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Discussion: Patient Ofthe Day Discussion: Patient

Discussion: Patient Ofthe Day Discussion: Patient Ofthe Day Discussion: Patient Ofthe Day ORDER NOW FOR AN ORIGINAL PAPER ASSIGNMENT: Discussion: Patient Ofthe Day NR 603 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. Surgeries: Tonsillectomy, Cholecystectomy 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. Diagnostic Testing: 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: 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. 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. Address Michelle’s request for an antibiotic. NR 603 Week 2: Case Discussion: Pulmonary Part One – SOAP Week 2 Patient Information: M.G., 40-year-old female, race unknown, insurance unknown. (S) Subjective: CC:“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. Current Medications: Multivitamin Zyrtec Allergies:Strawberries-Rash; erythromycin- severe GI upset. PMHx: Michelle G. reports her overall health as good. 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. PSHx:Tonsillectomy, Cholecystectomy Childhood Illnesses:eczema as a child Immunization Hx:up-to-date on all vaccinations. Other Screenings:Not reported. Soc Hx: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. 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. Fam Hx: 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. ROS: CONSTITUTIONAL: No reports of fever, chills, weight loss.Report sick contact-daughter has sinusinfection. HEENT:None reported. SKIN: None reported. CARDIOVASCULAR:None reported. RESPIRATORY:Shortness of breath at work. Denies sputum. GASTROINTESTINAL: Denies heartburn. GENITOURINARY: None reported. NEUROLOGICAL:None reported. MUSCULOSKELETAL: None reported. HEMATOLOGIC/LYMPHATICS: None reported. PSYCHIATRIC: None reported. ENDOCRINOLOGIC: None reported. ALLERGIES: Strawberries and erythromycin. Reports seasonal allergies-spring is worst. O: Vital signs:B/P 130/70, T 98.0, HR 75, RR 18 Sao2 98% RA. Height 5’10”, weight 140 pounds BMI: 20.1 PHYSICAL EXAM 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. 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 patentwith 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. HEART: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 organomegaly noted. SKIN:Skin warm, dry, and intact. Skin color is pale pink, no cyanosis or pallor. ADDITIONAL INSTRUCTIONS FOR THE CLASS Discussion Questions (DQ) Initial responses to the DQ should address all components of the questions asked, include a minimum of one scholarly source, and be at least 250 words. Successful responses are substantive (i.e., add something new to the discussion, engage others in the discussion, well-developed idea) and include at least one scholarly source. One or two sentence responses, simple statements of agreement or “good post,” and responses that are off-topic will not count as substantive. Substantive responses should be at least 150 words. I encourage you to incorporate the readings from the week (as applicable) into your responses. Weekly Participation Your initial responses to the mandatory DQ do not count toward participation and are graded separately. In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days, for a total of three replies. Participation posts do not require a scholarly source/citation (unless you cite someone else’s work). Part of your weekly participation includes viewing the weekly announcement and attesting to watching it in the comments. These announcements are made to ensure you understand everything that is due during the week. APA Format and Writing Quality Familiarize yourself with APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for APA paper templates, citation examples, tips, etc. Points will be deducted for poor use of APA format or absence of APA format (if required). Cite all sources of information! When in doubt, cite the source. Paraphrasing also requires a citation. I highly recommend using the APA Publication Manual, 6th edition. Use of Direct Quotes I discourage overutilization of direct quotes in DQs and assignments at the Masters’ level and deduct points accordingly. As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content. It is best to paraphrase content and cite your source. LopesWrite Policy For assignments that need to be submitted to LopesWrite, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me. Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes. Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own? Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for tips on improving your paper and SI score. Late Policy The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies. Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances. If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect. I do not accept assignments that are two or more weeks late unless we have worked out an extension. As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading. Communication Communication is so very important. There are multiple ways to communicate with me: Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class. Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.

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