Week Seven Signature Assignment
FNP 595: Main Healthcare of Continual Purchasers/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 as a result 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 Kind 2, Hypothyroidism, and Anemia. This paper will current a SOAP be aware relating to this case, evidence-based literature, dialogue, and suggestions associated to the EBP literature.
SOAP Observe
ID: B.V. is a 64-year-old Asian Indian male who presents to the clinic together 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 as a result of wheezing and a non-healing wound on his left plantar foot. This affected person lately moved to the US from India a month in the past and desires to ascertain his PCP on this clinic. The affected person seen 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 house dressings at house. Additionally, the affected person seen that he began having steady wheezing for greater than Three weeks. The affected person is a power 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 seems 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 together with his medicines
Previous Medical/Surgical Historical past:
HTN, DM 2, Hypothyroidism, Anemia.
Hospitalization: unable to recall Allergic reactions: NKDA
Medicines: Medicines from India
Vildagliptin 50 mg every day Levothyroxine 50 mcg every day
Telmisartan 40 mg every day Bisoprolol 50 mg every day
Lantus 20 models SC every 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 often and denies using avenue medication. He states that he consumes 2 cups of tea per day. He’s a retired instructor and isn’t sexually lively. He presently lives together with his 2 kids in a residential house. He lately moved to the US and is utilizing his journey insurance coverage for healthcare protection. His kids are supportive and supply for his wants.
Non secular Desire: Sikhism
Household Historical past:
Father- deceased at 55 y.o. as a result of respiratory failure, Mom- deceased at 80 y.o., no identified previous medical historical past.
Siblings- 1 brother- has DM 2, Kids- 1 lady, 1 boy- wholesome, no identified medical situation
ROS:
Basic: 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 belly 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.; Peak: 5ft, Eight inches, BMI: 22
Bodily Examination:
Basic 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, lots, 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 issue.
Neurologic: No syncope, confusion, or dizziness famous. The affected person is alert and oriented.
A:
COPD
Rationale: Smoking is probably the most vital reason behind 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 perhaps have uncontrolled DM. He has a longtime prognosis of DM 2. Diabetes mellitus is a syndrome of metabolic dysfunction and hyperglycemia as a result 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 as a result of lowered cell and development issue response decreased blood move within the peripheral areas, and impaired native angiogenesis (Syafril, 2018).
Diagnostics:
Random blood sugar, HbA1C, and TSH immediately
Lung Perform 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 models SC every day
5. Bactroban ointment to wound BID.
Schooling:
1. Imparted smoking cessation info. Smoking will increase the chance of growing coronary heart illnesses and worsening diabetic foot ulcers.
2. Blood sugar ought to be monitored frequently at house. 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 beneath 59, observe 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 ouncesof 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 will likely trigger diabetic ketoacidosis.
6. Recurrently test toes for cuts or lesions. Carry out every day dressing on the affected foot and maintain clear. Every day/PRN dressing—irrigate/clear with NS, pat dry, apply Bactroban ointment, and canopy with 4×4.
7. Preserve 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 respiratory or pursed-lip respiratory when in need of breath.
Comply with-up:
1. Dilated eye examination, fasting lipid profile and particular foot examination ought to be carried out yearly.
2. HbA1c ought to be monitored each Three months to test the affected person’s blood glucose management.
Three. Maintain BP lower than 140/80 mmHg.
Four. Maintain shingles, flu, pneumonia, and different vaccines updated.
5. Urine ought to be checked for the presence of protein/different issues.
(Money et al., 2021).
Referrals:
Comply with up in 1-2 weeks or earlier if signs worsen.
Podiatrist referral for administration of the diabetic wound.
Associated Literature
COPD is without doubt one of 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 achieved by Miravitlles et al. (2016) are centered on reducing signs, slowing down then pure illness development, enhancing life high quality, enhancing bodily exercise, stopping adversarial sequelae and problems, and enhancing 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 mixture of ICS and bronchodilator is beneficial in sufferers with FEV1<50% or <60%, those that are at excessive threat for exacerbations and hose with a earlier historical past of two or extra exacerbations up to now 12 months, and people who have asthma-COPD overlap syndrome (Miravitlles et al., 2016). One other research that was achieved by (Fazleen & Wilkinson, 2020) mentions using spirometry because the gold commonplace for COPD prognosis. As well as, in addition they point out potential early diagnostic modalities within the type of diffusion capability for carbon monoxide (DLCO), pressured expiratory move at 25-75% of FVC, whole lung quantity, and imaging. The second research additionally mentions that potential interventions for early COPD embody smoking cessation, inhaled bronchodilator and steroid remedy, phosphodiesterase-Four inhibitors, macrolides, N-acetylcysteine, and vaccinations (flu, RSV, and different viral infections).
The checklist of suggestions for diabetic foot administration by Pérez-Panero et al., (2019) contains the next: screening inspection of the leg and toes; use of therapeutic footwear, strain 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 better than or equal to six.5% for the prognosis of DM amongst Indian sufferers. As well as, screening and early detection embody using a threat Assessment questionnaire and glycemic measure amongst high-risk people. Medical vitamin remedy on this research recommends a food plan with the next breakdown: 50-60% carbohydrates with low glycemic load, 30% fats-avoid saturated fatty acids, 15% proteins-limit crimson meat and the remainder embody leafy greens, nuts, complete grains, and unsaturated fat (Chawla et al., 2020). Metformin is the drug of selection together with life-style modification. Twin remedy is required if glucose targets should not achieved. 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 writer believes that many of the diagnostic and administration orders are acceptable for this affected person. Some additions, nevertheless, might enhance the administration of this affected person. For the affected person’s COPD, to ascertain a correct prognosis, lung perform exams equivalent to spirometry ought to be included. The usage of QVAR and Combivent Respimat is acceptable for this affected person. Qvar accommodates a corticosteroid that helps with the inflammatory responses related to the affected person’s signs. The Combivent Respimat helps calm down the graceful muscle tissues of the airways. Some acceptable interventions that might be added embody a referral to a podiatrist and an ophthalmologist. Relying on the results of the A1c, this affected person ought 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 recently moved from India and will have a tough time searching for western equivalents or beforehand consumed Indian meals. On this case, a dietary seek the advice of with a registered dietician ought to be achieved. Scientific proof demonstrates that individuals with Diabetes who’re on medical vitamin remedy accomplish a 1-2% discount in A1c, similar 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 Tips (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 assessment. Medication, 98(35), e16877.
Syafril, S. (2018, March). Pathophysiology diabetic foot ulcer. In IOP Convention Collection: 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 Kind 2 Diabetes Mellitus: An Indian Perspective. Advances in remedy, 36(Three), 520–547. https://doi.org/10.1007/s12325-019-0872-Eight
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Signature Assignment for Week Seven
Week Seven Signature Assignment for FNP 595: Main Healthcare of Continual Purchasers/Households Throughout the Lifespan
This paper discusses a case of a 64-year-old Asian male who presents to the clinic as a result 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 Kind 2, Hypothyroidism, and Anemia. This paper will current a SOAP be aware relating to this case, evidence-based literature, dialogue, and suggestions associated to the EBP literature.
SOAP Observe ID: B.V. is a 64-year-old Asian Indian male who presents to the clinic together 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
