Assignment Details Case Study #2 Date: November 12, 2016, 2:00 pm Location: XYZ Family Practice You are an NP student in this practice. Your next patient is the following: “I had to come in today because I have been coughing for a long time” Amanda Smith (69 year old, black female) is a retired postal worker. During the visit, she is coughing continually. She states the cough started 5 days ago intermittently but 2 days ago it became constant. Her chart indicates that she has been a patient of the practice for 5 years, gets care regularly and her HTN has been controlled for 4 years. Social History Married – 2 adult children A & W Non-Smoker now. Smoke 1 pack a day for 15 years. Quit x5 years ago No alcohol or drug use Baptist, attends church regularly and is a member of the choir Family History Mother – Deceased at age 27 from traumatic accident Father – Deceased age 78 related to renal failure secondary to diabetes type II Siblings – one brother age 61 A & W Medical/Surgical/Health Maintenance Hx Measles, mumps and chicken pox as a child. Tetanus/Diptheria/Pertussis – Last dose 2 years ago Influenza – Last dose 9 months ago Pneumococcal vaccine at age 65 Zostivax at age 60 Chronic diagnoses – HTN x 5 years Takes HCTZ 25 mg daily ROS General Usual weight has been maintained Fever for 5 days up to 101 Skin Dry skin, uses emollient frequently HEENT Wears reading glasses Dentition fair. Partial upper denture Neck No swelling or stiffness Chest Substernal pain on cough Respiratory Began coughing 4 days ago. Started mild, intermittent and non-productive. Two days ago became constant and productive of frothy sputum. Keeps her awake at night. No relief with OTC cough syrup. She states she is short of breath today. CV No CP at rest or when not coughing PV Some swelling of feet and ankles at end of day, relieved by elevating feet GI Decreased appetite for one week No change in bowel habits GU No frequency, hesitancy, nocturia or change in bladder habits Genitalia No changes MS Stiffness in hands and legs on awakening. Relieved with activity Psych No depression, anxiety, or memory change Neurologic No numbness, weakness, headache, change in mentation, or paralysis Hematologic No past anemia Endocrine No change in weight, thirst, heat/cold intolerance. Your physical exam reveals: Temp 101.4, Resp 30 labored, no retractions, BP 135/92, HR 110, Pulse Ox 90 Wt 130 lbs General appearance – Alert in all spheres, in mild respiratory distress, able to answer questions with short sentences, tripod breathing HEENT – Eyes ,ear, nose, head wnl Mouth -mucosa dry Pharynx – tonsils present not enlarged, normal pink color Lymph – no enlargement Skin – Dry and scaly legs and arms. Tenting of skin noted Heart- regular rhythm at 110 bpm, no murmurs or extra sounds Lungs – normal breath sound without crackles, bronchophony or egophony Abdomen – no mass, tenderness, rigidity Extremities – Hands – no sw.

1. Assignment Details
Case Study #2
Date: November 12, 2016, 2:00 pm
Location: XYZ Family Practice
You are an NP student in this practice. Your next patient is the
following:
“I had to come in today because I have been coughing for a long
time”
Amanda Smith (69 year old, black female) is a retired postal
worker. During the visit, she is coughing continually. She states
the cough started 5 days ago intermittently but 2 days ago it
became constant. Her chart indicates that she has been a patient
of the practice for 5 years, gets care regularly and her HTN has
been controlled for 4 years.
Social History
Married – 2 adult children A & W
Non-Smoker now. Smoke 1 pack a day for 15 years. Quit x5
years ago
No alcohol or drug use
Baptist, attends church regularly and is a member of the choir
Family History

2. Mother – Deceased at age 27 from traumatic accident
Father – Deceased age 78 related to renal failure secondary to
diabetes type II
Siblings – one brother age 61 A & W
Medical/Surgical/Health Maintenance Hx
Measles, mumps and chicken pox as a child.
Tetanus/Diptheria/Pertussis – Last dose 2 years ago
Influenza – Last dose 9 months ago
Pneumococcal vaccine at age 65
Zostivax at age 60
Chronic diagnoses – HTN x 5 years
Takes HCTZ 25 mg daily
ROS
General
Usual weight has been maintained
Fever for 5 days up to 101
Skin
Dry skin, uses emollient frequently

3. HEENT
Wears reading glasses
Dentition fair. Partial upper denture
Neck
No swelling or stiffness
Chest
Substernal pain on cough
Respiratory
Began coughing 4 days ago. Started mild, intermittent and non-
productive. Two days ago became constant and productive of
frothy sputum. Keeps her awake at night. No relief with OTC
cough syrup. She states she is short of breath today.
CV
No CP at rest or when not coughing
PV
Some swelling of feet and ankles at end of day, relieved by
elevating feet
GI
Decreased appetite for one week
No change in bowel habits

4. GU
No frequency, hesitancy, nocturia or change in bladder habits
Genitalia
No changes
MS
Stiffness in hands and legs on awakening. Relieved with
activity
Psych
No depression, anxiety, or memory change
Neurologic
No numbness, weakness, headache, change in mentation, or
paralysis
Hematologic
No past anemia
Endocrine
No change in weight, thirst, heat/cold intolerance.
Your physical exam reveals:
Temp 101.4, Resp 30 labored, no retractions, BP 135/92, HR
110, Pulse Ox 90 Wt 130 lbs
General appearance – Alert in all spheres, in mild respiratory

5. distress, able to answer questions with short sentences, tripod
breathing
HEENT –
Eyes ,ear, nose, head wnl
Mouth -mucosa dry
Pharynx – tonsils present not enlarged, normal pink color
Lymph – no enlargement
Skin – Dry and scaly legs and arms. Tenting of skin noted
Heart- regular rhythm at 110 bpm, no murmurs or extra sounds
Lungs – normal breath sound without crackles, bronchophony or
egophony
Abdomen – no mass, tenderness, rigidity
Extremities – Hands – no swelling, Feet/legs - +1 edema feet to
ankle level
Pedal pulses – wnl
Differential diagnoses:
CAP
Acute bronchitis
Congestive heart failure

6. Influenza
Plan - transfer to acute care setting for further work-up
Assignment Details:
The “Elevator Consult”
In this activity, you will practice giving a synopsis of your
patient to your preceptor. In practice, you may often give this
type of report if you are sending a patient for a consultation and
your phone the specialist to discuss the patient. This report
should be concise and clear. The receiver should, within one
minute (slightly less for simple cases, slightly more for complex
cases) have a picture of the patient in his/her head. You will
report on ONLY items pertaining to the acute problem in this
case. Do not include extraneous material or material not directly
impacting the decision-making regarding this problem.
Remember, this is a FOCUSED visit and assessment to evaluate
a focused concern. The history and physical exam applies
techniques relevant to the specific complaint for the patient at
that visit. Your report should be similarly focused, providing
only information that relates specifically to the presenting
problem.
Please review the grading rubric under Course Resources in the
Grading Rubric section.