resources
Reuben, D., Herr, K. A., Pacala, J. T., Pollock, B. G., Potter, J. F., & Semla, T. P. (2020). Respiratory diseases. In Geriatrics at your fingertips 2020 (22nd ed., pp. 321–339). American Geriatrics Society.
USCD School of Medicine. (2018). USCD’s practical guide to clinical medicine. https://meded.ucsd.edu/clinicalmed/introduction.htm
You may also wish to access the following reference sites:
Merck. (2020). Merck manual professional version. https://www.merckmanuals.com/professional
Medscape
www.medscape.com
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Grand Rounds Discussion: Complex Case Study Presentation
Photo Credit: [RGtimeline]/[iStock / Getty Images Plus]/Getty Images
This week you participate in the second of four clinical discussions called grand rounds. In one of these 4 weeks, you will be a presenter as well as help facilitate the online discussion; in the others you will be an active discussion participant. When it is your week to present, you will create a focused SOAP note and a short didactic (teaching) video presenting a real (but de-identified) complex patient case from your practicum experience.
You should have received communication from your Instructor letting you know which week of the course you are assigned to present.
To prepare:
• Review this week’s Learning Resources and consider the insights they provide. Also review the Kaltura Media Uploader resource in the left-hand navigation of the classroom for help creating your self-recorded Kaltura video.
• Select a patient from your clinical experience that presents with significant comorbidities. This should not be a patient with a single, straightforward condition, such as an ear infection, nor should it be a wellness visit. Create a focused SOAP note for this patient using the template in the Resources. All SOAP notes must be signed and each page must be initialed by your preceptor. When you submit your SOAP Note, you should include the complete SOAP Note as a Word document and pdf/images of each page that is initialed and signed by your preceptor. You must submit your SOAP Note using SafeAssign.
Please Note: Electronic signatures are not accepted. If both files are not received by the due date, faculty will deduct points per the Walden Late Policies.
• Based on this patient case, and using the focused SOAP note as a reference, develop a case study presentation that includes the history of present illness (HPI), appropriate positive and negative physical exam findings, past medical and surgical history, diagnostic results, diagnosis including differentials that were ruled out, and treatment plan.
• Your presentation should also include objectives for your audience (see the resource on Bloom’s Taxonomy), at least three possible discussion questions/prompts for your classmates to respond to, and at least five scholarly resources to support your diagnostic reasoning and treatment plan.
• Ensure that you have the appropriate lighting and equipment to record the presentation.
Video Assignment for this week’s presenters:
Record yourself presenting the complex case study for your clinical patient. In your presentation:
• Dress professionally with a lab coat and present yourself in a professional manner.
• Display your photo ID at the start of the video when you introduce yourself.
• Ensure that you do not include any information that violates the principles of HIPAA (i.e., don’t use the patient’s name or any other identifying information).
• State 3–4 objectives for the presentation that are targeted, clear, use appropriate verbs from Bloom’s taxonomy, and address what the audience will know or be able to do after viewing.
• Present the full complex case study. Include the history of present illness, appropriate positive and negative physical exam findings, past medical and surgical history, diagnostic results, diagnosis including differentials that were ruled out, and treatment plan.
• Report normal diagnostic results as the name of the test and “normal” (rather than specific value). Abnormal results should be reported as a specific value.
• Pose three questions or discussion prompts, based on your presentation, that your colleagues can respond to after viewing your video.
• Be succinct in your presentation, and do not exceed 8 minutes.
A note on grading:
• Presenters: Review the Grand Rounds Presenter Rubric to ensure you meet the scoring criteria.
• Participants: Review the Grand Rounds Participant Rubric to ensure you meet the scoring criteria.
Week 6 Presenters:
By Day 3
Post your video and your focused SOAP note to the grand rounds discussion forum. You must submit two files for the SOAP note, including a Word document and scanned pdf/images of each page that is initialed and signed by your preceptor. Then, actively respond to your colleagues as they post responses to your video.
Week 6 Participants:
By Day 7
Respond at least two times each to both of your colleagues who presented this week. The goal is for the discussion forum to function as robust clinical conferences on the patients. Provide a response to one of the three discussion prompts that your colleague provided in his or her video presentation. You may also provide additional information, alternative points of view, research to support treatment, or patient education strategies you might use with the relevant patient.
Submission and Grading Information
Grading Criteria
To access your rubric:
Week 6 Grand Rounds Presenter Discussion Rubric
To access your rubric:
Week 6 Grand Rounds Participant Discussion Rubric
Post by Day 3 and Respond by Day 7
To Participate in this Discussion:
Week 6 Discussion
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Sample Focused SOAP Note
Focused SOAP Note
Patient Information:
W, 76, F
S (subjective)
CC (chief complaint): “Runny nose” for 3-week duration, associated clearing of throat, and nasal congestion on awakening in the morning.
HPI (history of present illness): The patient is a 76-year-old woman who recently moved into an independent living center after living in her home for 40 years. She states that, although she has had these symptoms before, generally the symptoms appeared in the spring, and she associated the nasal drainage with pollination. Because it is winter, she could not identify the trigger of her symptoms. Complains of nasal drainage, clearing of throat, and occasional nasal congestion, especially on waking in the morning.
Current Medications:
Ibuprofen
Multivitamin
Allergies: No known drug or food allergies.
PMHx:
HTN
Soc and Substance Hx:
Recently moved into an independent living center after living in her home for 40 years. She is a widow with three daughters. She has no history of drug and substance abuse. She has a history of taking alcohol during social occasions.
Fam Hx:
Mother and father had HTN. Mother died of cardiac arrest. Father died in a road accident. The daughters are healthy, but one has recently been diagnosed with high blood pressure. No significant health data about the grandparents. The first born daughter has a grand daughter who is 8 years and is healthy.
Surgical Hx: Brain surgery at 45 years of age to counter growth in the brain cells.
Mental Hx: The patient has no history of anxiety, stress, suicidal ideation, depression, or any mental illness.
Violence Hx: No history of sexual, physical, or mental abuse or violence.
Reproductive Hx: The 76-year old patient is past the reproductive age. She cannot remember her last menstrual date. She is widowed and is not sexually active. She has had three daughters in her lifetime.
ROS (review of symptoms):
GENERAL: She records a drop in weight since she moved to the Helped living facility. She has no fever, chills, or fatigue.
HEENT:
• Eyes: She is shortsighted and uses glasses. No history of injury. All the four daughters use eye glasses.
• Ears, Nose, Throat: No hearing loss. Complains of runny nose for the last 3 weeks. Other symptoms include nasal congestion on awakening in the morning. No sore throat.
SKIN: No bruises or itching.
CARDIOVASCULAR: No edema, chest pain, or discomfort.
RESPIRATORY: Coughs in the morning to clear the throat. No history of shortness of breath.
GASTROINTESTINAL: No diarrhea, vomiting or nausea.
GENITOURINARY: No burning sensation on urination. Her last menstrual date is unknown.
NEUROLOGICAL: No numbness, headache, or changes in bladder or bowel control patterns.
MUSCULOSKELETAL: No joint problems, pain in the muscles, or stiffness.
HEMATOLOGIC: No anemia or bleeding.
LYMPHATICS: No splenectomy or enlarged nodes.
PSYCHIATRIC: No history of depression or mental disorder.
ENDOCRINOLOGIC: No history of sweating or heat intolerance.
REPRODUCTIVE: No history of recent pregnancy. Not sexually active. No vaginal discharge.
ALLERGIES: No eczema or rhinitis.
O (objective)
Physical exam:
Blood pressure (BP) 130/84, temperature 98.6, pulse 78, respiratory rate 20.
Diagnostic results:
Percutaneous skin test and the allergen-specific immunoglobulin E (IgE) antibody test shows positive results for allergic rhinitis.
A (assessment)
Differential diagnoses:
J30. 9 Allergic rhinitis
The patient is likely suffering from allergic rhinitis based on the explanation and the symptoms. The patient indicates she suffered almost similar symptoms in the past during cold seasons (Kennedy-Malone et al., 2018). The condition involves inflammation of the nose caused by an allergen such as pollen, mold, or dust. It leads to sneezing and a runny nose (Kennedy-Malone et al., 2018). Antihistamine medication is necessary to reduce the symptoms.
J31. 0 Episodic rhinitis
The condition occurs due to exposure to airborne allergen on a short-term basis. It includes symptoms such as nasal congestion, sneezing, or postnasal drainage. The condition is likely to occur if a patient is suffering from asthma (Emeryk et al., 2019). Patients can use nasal spray or antihistamine to lessen the severity of the symptoms since there is no specific cure for rhinitis (Emeryk et al., 2019).
J30. 0 Vasomotor rhinitis
Vasomotor rhinitis is a chronic condition characterized by sneezing, watery nasal drainage, and sneezing. Some of the triggers of the condition include body spray, dust, pollen, or odor (Emeryk et al., 2019). Irritants such as changes in weather can trigger the symptoms. Patients should check for associated conditions such as flu or cold.
J98.0 Primary ciliary dyskinesia
Primary ciliary dyskinesia is characterized by chronic respiratory infection. The symptoms include wet cough, nasal congestion, recurring pneumonia, and middle ear infections (Lucas et al., 2020). Immediate and appropriate treatment is necessary to prevent the chronic condition from interfering with the respiratory system (Lucas et al., 2020).
P (plan)
The patient should start taking antihistamines to lessen the severity of the conditions. Brompheniramine dosage for 4mg oral tablet QID is effective in lessening the symptoms to allow the patient to live normally (Emeryk et al., 2019). The patient should avoid irritants that can trigger the symptoms. For instance, the patient should avoid dust, pollen, or spray which can affect the respiratory system. It is vital to communicate to the management in the Helped living facility to ensure she is placed in a condition that does not put her at risk of rhinitis.
Reflection.
I learned that adults who shift from their homes to Helped living facilities are at risk of illnesses due to changes in environment or weather. Appropriate lifestyle adjustments are necessary to avoid putting elderly people at risk of illnesses.
The patient should start taking the medication and come back for review. The patient should get tested for other related conditions such as flu or cold. It is vital to get a Covid-19 test as a routine procedure to ensure the safety of the patient.
Informed consent is the basis for the provision of quality, safe, and patient-centered care (McDermott-Levy et al., 2018). The patient should receive care without discrimination based on age or ethnic background. Veracity is vital in telling the patient about the triggers of the chronic respiratory condition (McDermott-Levy et al., 2018).
The patient should avoid irritants that affect the respiratory system. An appropriate diagnosis is effective to ensure the patient is not suffering from other conditions such as Covid-19, asthma, cold, or flu. A comprehensive assessment is critical for appropriate and safe treatment (Kennedy-Malone et al., 2018). Collaboration with different healthcare workers is critical for the health of the patient.
The management in the Helped living facility should be ready to provide first aid to the patient in case of nasal blockage. Elderly patients can suffer complications due to poor breathing systems.
The patient should adhere to treatment and come back for Assessment after two weeks.
References
Emeryk, A., Emeryk-Maksymiuk, J., & Janeczek, K. (2019). New guidelines for the treatment of seasonal allergic rhinitis. Advances in Dermatology and Allergology/Postȩpy Dermatologii i Alergologii, 36(3), 255.
Kennedy-Malone, L., Martin-Plank, L., & Duffy, E. (2018). Advanced practice nursing in the care of older adults. FA Davis.
Lucas, J. S., Davis, S. D., Omran, H., & Shoemark, A. (2020). Primary ciliary dyskinesia in the genomics age. The Lancet Respiratory Medicine, 8(2), 202-216.
McDermott-Levy, R., Leffers, J., & Mayaka, J. (2018). Ethical principles and guidelines of global health nursing practice. Nursing outlook, 66(5), 473-481.
