)",
+            "LFTs": "ALT 68 U/L (↑), AST 74 U/L (↑), LDH 420 U/L (↑)",
+            "UEC": "Cr 98 μmol/L, Uric acid elevated",
+            "Coagulation": "PT/APTT normal, fibrinogen 3.2 g/L",
+            "CTG": "Reactive — fetal wellbeing reassuring at this time",
+            "Ultrasound": "Fetus 36/40, estimated fetal weight 2.8 kg, reduced amniotic fluid",
+        },
+        "medical_diagnosis": "Severe Preeclampsia with severe features (36+2 weeks) ± evolving HELLP",
+        "nursing_priorities": [
+            "URGENT — notify obstetric registrar/MO immediately",
+            "Continuous BP monitoring every 5–15 minutes",
+            "IV antihypertensives: labetalol IV or hydralazine IV to bring BP < 160/110",
+            "Magnesium sulphate: 4 g loading dose IV over 15–20 min — eclampsia prophylaxis",
+            "Strict fluid balance — IDC for hourly urine output",
+            "Continuous CTG monitoring",
+            "Magnesium toxicity monitoring: urine output, RR, reflexes",
+            "Prepare for delivery — discuss timing with obstetric team",
+        ],
+        "nursing_diagnoses": [
+            {
+                "diagnosis": "Risk for Maternal Injury (Seizure/Stroke) related to severe preeclampsia",
+                "evidence": "BP 172/114, hyperreflexia, clonus, headache, visual disturbances",
+                "goal": "No eclamptic seizure; BP < 160/110 within 1 hour",
+                "interventions": [
+                    "Administer magnesium sulphate 4 g IV over 15–20 min loading dose",
+                    "Maintain maintenance MgSO₄ infusion 1–2 g/hr",
+                    "Antihypertensives: labetalol IV per protocol (SBP target < 160, DBP target < 110)",
+                    "Seizure precautions: cot sides up, suction at bedside, IV access confirmed",
+                    "Dark quiet room — minimise stimulation",
+                    "Monitor: RR ≥ 12, UO ≥ 25 mL/hr, reflexes — before each MgSO₄ dose",
+                ],
+            },
+            {
+                "diagnosis": "Risk for Fetal Distress related to placental insufficiency",
+                "evidence": "Hypertension affecting uteroplacental blood flow, oligohydramnios",
+                "goal": "Reassuring CTG; plan for delivery within 24–48 hours",
+                "interventions": [
+                    "Continuous CTG monitoring",
+                    "Left lateral position — maximises placental perfusion",
+                    "Report any late decelerations, reduced variability, or prolonged bradycardia immediately",
+                    "Prepare for emergency LSCS if fetal compromise",
+                    "Notify neonatal team — preterm delivery expected",
+                ],
+            },
+        ],
+        "adpie": {
+            "assessment": (
+                "Subjective: Frontal headache 7/10, visual disturbances, epigastric pain, facial swelling. "
+                "Objective: BP 172/114 (×2), proteinuria 3+, platelets 98, LFTs elevated (HELLP), "
+                "hyperreflexia, clonus, 36+2 weeks gestation."
+            ),
+            "diagnosis": (
+                "1. Risk for Maternal Injury r/t severe preeclampsia AEB hypertension, hyperreflexia, clonus.\n"
+                "2. Risk for Fetal Distress r/t placental insufficiency AEB oligohydramnios.\n"
+                "3. Anxiety r/t acute illness and pregnancy AEB distress and fear for baby."
+            ),
+            "planning": (
+                "BP < 160/110 within 1 hour. No seizure. "
+                "Continuous CTG monitoring. Delivery planning with obstetric team."
+            ),
+            "implementation": (
+                "• Obstetric registrar notified at 11:05 — reviewed at 11:10.\n"
+                "• Labetalol 20 mg IV — BP 158/105 at 20 min. Repeat dose → BP 148/98.\n"
+                "• MgSO₄ 4 g IV over 20 min loading dose; maintenance 2 g/hr.\n"
+                "• IDC inserted — UO 35 mL/hr. Continuous CTG — reactive.\n"
+                "• Neonatal team notified. Betamethasone for fetal lung maturity given.\n"
+                "• Partner informed; birth plan discussed."
+            ),
+            "evaluation": (
+                "BP stabilised 148/96 over next 2 hours. No seizure. CTG remained reactive. "
+                "Decision for induction of labour at 37+0 weeks (4 days later after monitoring). "
+                "Delivered healthy 2.9 kg boy via vaginal delivery with epidural. "
+                "MgSO₄ continued 24 hours post-partum."
+            ),
+        },
+    },
+
+    # ── 8. PAEDIATRIC — FEBRILE SEIZURE ───────────────────────────────────
+    {
+        "id": "case_008",
+        "title": "Paediatric Febrile Convulsion",
+        "category": "Paediatric",
+        "difficulty": "Beginner",
+        "tags": ["paediatric", "febrile seizure", "child", "fever", "convulsion", "airway"],
+        "learning_objectives": [
+            "Differentiate simple vs complex febrile seizure",
+            "Manage acute seizure: DRSABCD, airway positioning, benzodiazepines",
+            "Identify and treat the underlying febrile illness",
+            "Provide parent education and seizure first-aid teaching",
+            "Understand when to investigate for meningitis",
+        ],
+        "patient": {
+            "name": "Liam Nguyen",
+            "age": 2,
+            "gender": "Male",
+            "weight_kg": 12,
+            "height_cm": 88,
+            "allergies": ["NKDA"],
+            "pmhx": ["Nil significant", "No previous seizures", "Normal development"],
+            "medications": ["Nil regular"],
+            "social": "Lives with both parents and older sister. Fully vaccinated. Attends childcare 3 days/week.",
+            "family_hx": "Father had two febrile convulsions as a toddler.",
+        },
+        "presentation": (
+            "Liam's parents call an ambulance after witnessing a 2-minute tonic-clonic seizure at home. "
+            "He has had a runny nose and fever for 24 hours — temperature was 39.2°C at home. "
+            "The seizure was generalised and has now stopped. Liam is in the post-ictal phase — "
+            "drowsy but breathing. Parents are very distressed."
+        ),
+        "vitals": {
+            "BP": "Not measured initially (crying/post-ictal)",
+            "HR": "148 bpm",
+            "RR": "32 breaths/min",
+            "SpO2": "95% (improving — was 90% immediately post-seizure)",
+            "Temp": "39.8°C (axillary)",
+            "Pain": "Unable to assess (post-ictal)",
+            "GCS": "11 (E3 V3 M5 — improving)",
+            "Weight": "12 kg",
+        },
+        "physical_exam": (
+            "Post-ictal 2-year-old. Drowsy but gradually becoming more alert over 20 minutes. "
+            "Red, inflamed tympanic membranes bilaterally. Rhinorrhoea. Clear chest. "
+            "No rash. No petechiae. No neck stiffness. Anterior fontanelle normal. "
+            "Pupils equal and reactive. No focal neurological deficit once fully recovered."
+        ),
+        "investigations": {
+            "Temp": "39.8°C",
+            "BSL": "6.2 mmol/L (normal)",
+            "FBC": "WCC 16.8 (↑ — likely viral), Hb 112 g/L",
+            "CRP": "22 mg/L (mildly elevated)",
+            "UEC": "Normal",
+            "LP (lumbar puncture)": "NOT indicated — simple febrile seizure in child > 12 months, no meningism",
+            "EEG": "NOT indicated for first simple febrile seizure",
+            "CT Brain": "NOT indicated — no focal deficit, simple febrile seizure",
+        },
+        "medical_diagnosis": "Simple Febrile Convulsion secondary to bilateral otitis media",
+        "nursing_priorities": [
+            "DURING SEIZURE: DRSABCD — DO NOT restrain",
+            "Position: lateral/recovery position — airway protection",
+            "Timing: note seizure start time (if > 5 min — IV midazolam or diazepam)",
+            "Post-ictal: airway positioning, O₂ if SpO₂ < 94%, monitoring",
+            "Treat fever: paracetamol 15 mg/kg PO/PR",
+            "Identify fever source (bilateral OM — amoxicillin if bacterial)",
+            "Parent education: seizure first aid, 999 criteria, recurrence risk",
+            "Discharge planning: written information, follow-up",
+        ],
+        "nursing_diagnoses": [
+            {
+                "diagnosis": "Risk for Aspiration related to seizure and reduced consciousness",
+                "evidence": "Post-ictal GCS 11, SpO₂ 95%, seizure just ceased",
+                "goal": "Maintain patent airway; SpO₂ ≥ 95%; full recovery of consciousness within 30 min",
+                "interventions": [
+                    "Position: lateral/recovery position — maintains airway",
+                    "Suction available at bedside",
+                    "O₂ via face mask if SpO₂ < 94%",
+                    "Nil by mouth until fully alert (GCS 15)",
+                    "Monitor SpO₂ continuously for 30 minutes",
+                ],
+            },
+            {
+                "diagnosis": "Hyperthermia related to bilateral otitis media (infection)",
+                "evidence": "Temp 39.8°C, inflamed tympanic membranes, rhinorrhoea, WCC 16.8",
+                "goal": "Temperature < 38.5°C within 1 hour",
+                "interventions": [
+                    "Paracetamol 15 mg/kg = 180 mg PO/PR",
+                    "Remove excess clothing, fan",
+                    "Tepid sponging (not cold water — may cause shivering, increase temp)",
+                    "Adequate hydration — oral fluids when fully alert",
+                    "Amoxicillin if bacterial OM suspected per medical order",
+                ],
+            },
+            {
+                "diagnosis": "Parental Anxiety related to witnessed seizure in child",
+                "evidence": "Parents visibly distressed, asking 'will it happen again?'",
+                "goal": "Parents verbalise understanding of febrile seizures and first aid actions",
+                "interventions": [
+                    "Explain febrile seizures in simple, calm language",
+                    "Teach seizure first aid: recovery position, timing, when to call 000",
+                    "Reassure: simple febrile seizures do not cause brain damage",
+                    "Provide written information leaflet",
+                    "Discuss recurrence risk (~30%) and that fever does not need to be treated aggressively to prevent seizures",
+                ],
+            },
+        ],
+        "adpie": {
+            "assessment": (
+                "Subjective (parents): 2-min tonic-clonic seizure at home, 24-hr fever, runny nose. "
+                "Father had childhood febrile seizures. "
+                "Objective: Temp 39.8°C, GCS 11 (post-ictal, improving), bilateral OM, "
+                "SpO₂ 95%, WCC 16.8, simple febrile seizure (< 15 min, generalised, single)."
+            ),
+            "diagnosis": (
+                "1. Risk for Aspiration r/t post-ictal reduced consciousness.\n"
+                "2. Hyperthermia r/t bilateral otitis media AEB Temp 39.8°C.\n"
+                "3. Parental Anxiety r/t witnessed seizure."
+            ),
+            "planning": (
+                "Airway safety maintained. Temperature < 38.5°C within 1 hour. "
+                "Full neurological recovery within 30 min. Parents confident in first aid before discharge."
+            ),
+            "implementation": (
+                "• Liam positioned in lateral recovery position on arrival.\n"
+                "• SpO₂ improved to 98% without O₂ within 5 minutes.\n"
+                "• Paracetamol 180 mg PR given — temp 38.6°C at 1 hour.\n"
+                "• GP called — amoxicillin prescribed for bilateral OM.\n"
+                "• GCS 15 within 25 minutes post-ictal — Liam smiling and sitting up.\n"
+                "• Parents taught seizure first aid; written information provided."
+            ),
+            "evaluation": (
+                "Liam fully alert at 30 minutes. Temp 38.4°C at 1 hour. SpO₂ 99%. "
+                "Discharged home after 4 hours observation. "
+                "Parents demonstrated correct seizure first aid. Follow-up with GP in 2 days."
+            ),
+        },
+    },
+
+    # ── 9. MENTAL HEALTH — OVERDOSE ───────────────────────────────────────
+    {
+        "id": "case_009",
+        "title": "Paracetamol Overdose — Deliberate Self-Harm",
+        "category": "Mental Health / Toxicology",
+        "difficulty": "Intermediate",
+        "tags": ["overdose", "paracetamol", "mental health", "self-harm", "NAC", "toxicology"],
+        "learning_objectives": [
+            "Manage acute paracetamol overdose using the Rumack-Matthew nomogram",
+            "Administer N-acetylcysteine (NAC) safely",
+            "Perform a risk assessment for deliberate self-harm",
+            "Demonstrate therapeutic communication with mental health patients",
+            "Understand mandatory reporting and duty of care obligations",
+        ],
+        "patient": {
+            "name": "Mx. Alex Kim",
+            "age": 22,
+            "gender": "Non-binary (they/them)",
+            "weight_kg": 67,
+            "height_cm": 172,
+            "allergies": ["NKDA"],
+            "pmhx": ["Major Depressive Disorder", "Previous overdose 18 months ago"],
+            "medications": ["Sertraline 100 mg daily"],
+            "social": "University student. Shares house with friends. Recently broke up with partner. Support worker engaged. Family not yet notified per patient request.",
+            "family_hx": "Mother has depression.",
+        },
+        "presentation": (
+            "Alex presents to ED at 02:30 brought by a friend who found an empty paracetamol packet "
+            "(30 × 500 mg = 15 g) and a note. Alex is alert and cooperative. They report taking all "
+            "the tablets approximately 3 hours ago with alcohol. They state 'I wanted to disappear'. "
+            "Alex is tearful but not acutely agitated."
+        ),
+        "vitals": {
+            "BP": "118/74 mmHg",
+            "HR": "96 bpm",
+            "RR": "16 breaths/min",
+            "SpO2": "98% on room air",
+            "Temp": "36.9°C",
+            "Pain": "2/10 (mild nausea)",
+            "GCS": "15",
+        },
+        "physical_exam": (
+            "Alert and oriented × 3. Tearful, cooperative. No jaundice. Abdomen soft, mild "
+            "right upper quadrant tenderness. No crepitations. Pupils equal and reactive. "
+            "No needle marks. Alcohol on breath."
+        ),
+        "investigations": {
+            "Paracetamol level (4h post-ingestion)": "185 mg/L — ABOVE treatment line on nomogram (treat)",
+            "LFTs": "ALT 42 U/L (normal — too early for hepatotoxicity), Bili normal",
+            "INR": "1.2 (normal — will rise if hepatotoxicity develops)",
+            "UEC": "Na 139, K 4.0, Cr 82 μmol/L",
+            "FBC": "Normal",
+            "Blood alcohol": "0.08% (present — increases hepatotoxicity risk)",
+            "BSL": "5.6 mmol/L",
+            "Urine drug screen": "Positive: alcohol; negative for opioids, benzodiazepines",
+        },
+        "medical_diagnosis": "Paracetamol overdose (15 g, 3 hours ago) above treatment line — commence NAC",
+        "nursing_priorities": [
+            "Commence N-acetylcysteine (NAC) infusion per protocol — do not delay",
+            "LFTs, INR, creatinine monitoring every 4–8 hours",
+            "Safe room environment: remove sharps, ligature risks — 1:1 or enhanced observation",
+            "Mental health risk assessment — psychiatric team referral",
+            "Therapeutic communication — non-judgemental, trauma-informed approach",
+            "Activated charcoal if < 1 hour post-ingestion (not applicable here — 3 hours)",
+            "Social work involvement, safe discharge planning",
+        ],
+        "nursing_diagnoses": [
+            {
+                "diagnosis": "Risk for Liver Failure related to paracetamol hepatotoxicity",
+                "evidence": "Paracetamol 185 mg/L above nomogram treatment line, co-ingestion with alcohol",
+                "goal": "LFTs and INR remain normal; NAC infusion completed",
+                "interventions": [
+                    "Commence NAC: Bag 1 — 150 mg/kg in 200 mL over 60 min",
+                    "Bag 2 — 50 mg/kg in 500 mL over 4 hours; Bag 3 — 100 mg/kg in 1000 mL over 16 hours",
+                    "Monitor LFTs, INR, Cr every 4–8 hours",
+                    "Monitor for NAC anaphylactoid reaction (first 15 min): rash, wheeze, flushing",
+                    "Antiemetics for nausea",
+                ],
+            },
+            {
+                "diagnosis": "Risk for Self-Harm related to major depressive disorder",
+                "evidence": "Deliberate overdose, previous overdose history, suicide note found",
+                "goal": "Patient remains safe; psychiatric review completed within 4 hours",
+                "interventions": [
+                    "1:1 nursing observation — do not leave patient alone",
+                    "Remove all potential means of self-harm from environment",
+                    "Therapeutic communication: non-judgemental, empathetic, use they/them pronouns",
+                    "Psychiatric/mental health team consulted immediately",
+                    "Document risk assessment (CSSRS or institutional tool)",
+                    "Respect patient's request regarding family notification (within duty of care limits)",
+                ],
+            },
+        ],
+        "adpie": {
+            "assessment": (
+                "Subjective: Intentional paracetamol 15 g ingestion 3 hours ago with alcohol, "
+                "suicide note, previous overdose, MDD. Objective: GCS 15, haemodynamically stable, "
+                "paracetamol level 185 mg/L above treatment line, mild RUQ tenderness."
+            ),
+            "diagnosis": (
+                "1. Risk for Liver Failure r/t paracetamol hepatotoxicity AEB level above nomogram line.\n"
+                "2. Risk for Self-Harm r/t MDD and suicidal intent AEB deliberate overdose."
+            ),
+            "planning": (
+                "NAC infusion completed (21 hours). LFTs remain normal. "
+                "Psychiatric review and safe discharge planning. "
+                "Patient engaged with mental health team."
+            ),
+            "implementation": (
+                "• NAC Bag 1 commenced at 03:15 — no anaphylactoid reaction.\n"
+                "• 1:1 observation commenced. Environment cleared of hazards.\n"
+                "• Mental health consult at 06:00.\n"
+                "• Communicated using they/them pronouns throughout — patient acknowledged and appreciated.\n"
+                "• Social worker contacted at 08:00.\n"
+                "• LFTs and INR repeated at 8 and 16 hours — remained normal."
+            ),
+            "evaluation": (
+                "NAC infusion completed at 00:15 (Day 2). LFTs, INR normal throughout. "
+                "Psychiatric review at 06:00 — not for inpatient admission; community mental health follow-up arranged. "
+                "Discharged with crisis plan, mental health team contact, and GP review within 48 hours."
+            ),
+        },
+    },
+
+    # ── 10. RENAL — ACUTE KIDNEY INJURY ───────────────────────────────────
+    {
+        "id": "case_010",
+        "title": "Acute Kidney Injury (AKI) — Prerenal",
+        "category": "Renal",
+        "difficulty": "Intermediate",
+        "tags": ["AKI", "renal", "acute kidney injury", "fluid balance", "oliguria", "hypotension"],
+        "learning_objectives": [
+            "Classify AKI using KDIGO criteria (Stage 1, 2, 3)",
+            "Differentiate prerenal, intrinsic, and postrenal AKI",
+            "Manage fluid resuscitation in AKI",
+            "Monitor for hyperkalaemia — most dangerous complication",
+            "Avoid nephrotoxic medications and contrast in AKI",
+        ],
+        "patient": {
+            "name": "Mr. Daniel Obi",
+            "age": 55,
+            "gender": "Male",
+            "weight_kg": 78,
+            "height_cm": 180,
+            "allergies": ["Ibuprofen (worsens kidney function)"],
+            "pmhx": ["Hypertension", "Type 2 Diabetes", "CKD Stage 2 (baseline Cr 110 μmol/L)"],
+            "medications": [
+                "Ramipril 10 mg daily",
+                "Metformin 1000 mg BD",
+                "Furosemide 40 mg daily",
+                "Amlodipine 10 mg daily",
+            ],
+            "social": "Bank manager. Married, 2 children. Had gastroenteritis for 5 days — unable to eat or drink. Continued all medications including ramipril and furosemide.",
+            "family_hx": "Father has T2DM and hypertension.",
+        },
+        "presentation": (
+            "Mr. Obi is admitted by his GP with 5 days of gastroenteritis (vomiting and diarrhoea × 8/day), "
+            "poor oral intake, and dizziness on standing. His GP found BP 88/54 lying, Cr 348 on bloods. "
+            "He continued taking ramipril and furosemide throughout his illness. "
+            "He has not passed urine for 12 hours."
+        ),
+        "vitals": {
+            "BP": "88/54 mmHg (lying); 72/44 mmHg (standing — postural drop)",
+            "HR": "108 bpm",
+            "RR": "18 breaths/min",
+            "SpO2": "97% on room air",
+            "Temp": "37.3°C",
+            "Pain": "4/10 (abdominal cramps)",
+            "GCS": "15",
+            "UO": "0 mL last 12 hours",
+        },
+        "physical_exam": (
+            "Patient appears unwell and dehydrated. Dry mucous membranes, sunken eyes, reduced skin turgor. "
+            "Postural hypotension confirmed. Capillary refill 3 seconds. "
+            "Abdomen: mild diffuse tenderness, no guarding. No peripheral oedema. "
+            "No signs of urinary retention on palpation."
+        ),
+        "investigations": {
+            "Creatinine": "348 μmol/L (↑↑ from baseline 110 — Stage 3 AKI by KDIGO: × 3.17 baseline)",
+            "Urea": "28.4 mmol/L (↑↑)",
+            "eGFR": "16 mL/min/1.73m² (critically reduced)",
+            "Potassium": "6.2 mmol/L (↑↑ — dangerous hyperkalaemia)",
+            "Sodium": "128 mmol/L (↓ — hyponatraemia)",
+            "Bicarbonate": "14 mmol/L (↓ — metabolic acidosis)",
+            "FBC": "Hb 122 g/L, WCC 9.8",
+            "Urine": "No casts (consistent with prerenal), Urine Na < 20 mmol/L",
+            "Urine osmolality": "620 mOsm/kg (concentrated — prerenal physiology)",
+            "ECG": "Peaked T waves (hyperkalaemia). HR 108.",
+            "Renal ultrasound": "Normal kidney size. No obstruction. No hydronephrosis.",
+        },
+        "medical_diagnosis": "Stage 3 AKI — prerenal (dehydration + ACE inhibitor/diuretic in gastroenteritis)",
+        "nursing_priorities": [
+            "URGENT: Treat hyperkalaemia (K⁺ 6.2 + ECG changes) — calcium gluconate IV",
+            "IV fluid resuscitation: 0.9% NaCl 500 mL over 1 hour × 2",
+            "HOLD nephrotoxic medications: ramipril, furosemide, metformin, NSAIDs",
+            "Strict fluid balance — IDC for hourly urine output",
+            "Continuous cardiac monitoring — hyperkalaemia arrhythmia risk",
+            "Serial K⁺ and creatinine every 2–4 hours",
+            "Renal team review — consider dialysis if refractory (unlikely if prerenal)",
+            "Dietary consult — low potassium, low phosphate diet",
+        ],
+        "nursing_diagnoses": [
+            {
+                "diagnosis": "Deficient Fluid Volume related to gastroenteritis and diuretic use",
+                "evidence": "BP 88/54, postural hypotension, anuria × 12 hours, dry mucous membranes",
+                "goal": "UO ≥ 0.5 mL/kg/hr (≥ 39 mL/hr) within 4 hours; BP > 100 systolic",
+                "interventions": [
+                    "IV 0.9% NaCl 500 mL over 1 hour × 2 — reassess after each bolus",
+                    "IDC inserted — strict hourly UO",
+                    "Hold ramipril and furosemide",
+                    "Vital signs every 30–60 minutes",
+                ],
+            },
+            {
+                "diagnosis": "Risk for Cardiac Arrhythmia related to hyperkalaemia (K⁺ 6.2)",
+                "evidence": "K⁺ 6.2 mmol/L, peaked T waves on ECG, AKI",
+                "goal": "K⁺ < 5.5 mmol/L within 4 hours; no arrhythmia",
+                "interventions": [
+                    "Calcium gluconate 10 mL 10% IV over 10 min (cardioprotective — immediate effect)",
+                    "Insulin 10 units actrapid + 50 mL 50% dextrose IV (shifts K into cells)",
+                    "Salbutamol nebuliser 10–20 mg (adjunct K-lowering)",
+                    "Sodium bicarbonate 100 mmol IV if pH < 7.2 (treats acidosis/K shift)",
+                    "Resonium (kayexalate) PO/PR for K removal",
+                    "Continuous ECG monitoring — treat arrhythmias immediately",
+                    "Repeat K⁺ 2 hours after treatment",
+                ],
+            },
+        ],
+        "adpie": {
+            "assessment": (
+                "Subjective: 5-day gastroenteritis, unable to eat/drink, continued ramipril and furosemide, "
+                "anuria × 12 hours. Objective: BP 88/54, K⁺ 6.2, Cr 348 (Stage 3 AKI), "
+                "peaked T waves on ECG, dry mucous membranes, Urine Na < 20 (prerenal)."
+            ),
+            "diagnosis": (
+                "1. Deficient Fluid Volume r/t dehydration AEB hypotension, anuria, poor skin turgor.\n"
+                "2. Risk for Cardiac Arrhythmia r/t hyperkalaemia AEB K⁺ 6.2, peaked T waves."
+            ),
+            "planning": (
+                "Fluid resuscitation to restore UO. Treat hyperkalaemia urgently. "
+                "Hold nephrotoxic medications. Cr to trend downward within 24–48 hours."
+            ),
+            "implementation": (
+                "• Calcium gluconate 10 mL 10% IV given at 10:30 — ECG improved (T waves less peaked).\n"
+                "• Actrapid 10 units + 50 mL 50% dextrose IV given.\n"
+                "• 0.9% NaCl 500 mL × 2 over 2 hours.\n"
+                "• Ramipril, furosemide, metformin withheld — medications reviewed by team.\n"
+                "• IDC inserted — UO 15 mL/hr at 2 hours, 38 mL/hr at 4 hours.\n"
+                "• K⁺ repeat at 2 hours: 5.4 mmol/L (↓ from 6.2)."
+            ),
+            "evaluation": (
+                "At 12 hours: BP 118/76, UO 44 mL/hr, K⁺ 4.8, Cr 244 (↓ from 348 — prerenal responding). "
+                "At 48 hours: Cr 148 μmol/L (↓ improving). "
+                "Ramipril and furosemide restarted at discharge with sick-day medication advice."
+            ),
+        },
+    },
+
+]
+
+
+# ---------------------------------------------------------------------------
+# Helper functions
+# ---------------------------------------------------------------------------
+
+def get_all_cases():
+    return CASE_BANK
+
+
+def get_categories():
+    seen = []
+    for c in CASE_BANK:
+        if c["category"] not in seen:
+            seen.append(c["category"])
+    return seen
+
+
+def get_difficulties():
+    return ["Beginner", "Intermediate", "Advanced"]
+
+
+def get_by_category(category: str):
+    return [c for c in CASE_BANK if c["category"] == category]
+
+
+def get_by_difficulty(difficulty: str):
+    return [c for c in CASE_BANK if c["difficulty"] == difficulty]
+
+
+def get_by_id(case_id: str):
+    for c in CASE_BANK:
+        if c["id"] == case_id:
+            return c
+    return None
+
+
+def search_cases(query: str):
+    q = query.lower()
+    results = []
+    for c in CASE_BANK:
+        if (q in c["title"].lower()
+                or q in c["category"].lower()
+                or any(q in t for t in c["tags"])
+                or q in c["patient"]["name"].lower()
+                or q in c.get("medical_diagnosis", "").lower()):
+            results.append(c)
+    return results

requirements.txt

@@ -0,0 +1 @@
+streamlit>=1.32.0

streamlit_app.py

@@ -0,0 +1,679 @@
+"""
+Nursing Case Study Builder
+Streamlit app — Hugging Face Spaces (free CPU tier)
+"""
+
+import streamlit as st
+from cases.bank import (
+    get_all_cases, get_categories, get_by_category, get_by_difficulty,
+    get_by_id, search_cases, get_difficulties,
+)
+
+# ---------------------------------------------------------------------------
+# Page config
+# ---------------------------------------------------------------------------
+st.set_page_config(
+    page_title="Nursing Case Studies — Student Nurses",
+    page_icon="🏥",
+    layout="wide",
+    initial_sidebar_state="expanded",
+)
+
+# ---------------------------------------------------------------------------
+# CSS
+# ---------------------------------------------------------------------------
+st.markdown("""
+<style>
+.case-card {
+    background:#f8fafc; border:1px solid #d0dae8;
+    border-radius:10px; padding:1.2rem 1.4rem; margin-bottom:1rem;
+}
+.patient-banner {
+    background:#e3f2fd; border-left:5px solid #1565c0;
+    padding:0.8rem 1.2rem; border-radius:4px; margin-bottom:0.8rem;
+}
+.warning-banner {
+    background:#fff3e0; border-left:5px solid #e65100;
+    padding:0.8rem 1.2rem; border-radius:4px; margin-bottom:0.8rem;
+}
+.critical-banner {
+    background:#fce4ec; border-left:5px solid #c62828;
+    padding:0.8rem 1.2rem; border-radius:4px; margin-bottom:0.8rem;
+}
+.success-banner {
+    background:#e8f5e9; border-left:5px solid #2e7d32;
+    padding:0.8rem 1.2rem; border-radius:4px; margin-bottom:0.8rem;
+}
+.info-banner {
+    background:#e8eaf6; border-left:5px solid #3949ab;
+    padding:0.8rem 1.2rem; border-radius:4px; margin-bottom:0.8rem;
+}
+.badge-beginner   { background:#e8f5e9; color:#2e7d32; padding:3px 10px;
+                    border-radius:12px; font-size:0.78em; font-weight:700; }
+.badge-intermediate { background:#fff8e1; color:#f57f17; padding:3px 10px;
+                      border-radius:12px; font-size:0.78em; font-weight:700; }
+.badge-advanced   { background:#fce4ec; color:#c62828; padding:3px 10px;
+                    border-radius:12px; font-size:0.78em; font-weight:700; }
+.vital-box {
+    background:#f5f5f5; border-radius:8px; padding:0.6rem 1rem;
+    text-align:center; margin-bottom:0.4rem;
+}
+.nd-card {
+    background:#fafafa; border:1px solid #e0e0e0;
+    border-radius:8px; padding:1rem 1.2rem; margin-bottom:0.8rem;
+}
+</style>
+""", unsafe_allow_html=True)
+
+
+# ---------------------------------------------------------------------------
+# Helpers
+# ---------------------------------------------------------------------------
+DIFF_COLOURS = {"Beginner": "#2e7d32", "Intermediate": "#f57f17", "Advanced": "#c62828"}
+CAT_ICONS = {
+    "Cardiovascular": "❤️",
+    "Respiratory": "🫁",
+    "Endocrine": "🩸",
+    "Neurological": "🧠",
+    "Multi-system / Infectious": "🦠",
+    "Musculoskeletal / Surgical": "🦴",
+    "Maternal / Obstetric": "🤰",
+    "Paediatric": "👶",
+    "Mental Health / Toxicology": "💜",
+    "Renal": "💧",
+}
+
+
+def diff_badge(difficulty: str) -> str:
+    cls = f"badge-{difficulty.lower()}"
+    return f'<span class="{cls}">{difficulty}</span>'
+
+
+def cat_icon(category: str) -> str:
+    return CAT_ICONS.get(category, "📋")
+
+
+def init_state():
+    if "selected_case_id" not in st.session_state:
+        st.session_state.selected_case_id = None
+    if "adpie_answers" not in st.session_state:
+        st.session_state.adpie_answers = {}
+    if "quiz_answers" not in st.session_state:
+        st.session_state.quiz_answers = {}
+    if "quiz_submitted" not in st.session_state:
+        st.session_state.quiz_submitted = False
+    if "careplan_items" not in st.session_state:
+        st.session_state.careplan_items = {}
+
+
+init_state()
+
+# ---------------------------------------------------------------------------
+# Sidebar
+# ---------------------------------------------------------------------------
+with st.sidebar:
+    st.markdown("## 🏥 Case Studies")
+    st.divider()
+
+    all_cases = get_all_cases()
+    categories = get_categories()
+    difficulties = get_difficulties()
+
+    st.markdown("**Quick Stats**")
+    st.markdown(f"- 📋 {len(all_cases)} clinical cases")
+    st.markdown(f"- 🏷️ {len(categories)} body systems")
+    diff_counts = {d: len(get_by_difficulty(d)) for d in difficulties}
+    for d, n in diff_counts.items():
+        colour = DIFF_COLOURS[d]
+        st.markdown(f'- <span style="color:{colour}">⬤</span> {d}: {n} cases', unsafe_allow_html=True)
+
+    st.divider()
+    st.markdown("**Cases by System**")
+    for cat in categories:
+        icon = cat_icon(cat)
+        n = len(get_by_category(cat))
+        st.markdown(f"{icon} **{cat}** — {n}")
+
+    st.divider()
+    st.markdown("**ADPIE Framework**")
+    st.markdown("""
+- **A**ssessment
+- **D**iagnosis
+- **P**lanning
+- **I**mplementation
+- **E**valuation
+    """)
+    st.divider()
+    st.caption(
+        "Part of the [Nursing Citizen Development](https://huggingface.co/NurseCitizenDeveloper) suite"
+    )
+
+# ---------------------------------------------------------------------------
+# Header
+# ---------------------------------------------------------------------------
+st.title("🏥 Nursing Case Studies")
+st.caption(
+    "10 clinical scenarios across major body systems · ADPIE Framework · "
+    "Nursing Diagnoses · Care Planning · For educational purposes only"
+)
+
+# ---------------------------------------------------------------------------
+# Tabs
+# ---------------------------------------------------------------------------
+tab_lib, tab_case, tab_adpie, tab_quiz, tab_plan = st.tabs([
+    "📚 Case Library",
+    "🔍 Full Case",
+    "🧠 ADPIE Reasoning",
+    "❓ Quiz Questions",
+    "📝 Care Plan",
+])
+
+
+# ========================= CASE LIBRARY =====================================
+with tab_lib:
+    st.subheader("📚 Clinical Case Library")
+    st.caption("Browse 10 evidence-based patient scenarios. Click any case to open it.")
+
+    col_search, col_diff, col_cat = st.columns([3, 2, 2])
+    with col_search:
+        lib_query = st.text_input("🔍 Search cases", placeholder="e.g. sepsis, chest pain, stroke")
+    with col_diff:
+        diff_filter = st.selectbox("Difficulty", ["All"] + difficulties)
+    with col_cat:
+        cat_filter = st.selectbox("Body system", ["All"] + categories)
+
+    st.divider()
+
+    # Filter
+    if lib_query.strip():
+        display_cases = search_cases(lib_query)
+        if not display_cases:
+            st.info(f"No cases found for '{lib_query}'.")
+    elif diff_filter != "All" and cat_filter != "All":
+        display_cases = [c for c in get_by_category(cat_filter)
+                         if c["difficulty"] == diff_filter]
+    elif diff_filter != "All":
+        display_cases = get_by_difficulty(diff_filter)
+    elif cat_filter != "All":
+        display_cases = get_by_category(cat_filter)
+    else:
+        display_cases = all_cases
+
+    st.markdown(f"**Showing {len(display_cases)} case(s)**")
+    st.markdown("")
+
+    for case in display_cases:
+        icon = cat_icon(case["category"])
+        col_a, col_b = st.columns([5, 1])
+        with col_a:
+            st.markdown(
+                f'<div class="case-card">'
+                f'<b>{icon} {case["title"]}</b> &nbsp;'
+                f'{diff_badge(case["difficulty"])}<br/>'
+                f'<small>🏷️ {case["category"]} &nbsp;·&nbsp; '
+                f'👤 {case["patient"]["name"]}, {case["patient"]["age"]}yo &nbsp;·&nbsp; '
+                f'🔖 {", ".join(case["tags"][:4])}</small>'
+                f'</div>',
+                unsafe_allow_html=True
+            )
+        with col_b:
+            if st.button("Open →", key=f"open_{case['id']}", use_container_width=True):
+                st.session_state.selected_case_id = case["id"]
+                st.session_state.quiz_answers = {}
+                st.session_state.quiz_submitted = False
+                st.session_state.adpie_answers = {}
+                st.success(f"✅ Case loaded: **{case['title']}** — navigate to other tabs.")
+
+
+# ========================= FULL CASE ========================================
+with tab_case:
+    st.subheader("🔍 Full Case Study")
+
+    if not st.session_state.selected_case_id:
+        st.info("💡 Select a case from the **Case Library** tab to begin.")
+    else:
+        case = get_by_id(st.session_state.selected_case_id)
+        if not case:
+            st.error("Case not found.")
+        else:
+            p = case["patient"]
+
+            # Title banner
+            icon = cat_icon(case["category"])
+            st.markdown(
+                f'<div class="patient-banner">'
+                f'<h3 style="margin:0">{icon} {case["title"]}</h3>'
+                f'<span>{diff_badge(case["difficulty"])}</span> &nbsp;'
+                f'<small>{case["category"]}</small>'
+                f'</div>',
+                unsafe_allow_html=True
+            )
+
+            # Learning objectives
+            with st.expander("🎯 Learning Objectives", expanded=False):
+                for lo in case["learning_objectives"]:
+                    st.markdown(f"• {lo}")
+
+            st.divider()
+
+            # Patient demographics
+            col1, col2 = st.columns(2)
+            with col1:
+                st.markdown("### 👤 Patient Profile")
+                st.markdown(f"**Name:** {p['name']}")
+                st.markdown(f"**Age / Gender:** {p['age']} years · {p['gender']}")
+                st.markdown(f"**Weight / Height:** {p['weight_kg']} kg · {p['height_cm']} cm")
+                st.markdown(f"**Allergies:** {', '.join(p['allergies'])}")
+
+            with col2:
+                st.markdown("### 📋 Medical History")
+                st.markdown("**Past Medical History:**")
+                for h in p["pmhx"]:
+                    st.markdown(f"• {h}")
+                st.markdown(f"**Medications:** {', '.join(p['medications'])}")
+                st.markdown(f"**Social:** {p['social']}")
+                st.markdown(f"**Family History:** {p.get('family_hx', 'Nil relevant')}")
+
+            st.divider()
+
+            # Presentation
+            st.markdown("### 🚨 Presentation")
+            st.markdown(
+                f'<div class="warning-banner">📋 {case["presentation"]}</div>',
+                unsafe_allow_html=True
+            )
+
+            # Vital signs
+            st.markdown("### 📊 Vital Signs")
+            vitals = case["vitals"]
+            v_keys = list(vitals.keys())
+            cols = st.columns(min(len(v_keys), 5))
+            for i, key in enumerate(v_keys):
+                with cols[i % len(cols)]:
+                    st.markdown(
+                        f'<div class="vital-box"><small>{key}</small><br/>'
+                        f'<b>{vitals[key]}</b></div>',
+                        unsafe_allow_html=True
+                    )
+
+            # Physical exam
+            st.markdown("### 🩺 Physical Examination")
+            st.markdown(case["physical_exam"])
+
+            st.divider()
+
+            # Investigations
+            st.markdown("### 🔬 Investigations")
+            inv = case["investigations"]
+            inv_keys = list(inv.keys())
+            col_a, col_b = st.columns(2)
+            for i, key in enumerate(inv_keys):
+                col = col_a if i % 2 == 0 else col_b
+                with col:
+                    val = inv[key]
+                    flag = "🔴 " if ("↑↑" in val or "CRITICAL" in val or "severe" in val.lower()) else ""
+                    st.markdown(f"**{key}:** {flag}{val}")
+
+            st.divider()
+
+            # Medical diagnosis
+            st.markdown("### 🏥 Medical Diagnosis")
+            st.markdown(
+                f'<div class="critical-banner">⚕️ <b>{case["medical_diagnosis"]}</b></div>',
+                unsafe_allow_html=True
+            )
+
+            # Nursing priorities
+            st.markdown("### 🔔 Nursing Priorities")
+            for i, priority in enumerate(case["nursing_priorities"], 1):
+                colour = "#c62828" if i <= 3 else "#e65100" if i <= 6 else "#2e7d32"
+                st.markdown(
+                    f'<div style="padding:4px 0"><span style="color:{colour};font-weight:700">'
+                    f'{i}.</span> {priority}</div>',
+                    unsafe_allow_html=True
+                )
+
+
+# ========================= ADPIE REASONING ==================================
+with tab_adpie:
+    st.subheader("🧠 ADPIE Clinical Reasoning Framework")
+    st.caption("Work through the case using the ADPIE nursing process. Reveal the model answer when ready.")
+
+    if not st.session_state.selected_case_id:
+        st.info("💡 Select a case from the **Case Library** tab first.")
+    else:
+        case = get_by_id(st.session_state.selected_case_id)
+        adpie = case["adpie"]
+
+        st.markdown(
+            f'<div class="patient-banner">🏥 Active Case: <b>{case["title"]}</b> &nbsp;·&nbsp; '
+            f'👤 {case["patient"]["name"]}</div>',
+            unsafe_allow_html=True
+        )
+
+        st.markdown("**Instructions:** Read the case, then write your own answers before revealing the model answers.")
+        st.divider()
+
+        steps = [
+            ("A", "Assessment", "📋", "What are the key subjective and objective findings?", "assessment"),
+            ("D", "Nursing Diagnosis", "🔴", "Identify priority nursing diagnoses (NANDA format: problem r/t aetiology AEB evidence)", "diagnosis"),
+            ("P", "Planning", "🎯", "What are your SMART nursing goals (short and long term)?", "planning"),
+            ("I", "Implementation", "⚙️", "What nursing interventions will you implement and why?", "implementation"),
+            ("E", "Evaluation", "✅", "How will you evaluate if goals were met? What actually happened?", "evaluation"),
+        ]
+
+        for letter, title, icon, prompt, key in steps:
+            st.markdown(f"### {icon} {letter} — {title}")
+            st.markdown(f"*{prompt}*")
+
+            # Student input
+            ans_key = f"adpie_{case['id']}_{key}"
+            student_ans = st.text_area(
+                f"Your {title}:",
+                value=st.session_state.adpie_answers.get(ans_key, ""),
+                height=100,
+                key=f"adpie_input_{case['id']}_{key}",
+                placeholder=f"Write your {title.lower()} here...",
+                label_visibility="collapsed",
+            )
+            st.session_state.adpie_answers[ans_key] = student_ans
+
+            # Reveal model answer
+            with st.expander(f"🔍 Reveal Model Answer — {title}"):
+                st.markdown(adpie[key])
+
+            st.markdown("")
+
+        # Nursing diagnoses deep-dive
+        st.divider()
+        st.markdown("### 🔴 Nursing Diagnoses — Detailed")
+        for nd in case["nursing_diagnoses"]:
+            with st.expander(f"📌 {nd['diagnosis']}", expanded=False):
+                st.markdown(
+                    f'<div class="nd-card">'
+                    f'<b>Supporting Evidence:</b> {nd["evidence"]}<br/><br/>'
+                    f'<b>Goal:</b> {nd["goal"]}'
+                    f'</div>',
+                    unsafe_allow_html=True
+                )
+                st.markdown("**Nursing Interventions:**")
+                for inv in nd["interventions"]:
+                    st.markdown(f"• {inv}")
+
+
+# ========================= QUIZ QUESTIONS ===================================
+with tab_quiz:
+    st.subheader("❓ Case-Based Quiz Questions")
+    st.caption("NCLEX-style questions based on the active case. Select answers and submit for feedback.")
+
+    if not st.session_state.selected_case_id:
+        st.info("💡 Select a case from the **Case Library** tab first.")
+    else:
+        case = get_by_id(st.session_state.selected_case_id)
+
+        st.markdown(
+            f'<div class="patient-banner">🏥 Active Case: <b>{case["title"]}</b></div>',
+            unsafe_allow_html=True
+        )
+
+        # Generate case-specific questions dynamically
+        nd_names = [nd["diagnosis"].split(" related to")[0] for nd in case["nursing_diagnoses"]]
+        priorities = case["nursing_priorities"]
+
+        # Build 5 consistent case-based questions
+        questions = [
+            {
+                "q": f"Based on the case of {case['patient']['name']}, which nursing diagnosis should be prioritised FIRST?",
+                "options": nd_names + ["Pain management only"],
+                "answer": 0,
+                "rationale": (
+                    f"The priority nursing diagnosis is '{nd_names[0]}'. "
+                    f"Using Maslow's hierarchy, physiological and safety needs are addressed first. "
+                    f"The supporting evidence is: {case['nursing_diagnoses'][0]['evidence']}."
+                ),
+            },
+            {
+                "q": f"What is the FIRST priority nursing action for {case['patient']['name']}?",
+                "options": [
+                    priorities[0] if len(priorities) > 0 else "Call the doctor",
+                    priorities[2] if len(priorities) > 2 else "Reassess vitals",
+                    "Complete full medication history",
+                    "Discharge planning",
+                ],
+                "answer": 0,
+                "rationale": (
+                    f"The immediate priority is: '{priorities[0]}'. "
+                    "Nursing priorities are ordered by urgency — life-threatening physiological "
+                    "problems must be addressed before less urgent concerns."
+                ),
+            },
+            {
+                "q": f"Which assessment finding in {case['patient']['name']}'s case is MOST concerning?",
+                "options": list(case["vitals"].items())[:4],
+                "answer": 0,
+                "rationale": (
+                    "The most concerning vital sign is the first listed, which is outside normal limits. "
+                    "Always assess using ABCDE — Airway, Breathing, Circulation, Disability, Exposure — "
+                    "to prioritise life-threatening abnormalities."
+                ),
+                "is_vitals": True,
+            },
+            {
+                "q": f"The goal for the priority nursing diagnosis in this case is: '{case['nursing_diagnoses'][0]['goal']}'. Which nursing intervention BEST addresses this goal?",
+                "options": case["nursing_diagnoses"][0]["interventions"][:4],
+                "answer": 0,
+                "rationale": (
+                    f"The first listed intervention directly addresses the priority goal. "
+                    f"Rationale: {case['nursing_diagnoses'][0]['interventions'][0]}"
+                ),
+            },
+            {
+                "q": f"In evaluating the outcomes for {case['patient']['name']}, which finding would indicate the PRIORITY nursing goal has been MET?",
+                "options": [
+                    case["nursing_diagnoses"][0]["goal"],
+                    "Patient is pain-free",
+                    "Family is satisfied with care",
+                    "All documentation is complete",
+                ],
+                "answer": 0,
+                "rationale": (
+                    f"The priority goal for this case is: '{case['nursing_diagnoses'][0]['goal']}'. "
+                    "Goals must be patient-centred, measurable, and time-bound (SMART). "
+                    "This outcome directly measures resolution of the priority nursing diagnosis."
+                ),
+            },
+        ]
+
+        if st.button("🔄 Reset Quiz", use_container_width=False):
+            st.session_state.quiz_answers = {}
+            st.session_state.quiz_submitted = False
+            st.rerun()
+
+        st.divider()
+
+        for i, q in enumerate(questions):
+            st.markdown(f"**Question {i + 1}:** {q['q']}")
+
+            if q.get("is_vitals"):
+                opts = [f"{k}: {v}" for k, v in q["options"]]
+            else:
+                opts = q["options"]
+
+            selected = st.radio(
+                f"Q{i+1}",
+                options=opts,
+                key=f"quiz_{case['id']}_q{i}",
+                label_visibility="collapsed",
+            )
+            st.session_state.quiz_answers[i] = selected
+
+            if st.session_state.quiz_submitted:
+                correct_opt = opts[q["answer"]]
+                if selected == correct_opt:
+                    st.markdown(
+                        f'<div class="success-banner">✅ <b>Correct!</b> {q["rationale"]}</div>',
+                        unsafe_allow_html=True
+                    )
+                else:
+                    st.markdown(
+                        f'<div class="critical-banner">❌ <b>Incorrect.</b> '
+                        f'Correct answer: <b>{correct_opt}</b><br/>{q["rationale"]}</div>',
+                        unsafe_allow_html=True
+                    )
+
+            st.markdown("")
+
+        col_sub, col_score = st.columns([2, 3])
+        with col_sub:
+            if st.button("✅ Submit Answers", type="primary", use_container_width=True):
+                st.session_state.quiz_submitted = True
+                st.rerun()
+
+        if st.session_state.quiz_submitted:
+            score = 0
+            for i, q in enumerate(questions):
+                if q.get("is_vitals"):
+                    opts = [f"{k}: {v}" for k, v in q["options"]]
+                else:
+                    opts = q["options"]
+                if st.session_state.quiz_answers.get(i) == opts[q["answer"]]:
+                    score += 1
+
+            pct = round((score / len(questions)) * 100)
+            colour = "#2e7d32" if pct >= 80 else "#e65100" if pct >= 60 else "#c62828"
+            with col_score:
+                st.markdown(
+                    f'<div style="padding:0.6rem 1rem; background:#f5f5f5; border-radius:8px; '
+                    f'font-size:1.1em; font-weight:700; color:{colour};">'
+                    f'Score: {score} / {len(questions)} ({pct}%)</div>',
+                    unsafe_allow_html=True
+                )
+
+
+# ========================= CARE PLAN ========================================
+with tab_plan:
+    st.subheader("📝 Nursing Care Plan Builder")
+    st.caption("Build a structured care plan for the active case using the NANDA-NIC-NOC framework.")
+
+    if not st.session_state.selected_case_id:
+        st.info("💡 Select a case from the **Case Library** tab first.")
+    else:
+        case = get_by_id(st.session_state.selected_case_id)
+
+        st.markdown(
+            f'<div class="patient-banner">🏥 <b>{case["patient"]["name"]}</b> · '
+            f'{case["patient"]["age"]} y/o · {case["medical_diagnosis"]}</div>',
+            unsafe_allow_html=True
+        )
+
+        st.markdown("Complete the care plan below. Toggle **Show Model Answer** to reveal guidance.")
+        st.divider()
+
+        for idx, nd in enumerate(case["nursing_diagnoses"]):
+            st.markdown(f"### 📌 Nursing Diagnosis {idx + 1}")
+            st.markdown(
+                f'<div class="nd-card"><b>{nd["diagnosis"]}</b></div>',
+                unsafe_allow_html=True
+            )
+
+            cp_key = f"cp_{case['id']}_{idx}"
+            if cp_key not in st.session_state.careplan_items:
+                st.session_state.careplan_items[cp_key] = {
+                    "diagnosis": "", "goal": "", "interventions": "", "evaluation": ""
+                }
+
+            c1, c2 = st.columns(2)
+
+            with c1:
+                st.markdown("**Your Nursing Diagnosis (NANDA format):**")
+                nd_input = st.text_area(
+                    "nd",
+                    value=st.session_state.careplan_items[cp_key]["diagnosis"],
+                    height=80,
+                    placeholder="[Problem] related to [Aetiology] as evidenced by [Signs/Symptoms]",
+                    key=f"{cp_key}_nd",
+                    label_visibility="collapsed",
+                )
+                st.session_state.careplan_items[cp_key]["diagnosis"] = nd_input
+
+                st.markdown("**Your SMART Goal:**")
+                goal_input = st.text_area(
+                    "goal",
+                    value=st.session_state.careplan_items[cp_key]["goal"],
+                    height=80,
+                    placeholder="Patient will [outcome] by [time] as measured by [indicator]",
+                    key=f"{cp_key}_goal",
+                    label_visibility="collapsed",
+                )
+                st.session_state.careplan_items[cp_key]["goal"] = goal_input
+
+            with c2:
+                st.markdown("**Your Nursing Interventions (with rationale):**")
+                inv_input = st.text_area(
+                    "interventions",
+                    value=st.session_state.careplan_items[cp_key]["interventions"],
+                    height=80,
+                    placeholder="1. Intervention (Rationale)\n2. Intervention (Rationale)\n3. ...",
+                    key=f"{cp_key}_inv",
+                    label_visibility="collapsed",
+                )
+                st.session_state.careplan_items[cp_key]["interventions"] = inv_input
+
+                st.markdown("**Evaluation Criteria:**")
+                eval_input = st.text_area(
+                    "evaluation",
+                    value=st.session_state.careplan_items[cp_key]["evaluation"],
+                    height=80,
+                    placeholder="Goal met / partially met / not met because...",
+                    key=f"{cp_key}_eval",
+                    label_visibility="collapsed",
+                )
+                st.session_state.careplan_items[cp_key]["evaluation"] = eval_input
+
+            # Model answer toggle
+            with st.expander("🔍 Show Model Answer"):
+                st.markdown(f"**Diagnosis:** {nd['diagnosis']}")
+                st.markdown(f"**Evidence:** {nd['evidence']}")
+                st.markdown(f"**Goal:** {nd['goal']}")
+                st.markdown("**Model Interventions:**")
+                for i in nd["interventions"]:
+                    st.markdown(f"• {i}")
+
+            st.divider()
+
+        # Print / export summary
+        if any(
+            any(v for v in st.session_state.careplan_items.get(f"cp_{case['id']}_{i}", {}).values())
+            for i in range(len(case["nursing_diagnoses"]))
+        ):
+            st.markdown("### 📄 Care Plan Summary")
+            summary_lines = [f"# Care Plan: {case['patient']['name']}\n",
+                             f"**Diagnosis:** {case['medical_diagnosis']}\n"]
+            for idx, nd in enumerate(case["nursing_diagnoses"]):
+                cp_key = f"cp_{case['id']}_{idx}"
+                item = st.session_state.careplan_items.get(cp_key, {})
+                summary_lines.append(f"\n## Nursing Diagnosis {idx+1}\n")
+                summary_lines.append(f"**Diagnosis:** {item.get('diagnosis', '—')}\n")
+                summary_lines.append(f"**Goal:** {item.get('goal', '—')}\n")
+                summary_lines.append(f"**Interventions:** {item.get('interventions', '—')}\n")
+                summary_lines.append(f"**Evaluation:** {item.get('evaluation', '—')}\n")
+
+            summary_text = "\n".join(summary_lines)
+            st.download_button(
+                "⬇️ Download Care Plan (.txt)",
+                data=summary_text,
+                file_name=f"care_plan_{case['id']}.txt",
+                mime="text/plain",
+                use_container_width=False,
+            )
+
+
+# ---------------------------------------------------------------------------
+# Footer
+# ---------------------------------------------------------------------------
+st.divider()
+st.caption(
+    "Cases are fictional composite scenarios for educational purposes only. "
+    "Always follow your institution's clinical guidelines, evidence-based practice, "
+    "and clinical supervisor guidance in real patient care."
+)