Part 1: Advanced Primary Care of Family
Topic: Respiratory case
SUBJECTIVE:
Janis, a 59 – year – old female, presents with tachypnea, dyspnea on exertion, and mild chest discomfort. She was diagnosed with emphysema four years ago and was placed on bronchodilator therapy. She has an 80-pack-year history of smoking. “ I feel short of breath when I walk, and my chest is sore. ” She describes her chest soreness as mild pressure, rated as two on a 1 – 10 scale. The pain is over the anterior thorax, more pronounced in the ribs, which she believes has developed from coughing hard. She states that she has had a nonproductive cough for four days and feels more fatigued than usual.
Past medical history
She has osteoarthritis in the hands and knees. She has a surgical history of appendectomy and cholecystectomy. In the past year, she has had two exacerbations of her COPD and has attempted to stop smoking, using nicotine gum replacement unsuccessfully.
Family history
Noncontributory.
Social history
She lives with her husband, who also smokes two packs of cigarettes per day and cares for her elderly mother, who lives with them and is frail but ambulatory.
Medications
Albuterol MDI, 90 mcg/inhalation, two puffs as needed every 4 – 6 hours; ipratropium bromide MDI, 18 mcg/inhalation, two puffs four times/day; ibuprofen as needed for arthritic pain.
Allergies
Janis is allergic to Keflex and penicillin.
OBJECTIVE:
General: Janis is dyspneic at rest, sitting. The use of accessory muscles is evident. Pursed lip breathing noted.
Vital signs: BP: 122/64; P: 92; R: 26; T: 100.2; SpO2: 88. AP to transverse ratio is 1:1.
Skin: Warm and dry.
HEENT: Negative.
Cardiovascular: RRR: S1/S2; no murmurs, clips, rubs, or gallops. No evidence of peripheral edema. Posterior tibial and dorsalis pedis pulses 2 + /4 + .
Respiratory: Lungs have diffused wheezing and crackles in the right upper lobe. Tenderness to palpation along intercostal spaces on the right and left anterior and lateral thorax from the 2nd to 5th intercostal spaces. PFT conducted two months prior to the visit showed obstructive flow patterns and reduced FEV1/FVC.
Abdomen: Soft, with bowel sounds; tympanic to percussion.
Neurologic: Negative.
Based on the described case scenario, please answer two of the following questions:
1. Which diagnostic or imaging studies should be considered to Help with or confirm the diagnosis? (one paragraph)
a. Explain (one paragraph)
2. What is the most likely differential diagnosis, and why? (one paragraph)
a. Explain
3. What is your plan of treatment? (one paragraph)
a. Pharmacology
b. Nonpharmacology
4. What is your plan for follow-up care? also, include (one paragraph)
a. Are any referrals needed?
a. Explain and justify
5. What are additional risk factors evident for this patient? (one paragraph)
6. Explain two standardized guidelines that you should use to treat this patient (one paragraph)
Part 2: Advanced Primary Care of Family
Topic: Respiratory case
SUBJECTIVE:
Janis, a 59 – year – old female, presents with tachypnea, dyspnea on exertion, and mild chest discomfort. She was diagnosed with emphysema four years ago and was placed on bronchodilator therapy. She has an 80-pack-year history of smoking. “ I feel short of breath when I walk, and my chest is sore. ” She describes her chest soreness as mild pressure, rated as two on a 1 – 10 scale. The pain is over the anterior thorax, more pronounced in the ribs, which she believes has developed from coughing hard. She states that she has had a nonproductive cough for four days and feels more fatigued than usual.
Past medical history
She has osteoarthritis in the hands and knees. She has a surgical history of appendectomy and cholecystectomy. In the past year, she has had two exacerbations of her COPD and has attempted to stop smoking, using nicotine gum replacement unsuccessfully.
Family history
Noncontributory.
Social history
She lives with her husband, who also smokes two packs of cigarettes per day and cares for her elderly mother, who lives with them and is frail but ambulatory.
Medications
Albuterol MDI, 90 mcg/inhalation, two puffs as needed every 4 – 6 hours; ipratropium bromide MDI, 18 mcg/inhalation, two puffs four times/day; ibuprofen as needed for arthritic pain.
Allergies
Janis is allergic to Keflex and penicillin.
OBJECTIVE:
General: Janis is dyspneic at rest, sitting. The use of accessory muscles is evident. Pursed lip breathing noted.
Vital signs: BP: 122/64; P: 92; R: 26; T: 100.2; SpO2: 88. AP to transverse ratio is 1:1.
Skin: Warm and dry.
HEENT: Negative.
Cardiovascular: RRR: S1/S2; no murmurs, clips, rubs, or gallops. No evidence of peripheral edema. Posterior tibial and dorsalis pedis pulses 2 + /4 + .
Respiratory: Lungs have diffused wheezing and crackles in the right upper lobe. Tenderness to palpation along intercostal spaces on the right and left anterior and lateral thorax from the 2nd to 5th intercostal spaces. PFT conducted two months prior to the visit showed obstructive flow patterns and reduced FEV1/FVC.
Abdomen: Soft, with bowel sounds; tympanic to percussion.
Neurologic: Negative.
Based on the described case scenario, please answer two of the following questions:
1. Which diagnostic or imaging studies should be considered to Help with or confirm the diagnosis? (one paragraph)
a. Explain (one paragraph)
2. What is the most likely differential diagnosis, and why? (one paragraph)
a. Explain
3. What is your plan of treatment? (one paragraph)
a. Pharmacology
b. Nonpharmacology
4. What is your plan for follow-up care? also, include (one paragraph)
a. Are any referrals needed?
b. Explain
5. What are additional risk factors evident for this patient? (one paragraph)
6. Explain two standardized guidelines that you should use to treat this patient (one paragraph)
Part 3: Complementary and Alternative Health Care
1. What is Complementary and alternative medicine (CAM) (One paragraph)
2. How Complementary and alternative medicine (CAM) and nursing links (One paragraph)
3. How nurses can incorporate alternative medicine into a holistic approach to patient care (One paragraph)
4. Explain the benefits for the patient when nurses incorporate alternative medicine into a holistic approach to patient care (One paragraph)
5. Explain how holism and humanism improve the nurse’s patient care (One paragraph)
6. Explain the benefits for the patient when they get holism and humanism care from nurses (One paragraph)
Part 4: Crisis Intervention
Topic: Posttraumatic Stress Disorder
1. Introduction (One paragraph)
2. What is PTSD ? (One paragraph)
3. Explain the statistics data in the last 5 years of PTSD (Three paragraphs)
a. Global (One paragraph)
b. The USA (One paragraph)
c. Florida (One paragraph)
4. According to (ONLY) to DSM5 explain PTSD (Two paragraphs)
a. Diagnostic criteria (One paragraph)
b. Categorization (One paragraph)
5. Explain the physiological responses of PTSD (Two paragraphs)
6. Explain the maladaptive patterns of PTSD (Two paragraphs)
7. Interventions / Treatments (Two paragraphs)
a. Pharmacological (One paragraph)
b. Non-pharmacological (One paragraph)
8. Explain other considerations in the management of PTSD (Three paragraphs)
a. Management of behaviors (One paragraph)
b. Family considerations (One paragraph)
c. Challenges in the care of patients with this disorder (One paragraph)
9. Explain one evidence-based practice guidelines/research for nurses for the management of PTSD patient (One paragraph)
10. Explain one nursing theory that support the identification of clinical problems of PTSD patient (One paragraph)
11. Explain the important of implementation and imporve of nursing skills in the care of adults with this disorder. (Two paragraphs)
a. Which nursing skills are vitals (One paragraph)
b. Which nursing skills are secundaries (One paragraph)
12. Conclusion for nurses (One paragraph)
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Which diagnostic or imaging studies should be considered to Help with or confirm the diagnosis?
Chest X-ray and spirometry are the diagnostic or imaging studies that should be considered to Help with or confirm the diagnosis. Chest X-ray can help to identify signs of emphysema such as hyperinflation, flattened diaphragm, and bullae. Spirometry is a test that measures how well the lungs are working and can confirm the diagnosis of emphysema by measuring the forced expiratory volume in one second (FEV1) and the forced vital capacity (FVC). Additionally, a CT scan can be considered to detect any lung damage and identify the extent of the disease.
What is the most likely differential diagnosis, and why?
The most likely differential diagnosis is exacerbation of chronic obstructive pulmonary disease (COPD). The patient’s history of emphysema and bronchodilator therapy, as well as her presenting symptoms of tachypnea, dyspnea on exertion, and chest discomfort, are consistent with an exacerbation of COPD. Other possible differential diagnoses include pneumonia, asthma, and lung cancer, but these are less likely given the patient’s history and physical examination findings.
What is your plan of treatment?
a. Pharmacology:
Treatment for exacerbation of COPD includes bronchodilators, such as albuterol and ipratropium bromide, which can help to relax the airway muscles and improve airflow. In addition, the patient may be given a short course of oral corticosteroids, such as prednisone, to reduce inflammation in the airways. Antibiotics may also be prescribed if there is a suspected bacterial infection.
b. Nonpharmacology:
Nonpharmacologic treatment options include oxygen therapy, which can help to increase oxygen levels in the blood, and chest physical therapy, which can help to clear secretions from the lungs.
What is your plan for follow-up care? also, include
a. Are any referrals needed?
My plan for follow-up care includes scheduling a follow-up appointment within 1-2 weeks to evaluate the patient’s response to treatment and adjust therapy as needed. The patient will be instructed on how to properly use her bronchodilator and corticosteroid medications, as well as on the importance of staying compliant with her treatment regimen. The patient should also be referred to a smoking cessation program as smoking is a major risk factor for COPD. Additionally, referral to a pulmonologist for further management of her COPD may be considered.
What are additional risk factors evident for this patient?
Additional risk factors evident for this patient include her history of smoking and her age. As the patient is 59 years old, her age also increases her risk of developing COPD. Additionally, the patient’s occupation and environmental exposure to pollutants may also be contributing factors to the development of COPD.
Explain two standardized guidelines that you should use to treat this patient
The Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines, which provide recommendations for the diagnosis, management, and prevention of COPD. These guidelines recommend the use of bronchodilators, such as albuterol and ipratropium bromide, and corticosteroids for the treatment of exacerbations of COPD.
The National Institute for Health and Care Excellence (NICE) guidelines, which provide recommendations for the treatment and management of COPD in primary care. These guidelines recommend the use of bronchodilators, such
