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NR 601 Week 6 Case Study Discussions Health Promotion, Health Protection, Disease Prevention, and Treatment Considerations in Long-Term Care (Part-2) NEW
Discussion Part Two (graded)
Physical Exam:
Discussion Part Two (graded)
Vital signs: blood pressure 145/90, heart rate 100, respirations 20 height 5’1”; weight 210 pounds
Labwork:
CBC: normal
UA: 2+ glucose; 1+ protein; negative for ketones
CMP: BUN/Creat. elevated; Glucose is 300 mg/dL
Hemoglobin A1c: 12%
Thyroid panel: normal
LFTs: normal
Cholesterol: total cholesterol (206), LDL elevated; HDL is low EKG: normal
General: obese female in not acute distress HEENT: unremarkable
CV: S1 and S2 RRR without murmurs or rubs
Lungs: Clear to auscultation
Abdomen– soft, round, nontender with positive bowel sounds present; no organomegaly; no abdominal bruits
Discussion Questions Part Two
For the primary diagnosis, what non-pharmacological and pharmacological strategies would be appropriate?
Include the following: lab work and screenings to be completed. Describe patient education strategies.
Describe follow-up and any referrals that may be necessary.
Discussion Part One (graded)
C.G. is a 69-year-old male with a history of right head and neck cancer that you have been following for one year. The carcinoma was initially localized to the head and neck-specifically at the left lingual tonsil region and went on to complete a total of 6 weeks of radiation and chemotherapy. Recently, the last PET scan indicated some metabolic activity in the left lymph node area along with other regions of abnormal metabolic activity in the body-particularly the liver and the lungs indicating metastasis. C.G. indicates that he is tired of the effects of chemotherapy and radiation and does not want to pursue any more treatment for cancer.
Background:
Right head and neck cancer with metastasis to liver and lungs; patient is refusing further treatment.
PMH:
Hypertension
Hyperlipidemia
Stomatitis
Anemia
Neutropenia
Current medications:
Carvedilol 12.5 mg po 1 daily
Furosemide 40 mg po daily
Surgeries:
2012: right radical neck dissection
Allergies:
None
Vaccination History:
Influenza vaccine last received 1 year ago
Received pneumovax at age 65
Received Tdap 5 years ago
Has not had the herpes zoster vaccine
Social history and Risk Factors:
Former smoker-stopped smoking at the time his cancer was diagnosed-2 years ago
Negative for alcohol intake or drug use
Patient does not have an advanced directive or living will. He is refusing further treatment for his cancer and his wife and children are in disagreement with him. The patient wants to know what his options are for the remainder of his life.
Family history:
Negative
Discussion Part One:
Provide differential diagnoses (DD) with rationale.
Further ROS questions needed to develop DD.
Identify the legal/ethical issues involved with the patient and describe your approach to addressing end-of-life care for this patient.
Discussion Part Two (graded)
Physical examination:
Vital Signs: Height: 6’0 Weight: 140 pounds; BMI: 19.0 BP: 156/84 P: 84 regular R: 20
HEENT: normocephalic, symmetric PERRLA, EOMI; poor dentition NECK: left neck supple; non-palpable lymph nodes; no carotid bruits. Limited ROM
LUNGS: rhonchi in anterior chest bilaterally.
HEART: S1 and S2 audible; regular rate and rhythm
ABDOMEN: active bowel sounds all 4 quadrants; Normal contour; RUQ tenderness; liver palpable
NEUROLOGIC: negative
GENITOURINARY: negative
MUSCULOSKELETAL: negative
PSYCH: PHQ-9 is 15
SKIN: oral mucosa irritated-stomatitis
Discussion Part Two:
Summarize the history and results of the physical exam. Discuss the differential diagnosis and rationale for choosing the primary diagnosis. Include one evidence-based journal article that supports your rationale and include a complete treatment plan that includes medications, possible referrals, patient education, ICD 10 Codes, and plan for follow up.
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PSY 490 Capstone Course in Psychology
PSY 490 Capstone Course in Psychology Version 9, ~~~~ Week 4 Quiz Not Included in this.
PSY 490 Week 1 DQ 1
PSY 490 Week 1 DQ 2
PSY 490 Week 1 Individual The Diverse Nature of Psychology Paper
PSY 490 Week 1 Summary
PSY 490 Week 2 DQ 1
PSY 490 Week 2 DQ 2
PSY 490 Week 2 Individual Portfolio Presentation
PSY 490 Week 2 Learning Team Psychological Issue Summary
PSY 490 Week 2 Summary
PSY 490 Week 3 DQ 1
PSY 490 Week 3 DQ 2
PSY 490 Week 3 Individual Ethics Awareness Inventory
PSY 490 Week 3 Summary
PSY 490 Week 4 DQ 1
PSY 490 Week 4 DQ 2
PSY 490 Week 4 Individual Pay it Forward
PSY 490 Week 4 Summary
PSY 490 Week 5 DQ 1
PSY 490 Week 5 DQ 2
PSY 490 Week 5 Learning Team Jeopardy Game Presentation
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PSY 490 Week 1 Summary
PSY 490 Week 1 Summary
Write and present a summary of how this week’s readings and activities have affected your thought process regarding any aspect of this week’s Capstone course. (350 – 500 Words)
PSY 490 Week 2 Summary
Write and present a summary of how this week’s readings and activities have affected your thought process regarding any aspect of this week’s Capstone course. (300 – 500 Words)
PSY 490 Week 3 DQ 1
The Ethics Awareness Inventory CORE concepts do not include Kohlberg’s stages of moral development. Why do you think that is? Do you think they concur? Explain your responses.
PSY 490 Week 3 DQ 2
What are the advantages or disadvantages of a psychology degree? What are the advantages or disadvantages of a bachelor’s, master’s, and doctorate degree in psychology?
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NR 601 Week 2 Case Study Discussions Physical Examination (Part-1) NEW
Discussion Part One (graded)
B.J., a 70-year-old Caucasian female has been seen in the clinic several times over the last 3 years. However, she missed her last annual appointment-last appointment was 18 months ago and today you are the nurse practitioner seeing her. She arrived to the clinic alone and states she is “here for my check-up”.
Background:
The patient reports that “my feet just burn and tingle all the time and it is so much worse at night that I can hardly sleep at all”. She also indicates that “I need some new pillows; I use 3 of them now to just get comfortable at night to sleep. Those pillows help me catch my breath so I can sleep better”. She also reports dyspnea just walking to the bathroom, but it only happens when her legs are “swole up” and also states, “the coughing also keeps me up at night”. To be honest, “I’m just tired in general whether my feet are “swole” or not”. She also indicates that she cannot see well, especially at night. She also reported that at her last visit to the clinic, she was told that she had a “heart beat problem” and that she is supposed to be taking aspirin every day. She said she thinks all of her “heart pains” went away after she started taking the aspirin and “putting that pill under the tongue”. One of her concerns she has today is that since her husband died last year, she tells you, “I just don’t like doing things that I liked to do before my husband died. We used to like to do all sorts of stuff, but anymore….I just feel blue all the time”.
PMH:
Chronic back pain
Hypertension
Previous history of MI in 2010
Diabetes?
Hypothyroidism?
Constipation?
Congestive Heart Failure?
Current medications:
Coreg 6.25 mg PO BID
Colace 100 mg PO BID
Glucotrol XL 10 mg PO daily
Lantus insulin 20 units at HS
K-dur 20 mEq PO QD
Furosemide 40 mg PO QD
L-Thyroxine 112 mcg PO QD
Aspirin?
Nitroglycerine?
Surgeries:
2010-Left Anterior Descending (LAD) cardiac stent placement Allergies: Amoxicillin
Vaccination History:
She receives an annual flu shot. Last flu shot was this year Has never had a Pneumovax
Has not had a Td in over 20 years
Has not had the herpes zoster vaccine
Other:
Has not seen a dentist in over 15 years, the time she got her dentures
Last colorectal screening was 11 years ago
Last mammogram was 5 years ago
Has never had a DEXA/Bone Density Test
Last dilated eye exam was 4 years ago
Labs from last year’s visit: Hgb 12.2, Hct 37%, Hgb A1C 8.2%, K+ 4.2, Na+140,Cholesterol 186, Triglycerides 188, HDL 37, LDL 98, TSH 3.7, ALT/AST WNL.
Social history:
She graduated from high school, and thought about college, but got married right away and then had kids a short time later. Her two sons and their wives live with her, take her to church and to the local senior center; they do all the cleaning, run errands, and do grocery shopping. Family history:
Both parents are deceased. Father died of a heart attack; mother died of natural causes. She had one brother who died of a heart attack 20 years ago at the age of 52.
Habits:
Patient is a current tobacco user and has smoked 1 pack of cigarettes daily for the last 50 years and reports having no desire to quit. She uses occasional chew. She drinks one 4 ounce glass of red wine daily.
Discussion Part One:
Provide differential diagnoses (DD) with rationale.
Further ROS questions needed to develop DD.
Based on the patient data provided, choose geriatric assessment tools that would be appropriate to use in conducting a thorough geriatric assessment. Provide a rationale on why you are choosing these particular tools.
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