Week 3: Case Discussion: Cardiovascular
Post contributes clinically accurate perspectives/insights applicable to the results from the physical exam and diagnoses. Initial post includes the most likely diagnosis/specific treatment plan given case study information supported by rationale and answers all questions presented in the case. Demonstrates course knowledge/assigned readings by: linking tests/interventions accurately to diagnoses, applies learned knowledge specifically to the symptoms and patient information using original dialogue i.e., little to no direct quotes.
Evidence Based resources 20 20% Discussion post supported by evidence from appropriate sources published within the last five years. Focus of journal articles represents a logical link between the article content and the case study information. In-text citations and full references are provided.
Interactive Dialogue 20 20% Presents case study findings and responds substantively to at least one peer including evidence from appropriate sources, and all direct faculty questions posted. Substantive posts contribute new, novel perspectives to the discussion using original dialogue (not quotes from sources)
90 90% Total CONTENT Points= 90 pts
DISCUSSION FORMAT
Category Points % Description
Organization 5 5% Discussion post presented in a logical, meaningful, and understandable sequence. Headings reflect separation of criterion outlined in assignment guidelines.
**Direct quote should not exceed 15 words & must add substantively to the discussion
APA/Grammar/Spelling 5 5% Discussion post has minimal grammar, spelling, syntax, punctuation and APA* errors. Direct quotes (if used) is limited to 1 short statement** which adds substantively to the post.
* APA style references and in text citations are required; however, there are no deductions for errors in indentation or spacing of references. All elements of the reference otherwise must be included.
10 10% Total FORMAT Points= 10 pts
DISCUSSION TOTAL= 60 points
Requirements:
Setting: large rural clinic; family practice clinic that employs physicians, physician Helpants and nurse practitioners.
You open the chart to review for your next patient, and you see it is Lorene M. Lorene is a 60 year-old African American female with a history of hypertension and known documented metabolic syndrome following lifestyle changes per her request. You note she is not due for a follow up at this time, so you look at the chief complaint.
CC: Shoulder discomfort and SOB with exercise 3 days ago.
ORDER NOW FOR PLAGIARISM-FREE PAPERS
You enter the room and introduce yourself to Lorene who is sitting in the chair. You ask what brings her in today. She smiles, shaking her head and says “My daughter made me come, I feel fine. I am way too busy to be here today. Since my last visit, three months ago, I joined a gym and with the support of my daughter, we are going two days a week.” However, three days ago Lorene felt short of breath while in dance class. She developed what she calls as “a discomfort” that radiated back and up between her shoulder blades while at the peak of her exercise routine. She also felt a little nauseous and sweaty. Once she stopped dancing, all symptoms resolved in about 3 minutes and they have not re-occurred. Week 3: Case Discussion: Cardiovascular
PMHx: Reports general health as good. She has been trying to lose weight through exercise and avoiding processed foods. She admits that food is a large part of her background and heritage in social activities and so it is difficult to make healthy choices. She had been feeling great since starting to work out and has lost 2 inches around the abdomen. She describes having lots of energy until this episode three days ago. Now she is a little concerned because she feels a little more tired than usual. She has not participated in anything strenuous and has not worked out since
Childhood/previous illnesses: chicken pox.
Chronic illnesses: Hypertension, Metabolic Syndrome, and Dyslipidemia.(Lifestyle management was initiated per patient preference) Gestational Diabetes with 3 pregnancies managed with Insulin
Surgeries: T and A, cholecystectomy
Hospitalizations: None aside from surgeries listed above
Immunizations: Does not receive the flu shot.
Allergies: Reports remote Hx allergy to metformin. Describes a GI disturbance.
Blood transfusions: None
Current medications: None. Stopped Lisinopril one month ago as she read that it can cause a cough as one if its side effects. Prefers to get the BP under control with diet and exercise.
Social History: Married for 20 years. Children are grown and have moved out of the house but all live locally and are close to their parents. Lorene works full time as a CEO of a successful marketing company and travels often for work. She eats out a lot while entertaining business clients. She enjoys beer and wine and the occasional “social” cigarette when she gets together once weekly with her girlfriends.
Family History: Parents are deceased. Father had lung cancer and mother died from complications of a stroke due to complications of diabetes type 2. Brother died at 44 from malignant melanoma. Other sister and brother are healthy but they also have diagnoses of metabolic syndrome.
PE:
Height: 5’8″ weight: 220 pounds; BMI 33.5 vital signs: BP 146/90 P 70 Sao2 97% Random glucose finger stick in office: 130mgs/dl
General: African American female in NAD. Alert, oriented, and cooperative. Pain: 0/10 at present
Skin: Skin warm, dry, and intact. Skin color is light skinned brown, no cyanosis or pallor.
HEENT: Head normo-cephalic. Hair thick and distribution even throughout scalp.
Eyes: Sclera clear. Conjunctiva: white, PERRLA, EOMs intact. No AV nicking noted.
Ears: Tympanic membranes gray and intact with light reflex noted. Pinna and tragus non-tender
Nose: Nares patent without exudate. Sinuses non-tender to palpation, Right-sided Deviation
Throat: Oropharynx moist, no lesions or exudate. Teeth in poor repair, gums reddened and receding, filled cavities noted. Tongue smooth, pink, no lesions, protrudes in midline.
Neck supple. No cervical lymphadenopathy or tenderness noted. Thyroid midline, small and firm without palpable masses. Mild JVD in recumbent position
Lungs: Lungs clear to auscultation bilaterally. Respirations unlabored. No rashes or vesicles noted on chest.
CV: Heart S1 and S2 noted, RRR, no murmurs, noted. No parasternal lifts, heaves, and thrills. Peripheral pulses equally bilaterally. PMI 5th ICS displaced 4cm laterally. Trace edema in lower extremities. Week 3: Case Discussion: Cardiovascular
Abdomen: Abdomen round, soft, with bowel sounds noted in all four quadrants. No organomegaly noted.
Week 3: Cardiovascular Case Discussion
Week 3: Cardiovascular Case Discussion
Week 3: Cardiovascular Case Discussion
Post provides clinically correct perspectives/insights that are relevant to the physical exam and diagnosis results. The initial post includes the most likely diagnosis/specific treatment plan based on the case study information, as well as responses to all of the case’s questions. By accurately tying tests/interventions to diagnoses, applying learnt knowledge particularly to symptoms and patient information, and employing original dialogue (i.e., few to no verbatim quotes), the student demonstrates course knowledge/assigned readings.
Resources based on scientific evidence
20 percent 20 percent
Evidence from suitable sources published during the last five years is used to support this discussion thread. The focus of journal papers serves as a logical link between the substance of the article and the case study data. Full references and in-text citations are required.
