NSG 6001 South University Onl

Respond to at least two of your classmates’ initial postings. Participate in the discussion by asking a question, providing a statement of clarification, providing a point of view with a rationale, challenging an aspect of the discussion, or indicating a relationship between two or more lines of reasoning in the discussion. Cite sources in your responses to other classmates.

Tiffany Costley peer #1

  1. Discuss the history of present illness that you would take on this patient in preparation for the clinic visit. Include questions regarding Onset, Location, Duration, Characteristics, Aggravating Factors, Relieving Factors, Treatment, Severity (OLDCARTS).
  • The patient is a 60-year-old female with a past medical history of high cholesterol and hypertension. Patient presented to clinic with complaints of chest pain for three months. Ms. Johnston was asked about the onset of her chest pain; she states pain occurs with activity and at rest while watching tv. She also states that the pain subsides after three minutes. The patient described her pain as burning like sensation and occasional tingling in the middle of her chest. She states a 6 out of 10 pain intensity that does not radiate to her jaw, arms, or neck. When pain occurs, she is short of breath, but does not experience sweating, nausea, or vomiting. Ms. Johnston states that she tries to alleviate the pain through positioning, however, her pain seemed to be relieved by drinking cold water.
  1. Describe the physical examination and diagnostic tools to be used for Ms. Johnston. Are there any additional you would have liked to be included that were not?

Ms. Johnston’s assessment should include both subjective and objective date. This includes a full head to toe assessment. A complete vital sign, listening to heart and lung sounds through a stethoscope. Then palpating all major arteries such as bilateral carotid arteries, radial pulses, dorsalis pedis, and popliteal arteries (Toney-Butler & Unison-Pace, 2020). Patient’s jugular veins should also be examined for distention, as well as extremities checked for edema. Abdomen should also be examined through palpation as well auscultation. Ears, nose, throat, and eyes should be assessed for any abnormalities (Toney-Butler & Unison-Pace, 2020).

Additionally, patient should have a transthoracic echocardiogram done a CT coronary angiogram, and or a stress , if possible, before proceeding to a cardiac catheterization.

  1. What plan of care will Ms. Johnston be given at this visit; what is the patient education and follow-up?
  • Ms. Johnston should be referred to a cardiologist for further evaluation. However, because patient state chest pains a rest, it is best to send patient to the emergency room for a thorough cardiac evaluation. Patient has several risk factors that may lead to acute coronary syndrome. These include a family history of heart disease, age, obesity, hypertension, and high cholesterol levels.

Patient should be educated regarding lifestyle modifications such as

diet, exercise, and medication compliance to help reduce the recurrence of symptoms (Xian-liang et al., 2017). Patient should be prescribed antiplatelets medication such aspirin for daily maintenance. If she receives coronary stenting, Clopidogrel or Ticagrelor as well as statins for a proper maintenance for coronary syndrome must be prescribed.

Toney-Butler TJ, Unison-Pace WJ. Nursing Admission Assessment and Examination. Updated

(2020 Sep 2). In: StatPearls Internet. Treasure Island (FL): StatPearls Publishing; 2021 Jan-Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK493211/

Liu, X. L., Shi, Y., Willis, K., Wu, C. J. J., & Johnson, M. (2017). Health education for patients with acute coronary syndrome and type 2 diabetes mellitus: an umbrella review of systematic reviews and meta-analyses. BMJ Open, 7(10), e016857. https://doi.org/10.1136/bmjopen-2017-01685

Amber peer #2

  • Discuss the history of present illness that you would take on this patient in preparation for the clinic visit. Include questions regarding Onset, Location, Duration, Characteristics, Aggravating Factors, Relieving Factors, Treatment, Severity (OLDCARTS).

I would conduct a through history of Susan’s presenting symptoms. I would ask how long she has been having this chest pain, what brings it on and what makes it better, what is the description of the pain, point to where it is located, if it radiates to any other part of her body, how long the pain lasts at a time, if it causes shortness of breath, dizziness, passing out, diaphoresis, or palpitations, and what the pain scale is on a 0-10 rating.

  • Describe the physical examination and diagnostic tools to be used for Ms. Johnston. Are there any additional you would have liked to be included that were not?

During the physical examination I would include a full set of vitals and examine each body system with a focus on heart, lungs, abdomen, musculoskeletal, and vascular. Her vital signs show a BMI of 35.5 kg/m, blood pressure 136/82, and height/weight 5’6”/220lbs. These results are all concerning for cardiac complications. There is no tenderness to the chest wall, on auscultation, she has normal S1 and S2, lung sounds are normal with normal chest rise and fall, abdomen is nontender, obese, and soft with no organ enlargement, there is no edema in her extremities, and radial, carotid, and dorsalis pedis pulses are 2+ bilaterally with a regular rate. An ECG was ordered to examine any abnormalities in her heart rhythm, CBC, BMP, TSH, and fasting lipid panel were ordered to assess for hemoglobin, renal disease, electrolyte imbalances, kidney function, thyroid function, and hyperlipidemia. A positive stress examination led to admission to the hospital for a cardiac angiogram and placement of a stent in her LAD. I would not include any other diagnostic tests since they were able to determine Susan was having angina due to the 75% blockage in her left anterior descending.

  • What plan of care will Ms. Johnston be given at this visit; what is the patient education and follow-up?

At this current visit, Susan’s plan of care will be to reduce chest pain. She is being admitted to the hospital, so I would educate the patient to let their nurse know if she is having chest pain so they are able to treat her accordingly. At the follow up appointment after the cardiac catheterization, plan of care will be focused on medication management, weight loss, exercise, and dietary modification. Medication management and understanding why she takes each medicine will lead to increased compliance, reduce chances of clotting at the stent site, control blood pressure, and control lipids. Weight loss, exercise, and dietary changes will improve her health, decrease further cardiac and metabolic risks.

ORDER THIS OR A SIMILAR PAPER AND GET 20% DICOUNT. USE CODE: GET2O

NSG 6001 South University Onl

Cardiovascular Discussion

This discussion assignment provides a forum for discussing relevant topics for this week based on the course competencies covered. For this assignment, make sure you post your initial response to the Discussion Area by the due date assigned.

To support your work with evidence bases references. As in all assignments, cite your sources in your work and provide references for the citations in APA format.

Start reviewing and responding to the postings of your classmates as early in the week as possible. Respond to at least two of your classmates’ initial postings. Participate in the discussion by asking a question, providing a statement of clarification, providing a point of view with a rationale, challenging an aspect of the discussion, or indicating a relationship between two or more lines of reasoning in the discussion. Cite sources in your responses to other classmates. In addition you must respond to your professor if applicable. Complete your participation for this assignment by end of the week.

For this assignment, you will complete a Aquifer case study based on the course objectives and weekly content. Aquifer cases emphasize core learning objectives for an evidence-based primary care curriculum. Throughout your nurse practitioner program, you will use the Aquifer case studies to promote the development of clinical reasoning through the use of ongoing assessments and diagnostic skills and to develop patient care plans that are grounded in the latest clinical guidelines and evidence-based practice.

The Aquifer assignments are highly interactive and a dynamic way to enhance your learning. Material from the Aquifer cases may be present in the quizzes, the midterm exam, and the final exam.

Click here for information on how to access and navigate Aquifer.

This week, complete the Aquifer case titled “Internal Medicine 02: 60-year-old woman with chest pain

Apply information from the Aquifer Case Study to answer the following discussion questions:

  • Discuss the history of present illness that you would take on this patient in preparation for the clinic visit. Include questions regarding Onset, Location, Duration, Characteristics, Aggravating Factors, Relieving Factors, Treatment, Severity (OLDCARTS).
  • Describe the physical exam and diagnostic tools to be used for Ms. Johnston. Are there any additional you would have liked to be included that were not?
  • What plan of care will Ms. Johnston be given at this visit; what is the patient education and follow-up?

ORDER THIS OR A SIMILAR PAPER AND GET 20% DICOUNT. USE CODE: GET2O

NSG 6001 South University Onl

Discussion Mental Health

This discussion assignment provides a forum for discussing relevant topics for this week based on the course competencies covered. For this assignment, make sure you post your initial response to the Discussion Area by the due date assigned.

To support your work, use your course textbook readings and the South University Online Library. As in all assignments, cite your sources in your work and provide references for the citations in APA format.

Start reviewing and responding to the postings of your classmates as early in the week as possible. Respond to at least two of your classmates’ initial postings. Participate in the discussion by asking a question, providing a statement of clarification, providing a point of view with a rationale, challenging an aspect of the discussion, or indicating a relationship between two or more lines of reasoning in the discussion. Cite sources in your responses to other classmates. Complete your participation for this assignment by the end of the week.

For this assignment, you will complete a Aquifer case study based on the course objectives and weekly content. Aquifer cases emphasize core learning objectives for an evidence-based primary care curriculum. Throughout your nurse practitioner program, you will use the Aquifer case studies to promote the development of clinical reasoning through the use of ongoing assessments and diagnostic skills and to develop patient care plans that are grounded in the latest clinical guidelines and evidence-based practice.

The Aquifer assignments are highly interactive and a dynamic way to enhance your learning. Material from the Aquifer cases may be present in the quizzes, the midterm exam, and the final exam.

Learn how to access and navigate Aquifer.

This week, complete the Aquifer case titled “Family Medicine 03: 65-year-old woman with insomnia

Apply information from the Aquifer Case Study to answer the following discussion questions:

  • Discuss the Mrs. Gomez’s history that would be pertinent to her difficulty sleeping. Include chief complaint, HPI, Social, Family and Past medical history that would be important to know.
  • Describe the physical exam and diagnostic tools to be used for Mrs. Gomez. Are there any additional you would have liked to be included that were not?
  • Please list 3 differential diagnoses for Mrs. Gomez and explain why you chose them. What was your final diagnosis and how did you make the determination?
  • What plan of care will Mrs. Gomez be given at this visit, include drug therapy and treatments; what is the patient education and follow-up?

ORDER THIS OR A SIMILAR PAPER AND GET 20% DICOUNT. USE CODE: GET2O

NSG 6001 South University Onl

Gastrointestinal Discussion

This discussion assignment provides a forum for discussing relevant topics for this week based on the course competencies covered. For this assignment, make sure you post your initial response to the Discussion Area by the due date assigned.

To support your work with evidence bases references. As in all assignments, cite your sources in your work and provide references for the citations in APA format.

Start reviewing and responding to the postings of your classmates as early in the week as possible. Respond to at least two of your classmates’ initial postings. Participate in the discussion by asking a question, providing a statement of clarification, providing a point of view with a rationale, challenging an aspect of the discussion, or indicating a relationship between two or more lines of reasoning in the discussion. Cite sources in your responses to other classmates. In addition you must respond to your professor if applicable. Complete your participation for this assignment by the end of the week.

For this assignment, you will complete a Aquifer case study based on the course objectives and weekly content. Aquifer cases emphasize core learning objectives for an evidence-based primary care curriculum. Throughout your nurse practitioner program, you will use the Aquifer case studies to promote the development of clinical reasoning through the use of ongoing assessments and diagnostic skills and to develop patient care plans that are grounded in the latest clinical guidelines and evidence-based practice.

The Aquifer assignments are highly interactive and a dynamic way to enhance your learning. Material from the Aquifer cases may be present in the quizzes, the midterm exam, and the final exam.

Learn how to access and navigate Aquifer.

This week, complete the Aquifer case titled “Family Medicine 19: 39-year-old man with epigastric pain

Apply information from the Aquifer Case Study to answer the following discussion questions:

  • Discuss the Mr. Rodriquez’s history that would be pertinent to his gastrointestinal problem. Include chief complaint, HPI, Social, Family and Past medical history that would be important to know.
  • Describe the physical exam and diagnostic tools to be used for Mr. Rodriguez. Are there any additional you would have liked to be included that were not?
  • Please list 3 differential diagnoses for Mr. Rodriguez and explain why you chose them. What was your final diagnosis and how did you make the determination?
  • What plan of care will Mr. Rodriquez be given at this visit, include drug therapy and treatments; what is the patient education and follow-up?

ORDER THIS OR A SIMILAR PAPER AND GET 20% DICOUNT. USE CODE: GET2O

NSG 6001 South University Onl

  • Respond to 2 peers using APA format please site all references
  • PEER #1 Suel
  • Discuss the Mr. Barley’s history that would be pertinent to his respiratory problem. Mr. Barley reports smoking one to two packs a day for 26 years and now has cut back on smoking to half a pack per day. In addition, he is a farmer who is exposed to chemicals and irritants.

Chief complaint: Productive ough and shortness of breath

HPI: 58-year-old farmer Caucasian male presents to clinic complaining of shortness of breath on exertion and productive cough with white phlegm mainly in the mornings for 2 weeks. Patient reports similar symptoms for the past two winters. Patient reports smoking 2 packs a day x 26 years and now has cut back to half a pack per day.

Social: 40 cigarette pack year, and drinks one beer every few days.

Family: Father died of a stroke at age of 70, mother is alive and suffers from HTN.

Past medical history: Tonsillectomy at 12 years of age.

  • Describe the physical exam and diagnostic tools to be used for Mr. Barley.

Common tools used in a physical exam were used such as:

Penlight: conjunctivae and sclerae are normal, PERRL, oropharynx is normal Sphygmomanometer: BP128/78 mmHg

Thermometer: 98.9 Fahrenheit

Stethoscope: Inspiratory crackles at the bases, and end-expiratory wheezing diffusely, Regular rate and rhythm. 2/6 systolic murmur loudest at the right upper sternal border (RUSB) with radiation to the left lower sternal border (LLSB), Bowel sounds normal

Hands: For manual exam- neck is supple without masses, lymphadenopathy, or thyromegaly. Laryngeal height measures 2 cm from sternal notch to the top of the thyroid cartilage upon full expiration. no hepatomegaly, no tenderness, 1+ pitting pretibial edema.

The physical exam for this patient focused on the classic findings of COPD which in the case study was listed as:

Increased anteroposterior (AP) diameter of the chest

Decreased diaphragmatic excursion

Wheezing (often end-expiratory)

Prolonged expiratory phase

Thorat, Salvi, and Kodgule (2017) state, “The most commonly used objective tool to diagnose asthma and COPD is spirometry.” This is the diagnostic tool used on Mr. Barley. However, spirometry may not be readily available in some rural areas or third world countries for several reasons including lack cost and lack of knowledge. Other tools used are pulmonary function test, and an x-ray which does not rule out COPD but may look for other diagnosis that may cause shortness of breath.

Are there any additional you would have liked to be included that were not?

The case study discussed possible tools available to assess lung status and how each served for the diagnosis of other diseases and not COPD, thus feeling content about the route opted for in the scenario. On the other hand, new studies are looking for possible ways to diagnose COPD early as not too much attention has been paid to the pathologic changes in the lungs of young adults with risk factors for COPD. Polverino et al. (2020) states, “In the postsurfactant era, where more young adults will be spirometrically diagnosed with COPD, patients should be classified not only on the basis of their airflow limitation, but also on lung abnormalities identified with safe, comprehensive imaging technologies that allow regular, longitudinal follow-up.” Lung MRI as a potential complementary diagnostic tool for early COPD is a tool that could deem effective in early diagnosis.

  • What plan of care will Mr. Barley be given at this visit, include drug therapy and treatments; what is the patient education and follow-up? According to the Global Initiative for Chronic Obstructive Lung disease, all symptomatic patients with COPD should be prescribed a short-acting bronchodilator and in this scenario, Albuterol is prescribed. However, as stated in the case study, “Smoking cessation is single-most important treatment strategy for COPD”. The patient education focuses on smoking cessation and provide patient with information about available smoking-cessation programs. Influenza and pneumococcal vaccines are recommended for adults with COPD to prevent exacerbations. Patient should return for regular check-ups and a follow up to perform another pulmonary function test in six months to a year is needed to determine how well patient is responding to treatment and if the disease is progressing. Follow ups will also monitor nutrition through body mass index (BMI), as good nutrition is especially important in COPD.

References

Thorat, Y. T., Salvi, S. S., & Kodgule, R. R. (2017). Peak flow meter with a questionnaire and mini-spirometer to help detect asthma and COPD in real-life clinical practice: a cross-sectional study. NPJ primary care respiratory medicine, 27(1), 1-7.

Polverino, F., Hysinger, E. B., Gupta, N., Willmering, M., Olin, T., Abman, S. H., & Woods, J. C. (2020). Lung MRI as a potential complementary diagnostic tool for early COPD. The American journal of medicine, 133(6), 757-760.

PEER #2 LorenaChief Complaint: Cough and SOB

HPI: Mr. Barley is 58-year-old male, smoker, who presents at the clinic with complaints of a 2-week productive cough progressively getting worse and shortness of breath on exertion. Symptoms are similar from the past 2 years around wintertime. Pt denies fever, chest pain, recent travel, TB, or recent chemical exposure.

Social History: Mr. Barley is a farmer, married for 35 years with whom he has 2 grown children. He is a smoker and has a 40-cigarette pack-year history. Pt drinks one beer every few days.

Family History: Father died at the age of 70 from a stroke; mother alive with history of hypertension; 2 healthy sisters.

Past Medical History: Denies any significant PMH.

Physical Exam:

Vital Signs: BP 128/78; P94 bpm; T; 98.9 F Wt.; Ht.; BMI.

Physical Assessment Findings:

HEENT: Normocephalic / atraumatic, conjunctivae and sclerae are normal, PERRL, oropharynx is normal.

Neck: Supple without masses, lymphadenopathy, or thyromegaly. Laryngeal height measures 2cm from sternal notch to the top of the thyroid cartilage upon full expiration.

Lungs: Increased AP diameter. Percussion is normal. Inspiratory crackles at the bases, and end-expiratory wheezing diffusely.

Heart: Regular rate and rhythm. 2/6 systolic murmur loudest at the right upper sternal border with radiation to the left lower sternal border.

Abdomen: Bowel sounds normal, no hepatomegaly, no tenderness.

Extremities/Pulses: +1 pitting pretibial edema.

Diagnostic Tools: Pulmonary Function Test (PFT), chest x-ray, and spirometry.

Are there any additional you would have liked to be included that were not? Arterial blood gas test to measure how well Mr. Barley’s lungs are bringing oxygen into his blood and removing carbon monoxide.

Plan of Care

Drug Therapy: Albuterol MDI PRN

Treatments: Smoking cessation and Immunizations (Influenza and Pneumococcal)

Patient Education: Instructions on how to use a meter dose inhaler with spacer; information of the benefits of smoking cessation; information on what is COPD, what to expect, and how to continue treatment. Also, warning signs regarding COPD exacerbation and when to seek help.

Follow-Up: Follow up to be scheduled in 6-12 months for another PFT and overall condition management.

ORDER THIS OR A SIMILAR PAPER AND GET 20% DICOUNT. USE CODE: GET2O