WEEK SEVEN Four
Week Seven Signature Assignment
FNP 595: Main Healthcare of Persistent Shoppers/Households Throughout the Lifespan
Week Seven Signature Assignment
This paper discusses a case of a 64-year-old Asian male who presents to the clinic on account of wheezing and a non-healing wound on his left foot. His subjective and goal info is important for a historical past of Hypertension, Diabetes Mellitus Sort 2, Hypothyroidism, and Anemia. This paper will current a SOAP observe concerning this case, evidence-based literature, dialogue, and proposals associated to the EBP literature.
SOAP Word
ID: B.V. is a 64-year-old Asian Indian male who presents to the clinic along with his son. He seems to be a dependable historian and the son interpreted for his father.
CC: Wheezing and non-healing wound on the left foot.
HPI: B.V. is a 64-year-old Asian Indian male who offered to the clinic on account of wheezing and a non-healing wound on his left plantar foot. This affected person just lately moved to the US from India a month in the past and desires to ascertain his PCP on this clinic. The affected person observed a wound that has not healed for greater than 1 month. The affected person states that the wound has no drainage, and his son has been doing dwelling dressings at dwelling. Additionally, the affected person observed that he began having steady wheezing for greater than Three weeks. The affected person is a continual smoker x 20 years x 1 PPD. He admits to having a cough with minimal sputum (greenish). Hoarseness, dysphagia, SOB is current and he vomited Three days in the past. He appears like there’s a “lump in his throat”. He has a previous medical historical past of HTN, DM, 2, hypothyroidism, and Anemia. He denies taking any medicines for his wheezing. Dyspnea is worsened by exercise. He denies chest ache, palpitations, and dizziness. The son states that the affected person has been non-compliant along with his medicines
Previous Medical/Surgical Historical past:
HTN, DM 2, Hypothyroidism, Anemia.
Hospitalization: unable to recall Allergy symptoms: NKDA
Drugs: Drugs from India
Vildagliptin 50 mg day by day Levothyroxine 50 mcg day by day
Telmisartan 40 mg day by day Bisoprolol 50 mg day by day
Lantus 20 items SC day by day Delpran-L ½ tab at evening (dosage unable to recall)
Vaccinations: Tdap- UTD, 2018 Flu- not updated, refused vaccination; COVID vaccine- obtained 2 doses, different vaccinations- unknown if obtained
Social Historical past:
The affected person states that he has been actively smoking for 20 years x 1PPD. He stopped smoking every week in the past. He drinks alcohol sometimes and denies using avenue medicine. He states that he consumes 2 cups of tea per day. He’s a retired instructor and isn’t sexually lively. He at present lives along with his 2 kids in a residential dwelling. He just lately moved to the US and is utilizing his journey insurance coverage for healthcare protection. His kids are supportive and supply for his wants.
Spiritual Choice: Sikhism
Household Historical past:
Father- deceased at 55 y.o. on account of respiratory failure, Mom- deceased at 80 y.o., no identified previous medical historical past.
Siblings- 1 brother- has DM 2, Youngsters- 1 lady, 1 boy- wholesome, no identified medical situation
ROS:
Normal: Denies fever, chills, or urge for food modifications. Admits to feeling fatigued.
Pores and skin: States that he has a non-healing wound on his left plantar foot that has been there for 1 month.
Head/Neck: He denies any headache or neck ache.
ENT: Denies blurry imaginative and prescient or rhinorrhea. Admits to having dysphagia and voice hoarseness x weeks.
Respiratory: States that he has a cough with minimal greenish sputum and dyspnea that’s worsened by exertion.
C/V: denies chest ache or palpitations. Endocrine: Has a historical past of hypothyroidism and DM 2.
GI: Denies stomach ache, diarrhea, constipation, nausea, or vomiting. States that he was 2-Three episodes of vomiting Three days in the past. Neuro: Denies seizures, tingling on decrease extremities, numbness.
Psychiatric: Denies melancholy, nervousness, or insomnia
Vitals Indicators:
Temperature: 98.1 (pores and skin) BP: 125/76 (left arm, sitting), HR: 94, O2 saturation 99% on RA
RR:20 ; Weight: 144 lbs.; Top: 5ft, Eight inches, BMI: 22
Bodily Examination:
Normal Look: Affected person is alert and oriented x Three. He seems fatigued.
Pores and skin: Wound famous on the left plantar foot, dime-sized and with scant clear discharge. No bleeding or purulent discharge was famous.
ENT: No discharges on ear canals. Moist and pink oral mucosa with out lesions. Posterior pharynx moist, pink with none exudate.
GI: Regular bowel sounds. No tenderness, plenty, or lumps have been famous upon palpation.
Respiratory: Rhonchi and wheezing have been famous bilaterally all through upon auscultation.
Cardiovascular: No gallops, friction rubs, or murmurs famous. RRR, S1 and S2 have been famous. No edema on extremities was famous.
Musculoskeletal: In a position to carry out ROM with out problem.
Neurologic: No syncope, confusion, or dizziness famous. The affected person is alert and oriented.
A:
COPD
Rationale: Smoking is probably the most vital explanation for COPD. People who’ve COPD often current of their fifth or sixth decade of life manifesting extreme sputum manufacturing, cough, and dyspnea (Papadakis et al., 2021).
DM 2
Rationale: This affected person is non-compliant and possibly have uncontrolled DM. He has a longtime prognosis of DM 2. Diabetes mellitus is a syndrome of metabolic dysfunction and hyperglycemia on account of insulin secretion deficiency and or insulin resistance (Papadakis et al., 2021)
Diabetic wound left foot
Rationale: The impaired metabolic mechanism in DM 2 results in poor wound therapeutic. The mechanisms of DM are on account of decreased cell and progress issue response decreased blood stream within the peripheral areas, and impaired native angiogenesis (Syafril, 2018).
Diagnostics:
Random blood sugar, HbA1C, and TSH at the moment
Lung Operate Take a look at/Spirometry- not ordered throughout this encounter
Administration
Pharmacologic/Therapeutic:
1. Combivent Respimat 1 puff QID
2. Augmentin 875 mg 1 tab q 12 x 10 days
Three. Qvar 80 mcg/puff 2 puffs BID x 7 days
Four. Lantus 20 items SC day by day
5. Bactroban ointment to wound BID.
Schooling:
1. Imparted smoking cessation info. Smoking will increase the chance of creating coronary heart illnesses and worsening diabetic foot ulcers.
2. Blood sugar needs to be monitored often at dwelling. Glycemic management objectives are as follows: Fasting blood sugar- 80-120 mg/dL and Glucose at bedtime- 100-140 mg/dL
Three. If the blood sugar drops under 59, comply with the 15:15 rule- eat 15 grams of Carbohydrates and wait 15 minutes earlier than taking both of the next: Three glucose tablets, ½ cup orange juice, ½ cup apple juice, 1/Three cup grape juice, or 6 ozof normal coke (Money et al., 2021).
Four. Carry out moderate-intensity workout routines (jogging, biking, strolling) 20-45 minutes/day Three to 4x per week.
5. Chorus from exercising if the fasting blood sugar is > 250 or random BS is > 300 mg/dL as this may increasingly trigger diabetic ketoacidosis.
6. Frequently test ft for cuts or lesions. Carry out day by day dressing on the affected foot and hold clear. Day by day/PRN dressing—irrigate/clear with NS, pat dry, apply Bactroban ointment, and canopy with 4×4.
7. Keep wholesome physique weight and devour meals which have a low glycemic index. Keep away from starchy meals and greens.
Eight. Scale back publicity to environmental irritants/pollution.
9. Carry out deep respiration or pursed-lip respiration when wanting breath.
Observe-up:
1. Dilated eye examination, fasting lipid profile and particular foot examination needs to be carried out yearly.
2. HbA1c needs to be monitored each Three months to test the affected person’s blood glucose management.
Three. Hold BP lower than 140/80 mmHg.
Four. Hold shingles, flu, pneumonia, and different vaccines updated.
5. Urine needs to be checked for the presence of protein/different issues.
(Money et al., 2021).
Referrals:
Observe up in 1-2 weeks or earlier if signs worsen.
Podiatrist referral for administration of the diabetic wound.
Associated Literature
COPD is among the most typical problems of smoking cigarettes and long-term publicity to irritants (Money et al., 2021). The criterion that defines obstruction of airflow that’s utilized in diagnosing COPD in most tips is an FEV1/FVC ratio of <70% (Miravitlles et al., 2016). The remedy objectives in a research executed by Miravitlles et al. (2016) are centered on lowering signs, slowing down then pure illness development, bettering life high quality, bettering bodily exercise, stopping antagonistic sequelae and problems, and bettering life expectancy. As well as, this research recommends a short-acting muscarinic agent (SAMA) or short-acting β2-agonist (SABA) for delicate illness and a LABA or LAMA for extra symptomatic sufferers. The mix of ICS and bronchodilator is really helpful in sufferers with FEV1<50% or <60%, those that are at excessive danger for exacerbations and hose with a earlier historical past of two or extra exacerbations up to now yr, and those that have asthma-COPD overlap syndrome (Miravitlles et al., 2016). One other research that was executed by (Fazleen & Wilkinson, 2020) mentions using spirometry because the gold customary for COPD prognosis. As well as, additionally they point out potential early diagnostic modalities within the type of diffusion capability for carbon monoxide (DLCO), compelled expiratory stream at 25-75% of FVC, whole lung quantity, and imaging. The second research additionally mentions that potential interventions for early COPD embrace smoking cessation, inhaled bronchodilator and steroid remedy, phosphodiesterase-Four inhibitors, macrolides, N-acetylcysteine, and vaccinations (flu, RSV, and different viral infections).
The listing of suggestions for diabetic foot administration by Pérez-Panero et al., (2019) consists of the next: screening inspection of the leg and ft; use of therapeutic footwear, stress offloading, debridement, dressings, antibiotic remedy, adjuvant remedies (G-CSF), administration of neuropathic ache and a multi-disciplinary method. In a research by (Chawla et al., 2020) that concerned the prognosis of DM amongst Indian sufferers, the panel suggests an A1c of larger than or equal to six.5% for the prognosis of DM amongst Indian sufferers. As well as, screening and early detection embrace using a danger Assessment questionnaire and glycemic measure amongst high-risk people. Medical diet remedy on this research recommends a weight loss plan with the next breakdown: 50-60% carbohydrates with low glycemic load, 30% fats-avoid saturated fatty acids, 15% proteins-limit pink meat and the remaining embrace leafy greens, nuts, entire grains, and unsaturated fat (Chawla et al., 2020). Metformin is the drug of selection together with way of life modification. Twin remedy is required if glucose targets aren’t completed. A sulfonylurea, or thiazolidinediones, or SGLT2 inhibitor or DPP-Four inhibitor or AGI could also be added.
Dialogue
Primarily based on the information gained, the creator believes that a lot of the diagnostic and administration orders are applicable for this affected person. Some additions, nevertheless, could enhance the administration of this affected person. For the affected person’s COPD, to ascertain a correct prognosis, lung operate exams reminiscent of spirometry needs to be included. The usage of QVAR and Combivent Respimat is acceptable for this affected person. Qvar comprises a corticosteroid that helps with the inflammatory responses related to the affected person’s signs. The Combivent Respimat helps calm down the sleek muscle tissue of the airways. Some applicable interventions that might be added embrace a referral to a podiatrist and an ophthalmologist. Relying on the results of the A1c, this affected person needs to be referred to a diabetes specialist. People who find themselves of Asian Indian descent could also be uncovered to extreme consumption of sugary sweets which have vital cultural relevance. As well as, this affected person only in the near past moved from India and should have a tough time on the lookout for western equivalents or beforehand consumed Indian meals. On this case, a dietary seek the advice of with a registered dietician needs to be executed. Medical proof demonstrates that individuals with Diabetes who’re on medical diet remedy accomplish a 1-2% discount in A1c, corresponding to the outcomes of antidiabetic remedy, resulting in a discount in prices and enchancment within the high quality of life (Viswanathan et al., 2019).
References
Money, J. C., Glass, C. A., & Mullen, J. (2021). Household Apply Pointers (fifth ed.). Springer Publishing Firm, LLC.
Papadakis, M., McPhee, S., & Rabow, M. (2021). Present medical prognosis and remedy. McGraw Hill
Pérez-Panero, A. J., Ruiz-Muñoz, M., Cuesta-Vargas, A. I., & Gónzalez-Sánchez, M. (2019). Prevention, Assessment, prognosis and administration of diabetic foot primarily based on medical follow tips: A scientific overview. Medication, 98(35), e16877.
Syafril, S. (2018, March). Pathophysiology diabetic foot ulcer. In IOP Convention Sequence: Earth and Environmental Science (Vol. 125, No. 1, p. 012161). IOP Publishing.
Viswanathan, V., Krishnan, D., Kalra, S., Chawla, R., Tiwaskar, M., Saboo, B., Baruah, M., Chowdhury, S., Makkar, B. M., & Jaggi, S. (2019). Insights on Medical Vitamin Remedy for Sort 2 Diabetes Mellitus: An Indian Perspective. Advances in remedy, 36(Three), 520–547. https://doi.org/10.1007/s12325-019-0872-Eight
SEVENTH WEEK Four
Signature Assignment for Week Seven
