Case Discussion Pulmonary – Part 1
Save your time - order a paper!
Get your paper written from scratch within the tight deadline. Our service is a reliable solution to all your troubles. Place an order on any task and we will take care of it. You won’t have to worry about the quality and deadlinesOrder Paper Now
The purpose of this assignment is for students to:
1. Improve their ability to formulate diagnoses based on clinical presentation of patients
2. Improve their ability to understand and apply National Guidelines for the diagnosis and treatment of Pulmonary disorders
Activity Learning Outcomes
Through this discussion, the student will demonstrate the ability to:
1. Utilize healthcare delivery system resources in a fiscally responsible manner in the diagnosis and treatment of patients and families across the lifespan. (PO 5)
2. Develop management plans based on current scientific evidence and national guidelines. (PO 5)
3. Educate patients on treatment decisions (WO1)
4. Select an evidence-based article to support the plan of care for the case study patient. (WO2)
5. Analyze national guidelines and apply them to specific case study situations. (WO3)
6. Review appropriate antibiotic prescribing guidelines. (WO4)
Week 2: Case Discussion: Pulmonary Part One
Setting: A free medical clinic that provides health care for the under-insured.
Your next patient, Michelle G., age 40, is a regular of the clinic and the last patient of the day. The chart states she is here for recent episodes of shortness of breath.
You enter the room and Michelle G is dressed in work clothes, standing up looking at a health poster on the wall. You introduce yourself and ask her what brings her to the clinic today. “I think I may have a cold. I’ve been having a hard time breathing on and off lately.”
HPI: “I notice I’m short of breath mostly at work but by the time I get home feel fine. No episodes of shortness of breath on the weekends that I can recall. But a few hours back at work and I start to feel like I cannot catch my breath again. A few months ago this happened and it was so bad I left work and went to urgent care where they gave me a breathing treatment of some kind and sent me home on an antibiotic. I would like you to give me another antibiotic. She denies sputum. No new allergy triggers noted. She denies heartburn.
PMHx: Michelle G. reports her overall health as good.
Childhood/previous illnesses: eczema as a child
Chronic illnesses: Has seasonal allergies, spring is her worst season. Was seen by an allergy specialist ten years ago, Took allergy shots for five years with great results, now only takes Zyrtec when needed.
Hospitalizations: childbirth x 3.
Immunizations: up-to-date on all vaccinations.
Allergies: Strawberries-Rash; erythromycin- severe GI upset.
Blood transfusions: none
Drinks alcohol socially, smoked 1 pack per week for 3 years in her 20’s. Denies illicit drug use.
Sleeps 6 to 7 hours a night. Exercises four to five days per week.
Current medications: Multivitamin, Zyrtec
Social History: Married, lives with husband and 3 children. Worked in advertising up until 18 months ago when she got laid off. In order to help with the household finances she took a job as a Baker’s assistant at an Artisan Bread Bakery. She arrives at 4 a.m. every morning to begin baking breads/pastries for the day.
Family History: Children are healthy- daughter currently has a sinus infection. Parents are deceased. Mother at age 80 from congestive heart failure. Father died at age 82 from lung cancer, diagnosed when metastasized to brain. PGM: died from unknown causes, PGF: Stroke at age 82. MGM: died at 83, had HTN, atherosclerosis and many heart attacks. PGF: died at 71 from complications of COPD.
PE: Height 5’10”, Weight 140 pounds
Vital signs : BP 130/70, T 98.0, P 75, R 18 Sao2 98% on RA
General: 40-year-old Caucasian female appears stated age in no apparent distress. Alert, oriented, and cooperative. Able to speak in full sentences and does not appear breathless. Skin: Skin warm, dry, and intact. Skin color is pale pink, no cyanosis or pallor.
HEENT: Head normo-cephalic. Hair thick and distribution even throughout scalp.
Eyes: Sclera clear. Conjunctiva: white, PERRLA, EOMs intact.
Ears: Tympanic membranes gray and intact with light reflex noted. Pinna and tragus non-tender
Nose: Nares patent with thin white exudate noted. Mucosa appears boggy and pale. Deviated septum noted. Sinuses non-tender to palpation.
Throat: Oropharynx pink, moist, no lesions or exudate. Tonsils 1+ bilaterally. Teeth in good repair, no 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.
Lungs: Lungs clear to auscultation bilaterally. Respirations unlabored. Slight wheezing noted inspiration and on forced expiration. Wheezing does not clear with forced cough.
CV: Heart S1 and S2 noted, RRR, no murmurs noted, no displaced PMI. Peripheral pulses equal bilaterally, no peripheral edema
Abdomen: Abdomen round, soft, with bowel sounds noted in all four quadrants. No organo-megaly noted.
Review of the patient’s EMR reveals an old CXR from last winter when she had Bronchitis.
CXR Report: 11/7/2016
This is a PA and lateral chest radiograph on Ms. Michelle X, performed on 11/7/16. Clinical information: low grade fever, productive cough, malaise.
Findings: Cardio-mediastinal silhouette is normal. B/L lung fields are clear. There are no effusions. The bony thorax appears normal. No opacities or fluid. Diaphragm normal.
Impression: Normal chest radiograph without pathology.
You suspect an obstructive/restrictive process and order Pulmonary Function Testing
Pre-Bronchodilator Challenge- FEV1/FVC 60%, FVC decreased
Post Bronchodilator Challenge- FEV1/FVC 75%
Discussion Questions Part One:
1. What is your primary diagnosis for Michelle given the pattern of occurrence of symptoms, exam results, and recent history? Include the rationale and a reference for your diagnoses.
2. What is your first-line treatment plan for Michelle including medications, labs, education, referrals, and follow-up? Identify the drug class of each medication you prescribe and exactly what symptom it is targeted to address.
3. Address Michelle’s request for an antibiotic.
**To see view the grading criteria/rubric, please click on the 3 dots in the box at the end of the solid gray bar above the discussion board title and then Show Rubric.
|This criterion is linked to a Learning OutcomeDiscussion Content Possible Points = 90 Points
Application of Course Knowledge Post contributes unique perspectives/insights applicable to the identified diseases. Original dialogue is used with little or zero direct quotes. Demonstrates course knowledge by thorough, detailed, thoughtful, evidence-based discussion of similarities and differences between assigned diseases in reference to: • Presentation (demographics, onset of symptoms, associated risk factors) • Pathophysiology (knowledge demonstrated in original dialogue) • Assessment (physical assessment, diagnostic testing) • Diagnosis • Treatment *Note listing the components of each disease separately without reflecting on them in relation to each other does not demonstrate course knowledge.
|This criterion is linked to a Learning OutcomeSupport from Evidence-Based Practice
Discussion post supported by evidence from appropriate sources published within the last five years. Content of journal articles represents a logical link between the article content and the case study information. In-text citations and full references are provided.
|This criterion is linked to a Learning OutcomeInteractive Dialogue
Presents diseases together 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)
|This criterion is linked to a Learning OutcomeDiscussion Format Possible Points = 10 Points
Organization Discussion post presented in a logical, meaningful, and understandable sequence. Headings reflect separation of criterion outlined in assignment guidelines.
|This criterion is linked to a Learning OutcomeAPA/Grammar/Spelling
(*) 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.
|This criterion is linked to a Learning OutcomeParticipation
Discussion late penalty deductions A 10% late penalty will be imposed for discussions posted after the deadline on Wednesday at 1159pm MT, regardless of the number of days late. NOTHING will be accepted after 11:59pm MT on Sunday (i.e. student will receive an automatic 0)