NR601 Case Study Part 1 Week 2

NR601 Case Study Part 1 Week 2
NR601 Case Study Part 1 Week 2
Activity Learning Outcomes
Through this discussion, the student will demonstrate the ability to:
Demonstrate competence in the evaluation and management of common respiratory problems (WO 2.1)  (CO,2,3,4,5)Distinguish between obstructive and restrictive lung disease (CO 2, 4) Develop a management plan for the case study patient based on identified primary, secondary and differential diagnoses. (WO 2.2) (CO 2,4)Interpret pulmonary function test results. (WO 2.3) (CO 2, 4)Due Date:Student enters initial post to part one by 11:59 p.m. MT on Tuesday; responds substantively to at least one topic-related post of a peer including evidence from appropriate sources AND all direct faculty questions in parts one by Sunday, 11:59 p.m. MT. NR601 Case Study Part 1 Week 2

A 10% late penalty will be imposed for discussions posted after the deadline on Tuesday 11:59pm MT, regardless of the number of days late. NOTHING will be accepted after 11:59pm MT on Sunday (i.e. student will receive an automatic 0).there’s part two to this case study
Total Points Possible: 50
Case Study – Part 1
Date of visit: November 20,2019
A 62 year-old Caucasian male presents to the office with persistent cough and recent onset of shortness of breath. Upon further questioning you discover the following subjective information regarding the chief complaint.
History of Present IllnessOnset6 monthsLocationChestDurationCough is intermittent but frequent, worse in the AMCharacteristicsProductive; whitish-yellow phlegmAggravating factorsActivityRelieving factorsRestTreatmentsTried Robitussin DM without relief of symptoms
SeverityUnable to walk > 20ft without stopping to catch his breath. Last year at this time he routinely walked 1 mile per day without difficultyReview of Systems (ROS)ConstitutionalDenies fever, chills, or weight lossEarsDenies otalgia and otorrheaNoseDenies rhinorrhea, nasal congestion, sneezing or post nasal drip.ThroatDenies ST and rednessNeckDenies lymph node tenderness or swellingChestDescribes a persistent productive cough upon wakening for the last 6 months. Color of phlegm is usually white-yellowish. Shortness of breath with activity.CardiovascularDenies chest pain and lower extremity edema
HistoryMedicationsMetoprolol succinate ER (Toprol-XL) 50mg daily for hypertension; Multivitamin dailyPMHPrimary hypertensionPSHCholecystectomy, appendectomyAllergiesPenicillin (hives)SocialMarried, 3 children
Senior accountant at a risk management firmHabitsFormer smoker (20 pack-year), quit “cold turkey” when father died; Denies alcohol or illicit drug use.FHFather died of MI & CHF at age 59 years (diabetes, hypertension, smoker)
Mother is alive (osteoporosis)
Healthy siblings
Physical exam reveals the following:
Physical ExamConstitutionalAdult male in NAD, alert and oriented, able to speak in full sentencesVSTemp-98.1, P-66, RR-20, BP 156/94, Height 68.9in, Weight 258 pounds, O2sat 94% on RAHeadNormocephalicEarsTympanic membranes gray and intact with light reflex noted. Pinna and tragus nontender.NoseNares patent. Nasal turbinates clear without redness or edema. Nasal drainage is clear.ThroatOropharynx moist, no lesions or exudate. Tonsils ¼ bilaterally. Teeth in good repair, no cavities noted.NeckNeck supple. No lymphadenopathy. Thyroid midline, small and firm without palpable masses. No JVDCardiopulmonaryHeart S1 and S2 with no murmurs, noted. Lungs clear to auscultation bilaterally with faint forced expiratory wheezes in bilateral bases. Respirations unlabored. Legs without edema.AbdomenSoft, non-tender. No organomegaly
Requirements/Questions:
Briefly and concisely summarize the history and physical (H&P) findings as if you were presenting it to your preceptor using the pertinent facts from the case. May use approved medical abbreviations. Avoid redundancy and irrelevant information.Provide a differential diagnosis (minimum of 3) which might explain the patient’s chief complaint along with a brief statement (2-3 sentences) of pathophysiology for each.
Analyze the differential by using the pertinent findings from the history and physical to argue for or against a diagnosis.Rank the differential in order of most likely to least likely.
Identify any additional tests and/or procedures that you feel is necessary or needed to help you narrow your differential. All testing decisions must be supported with an evidence-based practice (EBP) argument as to why it is necessary or pertinent in this case. If no testing is indicated or needed, you must also support this decision with EBP evidence.
DISCUSSION CONTENTCategoryPoints%Description
NR601 Case Study Part 1 Week 2 Sample Approach
1.  Briefly and concisely summarize the history and physical (H&P) findings as if you were presenting it to your preceptor using the pertinent facts from the case. May use approved medical abbreviations. Avoid redundancy and irrelevant information.
A 62-year-old Caucasian male arrived at the clinic today with CC of a persistent, intermittent, productive cough with yellow/white sputum that his worse in the morning and recent onset of SOB. These symptoms started six months ago and are aggravated with activity and relieved by rest. The only treatment used is over the counter Robitussin DM without relief. Patient states he is unable to walk more than twenty feet without having to stop due to SOB and one year ago routinely walked one mile per day without incidence. ROS is unremarkable other than the above reported. He has a history of primary HTN, treated with metoprolol succinate ER 50 mg daily. He also takes a daily vitamin and has a surgical history of an appendectomy and cholecystectomy. He is a former twenty pack per year smoker who quit when his father died at age 59 of an MI and CHF who also had HTN, DM and was a smoker. His mother is still alive who has osteoarthritis, and his siblings are reported as healthy. On PE, he is alert and oriented, hypertensive, and normocephalic. The only other positive findings on PE include the cardiopulmonary assessment in which the lungs are clear to auscultation with faint, forced expiratory wheezes in bilateral bases.
2.  Provide a differential diagnosis (minimum of 3) which might explain the patient’s chief complaint along with a brief statement (2-3 sentences) of pathophysiology for each.
COPD: COPD is a progressive disease that limits air flow in the lungs and the bronchioles that is not fully reversible (Dunphy et al., 2019). COPD consists of two clinical disorders, chronic bronchitis and emphysema and is the third leading cause of death and the fourth leading cause of disability in the United States (Dunphy et al., 2019).
Asthma: Asthma is a chronic inflammatory disease that is reversible. In this condition the airways constrict and swell, also known as hyperreactivity, producing an increased amount of mucous (Dunphy et al., 2019). When acute exacerbations occur due to hyperreactivity airflow is limited causing wheezing, coughing, chest tightness and breathlessness.
Heart Failure: Heart failure is a complex, progressive disease that results in the heart’s inability to properly function causing inadequate perfusion to peripheral tissues. Heart failure can be systolic, diastolic, or mixed in nature, and causes a cascade of changes within the body hemodynamically, neurohormonally, vasoactively, and alters cardiac structure (Dunphy et al., 2019). Each of these changes cause systemic sequel.
Cont’
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