No Plegarism please,  will be checked with Turnitin. 

Will need minimum of 300 words, APA Style, double spaced, times new roman, font 12, and and Include: 3 references with intext citations.  

Topic: Cough

Respiratory System

You will be assigned one topic from the list below.

For your assigned topic (Cough), you are to discuss:

the incidence and prevalence of the disorder

pathophysiology from an advanced practice perspective

physical assessment and examination, 

evidence-based treatment plan and patient education, as well as follow up and evaluation to assess the efficacy and outcomes of the evidence-based treatment plan for management of an episodic, acute, and chronic case involving the pathology(s) you are sharing. 

 

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No Plegarism please, assignment will be checked with Turnitin. 

Will need minimum of 3 full content pages, plus title, and reference page APA Style, double spaced, times new romans, font 12, and and 3 references with intext citations. References within 5 years (2014-2018). 

 

Hypertension Case Study

C.D is a 55-year-old African American male who presents to his primary care provider with a 2-day history of a headache and chest pressure.

PMH

Allergic Rhinitis

Depression

Hypothyroidism

Family History

Father died at age 49 from AMI: had HTN

Mother has DM and HTN

Brother died at age 20 from complications of CF

Two younger sisters are A&W

Social History

The patient has been married for 25 years and lives with his wife and two children. The patient is an air traffic controller at the local airport. He has smoked a pack of cigarettes a day for the past 15 years. He drinks several beers every evening after work to relax. He does not pay particular attention to sodium, fat, or carbohydrates in the foods he eats. He admits to “salting almost everything he eats, sometimes even before tasting it.” He denies ever having dieted or exercised.

Medications

Zyrtec 10 mg daily

Allergies

Penicillin

ROS

States that his overall health has been fair to good during the past year.

Weight has increased by approximately 30 pounds in the last 12 months.

States he has been having some occasional chest pressure and headaches for the past 2 days. Shortness of breath at rest, headaches, nocturia, nosebleeds, and hemoptysis.

Reports some shortness of breath with activity, especially when climbing stairs and that breathing difficulties are getting worse.

Denies any nausea, vomiting, diarrhea, or blood in stool.

Self treats for occasional right knee pain with OTC Ibuprofen.

Denies any genitourinary symptoms.

Vital Signs

B/P 190/120, HR 73, RR 18, T. 98.8 F., Ht 6’1”, Wt 240 lbs.

HEENT

TMs intact and clear throughout

No nasal drainage

No exudates or erythema in oropharynx

PERRLA

Funduscopy reveals mild arteriolar narrowing without nicking, hemorrhages, exudates, or papilledema

Neck

Supple without masses or bruits

Thyroid normal

No lymphadenopathy

Lungs

Mild basilar crackles bilaterally

No wheezes

Heart

RRR

No murmurs or rubs

Abdomen

Soft and non-distended

No masses, bruits, or organomegaly

Normal bowel sounds

Ext

Moves all extremities well

Neuro

No sensory or motor abnormalities

CN’s II-XII intact

DTR’s = 2+

Muscle tone=5/5 throughout

What you should do:

• Develop an evidence-based management plan.
• Include any pertinent diagnostics. (Screening Chest Xray/EKG, LABS, referrals to cardiologist to eval cardiovascular disease, smoking cessation education, nutritional consult) 
• Describe the patient education plan. (lifestyle changes, weight management, AHA/DASH diet)
• Include cultural and lifespan considerations. ( Common in African American )
• Provide information on health promotion or health care maintenance needs.
• Describe the follow-up and referral for this patient.
• Prepare a 3 page paper (not including the title page or reference page).

 

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No Plegarism please, assignment will be checked with Turnitin. 

Will need minimum of 3 pages, title, and reference page APA Style, double spaced, times new romans, font 12, and and 3 references with intext citations.

   

Poor Patient Outcome

Relying solely on the classic features of a disease may be misleading. That’s because the clinical presentation of a disease often varies: the symptoms and signs of many conditions are non-specific initially and may require hours, days, or even months to develop.

Generating a differential diagnosis; that is, developing a list of the possible conditions that might produce a patient’s symptoms and signs — is an important part of clinical reasoning. It enables appropriate testing to rule out possibilities and confirm a final diagnosis.

This case portrays a poor patient outcome after a misdiagnosis.

Case scenario

A previously healthy 35-year-old lawyer presents to a primary care office with a chief complaint of chest pain and a non-productive cough. The pain started suddenly 2 hours prior to coming to the office while the patient was sitting at his desk. The patient describes the pain as sharp in nature, constantly present but made worse with inspiration and movement, and with radiation to the base of the neck. His blood pressure in the right arm and other vital signs are normal.

On physical examination the only findings of note are chest wall tenderness and a faint cardiac murmur. The ECG in the office is normal. The patient is observed for an hour in the office and assessed. He is diagnosed with viral pleurisy and sent home on non-steroidal analgesics.

The following day the patient collapses at home and cannot be resuscitated by the paramedic service. An autopsy reveals a Type 1 aortic dissection with pericardial tamponade.

Written Assignment:

Developing a list of possible conditions that might produce a patient’s symptoms and signs is an important part of clinical reasoning.

As an NP in primary care what would you have done differently?

Discuss the importance of creating a list of differentials for this patient. How could it have changed this outcome?

If a serious diagnosis comes to mind based on a patient’s symptoms:

Ask yourself; Have you considered the likelihood of it and whether it needs to be ruled out by testing or referral?

Because many serious disorders are challenging to diagnose, have you considered ruling out the worst case scenario?

Ask yourself: Do you have sufficient understanding of the clinical presentation to offer an opinion on the diagnosis?

What other diagnosis could it be? How might the treatment to date have altered the patient outcome?

What other diagnostic and laboratory or imaging was needed in order to make a complete differential list?  

What support tools would you consider using in helping to create a differential diagnosis list?

Are you familiar with the current clinical practice guidelines for the investigation of a suspected condition such as chest pain?

 

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No Plegarism please, assignment will be checked with Turnitin. 

Will need Title page, Reference page, APA Style, double spaced, times new romans, font 12, and and (3 references with intext citations) 

 

Translating Evidence into Clinical Practice

Choose one evidence-based practice that you see yourself using as a provider in your clinical practice and discuss how it meets the listed benefits.

Why should we, as healthcare providers, use evidence-based practice?

Evidence-based practice benefits:

• Leads to highest quality care and patient outcomes
• Reduces health care costs
• Reduces geographic variations in the delivery of care
• Increases healthcare provider empowerment and role satisfaction
• Reduces healthcare provider turnover rate
• Increases reimbursement from 3rd party payers
• Reduces complications and payment denials
• Meets the expectation of an informed public

Include 3 evidence-based articles to support your work that are less than 3 years old.

 

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This is discussion board: No Plegarism please, assignment will be checked with Turnitin. Will need minimum of 250 words, APA Style, double spaced, times new romans, font 12, and and minimum 3 References with intext citations.

The Medical Interview:

The medical interview serves several functions. It is used to collect information to assist in diagnosis of the present illness, to understand the patient’s values, to assess and communicate prognosis, to establish a therapeutic relationship and to reach agreement with the patient about further diagnostic procedures and therapeutic options. The interview also offers an opportunity to influence patient behaviors.

Discuss the following:

Please answer the following questions and include your rationale and evidence-based research to support your written work.

· What does it means to document accurately and appropriately?

· What are the documenting guidelines? When is it appropriate to use abbreviations?

· What is the difference between subjective and objective data?

· What does it mean to demonstrate clinical reasoning skills?

· How can you use clinical reasoning to plan the organization of a comprehensive exam?

· How will you document variations of normal and abnormal assessment findings?

· What factors influence appropriate tools and tests necessary for a comprehensive assessment?

· Reflect on personal strengths, limitations, beliefs, prejudices, and values.

· How will these impact your ability to collect a comprehensive health history?

· How can you develop strong communication skills.

· What interviewing techniques will you use to interview the patient to elicit subjective health information about their health history?

· What relevant follow-up questions will you use to evaluate patient condition?

· How will you demonstrate empathy for patient perspectives, feelings, and sociocultural background?

· What opportunities will you take to educate the patient?

 

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