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NR 601 Week 6 Case Study Discussions Health Promotion, Health Protection, Disease Prevention, and Treatment Considerations in Long-Term Care (Part-2) NEW

Discussion Part Two (graded)

 Physical Exam:

Discussion Part Two (graded)

Vital signs: blood pressure 145/90, heart rate 100, respirations 20 height 5’1”; weight 210 pounds

Labwork:

CBC: normal

UA: 2+ glucose; 1+ protein; negative for ketones

CMP: BUN/Creat. elevated; Glucose is 300 mg/dL

Hemoglobin A1c: 12%

Thyroid panel: normal

LFTs: normal

Cholesterol: total cholesterol (206), LDL elevated; HDL is low EKG: normal

General: obese female in not acute distress HEENT: unremarkable

CV: S1 and S2 RRR without murmurs or rubs

Lungs: Clear to auscultation

Abdomen– soft, round, nontender with positive bowel sounds present; no organomegaly; no abdominal bruits

Discussion Questions Part Two

 For the primary diagnosis, what non-pharmacological and pharmacological strategies would be appropriate?

Include the following: lab work and screenings to be completed. Describe patient education strategies.

Describe follow-up and any referrals that may be necessary.

Discussion Part One (graded)

C.G. is a 69-year-old male with a history of right head and neck cancer that you have been following for one year. The carcinoma was initially localized to the head and neck-specifically at the left lingual tonsil region and went on to complete a total of 6 weeks of radiation and chemotherapy. Recently, the last PET scan indicated some metabolic activity in the left lymph node area along with other regions of abnormal metabolic activity in the body-particularly the liver and the lungs indicating metastasis. C.G. indicates that he is tired of the effects of chemotherapy and radiation and does not want to pursue any more treatment for cancer.

Background:

Right head and neck cancer with metastasis to liver and lungs; patient is refusing further treatment.

PMH:

Hypertension

Hyperlipidemia

Stomatitis

Anemia

Neutropenia 

Current medications: 

Carvedilol 12.5 mg po 1 daily

Furosemide 40 mg po daily

Surgeries:      

2012: right radical neck dissection 

Allergies:

None 

Vaccination History:

Influenza vaccine last received 1 year ago

Received pneumovax at age 65

Received Tdap 5 years ago

Has not had the herpes zoster vaccine 

Social history and Risk Factors:

Former smoker-stopped smoking at the time his cancer was diagnosed-2 years ago

Negative for alcohol intake or drug use

Patient does not have an advanced directive or living will. He is refusing further treatment for his cancer and his wife and children are in disagreement with him. The patient wants to know what his options are for the remainder of his life.  

Family history:

Negative 

 Discussion Part One:

 Provide differential diagnoses (DD) with rationale.

Further ROS questions needed to develop DD.

Identify the legal/ethical issues involved with the patient and describe your approach to addressing end-of-life care for this patient.

Discussion Part Two (graded)

 Physical examination:

Vital Signs: Height:  6’0   Weight: 140 pounds; BMI: 19.0   BP: 156/84  P: 84 regular R: 20

HEENT: normocephalic, symmetric PERRLA, EOMI; poor dentition NECK: left neck supple; non-palpable lymph nodes; no carotid bruits. Limited ROM

LUNGS: rhonchi in anterior chest bilaterally.

HEART: S1 and S2 audible; regular rate and rhythm

ABDOMEN: active bowel sounds all 4 quadrants; Normal contour; RUQ tenderness; liver palpable

NEUROLOGIC: negative

GENITOURINARY: negative

MUSCULOSKELETAL: negative

PSYCH: PHQ-9 is 15

SKIN: oral mucosa irritated-stomatitis

 Discussion Part Two:

Summarize the history and results of the physical exam. Discuss the differential diagnosis and rationale for choosing the primary diagnosis. Include one evidence-based journal article that supports your rationale and include a complete treatment plan that includes medications, possible referrals, patient education, ICD 10 Codes, and plan for follow up.

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NR 601 Week 6 Case Study Discussions Health Promotion, Health Protection, Disease Prevention, and Treatment Considerations in Long-Term Care (Part-1) NEW

Discussion Part One (graded)

 Ms. S. is a 62-year-old black female who has returned to the clinic to discuss her concerns that her lifestyle modifications to lose weight have not worked. At the last visit 3 months ago, she was advised to change her eating habits and increase activity to promote weight loss. She reports walking at least 30 minutes a day but has lost very little weight. ……….. indicates that the walking only made her extremely thirsty and hungry and attributes her increased thirst and hunger to increased exercise and her increased urination due to drinking more water since “it’s been hot lately” and exercise makes me thirsty”…… has returned to the clinic to discuss if there is anything else that can be done to lose weight and to determine why she is so tired, thirsty and hungry all the time. She also thinks she may have an overactive bladder since she has to urinate frequently during the day, which has influenced her not to go on outings with her friends.

  Discussion Questions Part One

 Conduct a ROS on this patient.

Indicate which symptoms are most concerning to you.

List your differential diagnoses.

What types of screenings would be appropriate to use based on the chief complaint?

What primary diagnosis are you choosing at this point?

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PSY 490 Week 1 DQ 2

How is the field of psychology similar to other sciences? How is it different? Do you believe that psychology should be classified as a science? Why or why not?  

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NR 601 Week 4 Case Study Discussions Physical Examination  (Part-1) NEW

Discussion Part One (graded)

 You are seeing S.F., a 74-year-old. Hispanic male in the office this morning for difficulty breathing.

Background:

S.F. presents with increased dyspnea on exertion that has become progressively worse over the last 3 days. You observe that he is using pursed lip breathing as he explains his chief complaint. He reports that he has been coughing up a moderate amount of thick, green sputum for approximately one week that was accompanied by a fever of 100.6 and chills. He took Ibuprofen 400 mg every 4 hours and increased his fluid intake for the last week. Two days ago he noticed that the sputum is now yellow rather than green and that he has not experienced any more fever. Overall, he feels like he is getting better. However, the dyspnea on exertion developed three days ago without relief despite the use of his Spiriva HandiHaler. He reports that he lost his rescue inhaler and has not had it to use in over 2 months. 

PMH:

COPD

Hypertension

Osteoarthritis 

Current medications: 

Asprin-81 daily

Cyclobenzaprine 10 mg prn

Meloxicam 15 mg daily

Metoprolol 25 mg daily

Spiriva HandiHaler daily as directed

Tramadol 50 mg daily prn

Surgeries:      

Appendectomy as a child (date unknown)

2004-Left cataract extraction with intraocular lens placement

2008-Right cataract extraction with intraocular lens placement 

Allergies: NKA

Vaccination History:

Influenza vaccine- October 2013

Pneumovax-2010

His last TD-can’t remember

Has not a TDAP/TD in 20 years 

Screening History:

Last Colonoscopy was 2012-normal

Last dilated retinal and glaucoma exam was 2013 

Social history:

Retired roofer-stopped working in 2004 due to arthritis and pain in his rotator cuff. Is married and lives with spouse. They have 4 grown children who live within a 10 mile radius of them. Currently smokes-is down to ½ pack cigarettes daily. Has smoked for 45 years total. Family history:

Father is deceased and had a history of hypertension and diabetes; Mother is deceased and had a history of CAD/MI; Sister-history of colon cancer. 

 Discussion  Part One:

Provide differential diagnoses  (DD)with rationale. 

Further ROS questions needed to develop DD. 

Based on the patient data provided, choose geriatric assessment tools that would be appropriate to use in conducting a thorough geriatric assessment. Provide a rationale on why you are choosing these particular tools.

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