This document discusses three case studies involving patients presenting with ear, nose, and throat symptoms. For Case 1, Richard presents with nasal congestion and drainage. A physical exam shows pale nasal mucosa and enlarged turbinates. For Case 2, Lily presents with a sore throat and symptoms of a viral infection. For Case 3, James presents with right ear pain and decreased hearing. He has spent time in the pool recently. The document provides guidance on collecting patient history, performing exams, selecting diagnostic tests, and generating differential diagnoses for the cases.
Make a SOAP Note Assessing Ear, Nose, and ThroatMost ear, nose, a.docxeubanksnefen
Make a SOAP Note: Assessing Ear, Nose, and Throat
Most ear, nose, and throat conditions that arise in non-critical care settings are minor in nature. However, subtle symptoms can sometimes escalate into life-threatening conditions that require prompt assessment and treatment. Nurses conducting assessments of the ears, nose, and throat must be able to identify the small differences between life-threatening conditions and benign ones. For instance, if a patient with a sore throat and a runny nose also has inflamed lymph nodes, the inflammation is probably due to the pathogen causing the sore throat rather than a case of throat cancer. With this knowledge and a sufficient patient health history, a nurse would not need to escalate the assessment to a biopsy or an MRI of the lymph nodes, but would probably perform a simple strep test.
In this Discussion, you consider case studies of abnormal findings from patients in a clinical setting. You determine what history should be collected from the patients, what physical exams and diagnostic tests should be conducted, and formulate a differential diagnosis with several possible conditions.
Note:
By Day 1 of this week, your instructor will have assigned you to one of the following case studies to review for this Discussion. Also, your Discussion post should be in the SOAP Note format, rather than the traditional narrative style Discussion posting format. Refer to Chapter 2 of the Sullivan text and the Comprehensive SOAP Template in the Week 4 Learning Resources for guidance.
Remember that not all comprehensive SOAP data are included in every patient case.
Case 1:
Nose Focused Exam
Richard is a 50-year-old male with nasal congestion, sneezing, rhinorrhea, and postnasal drainage. Richard has struggled with an itchy nose, eyes, palate, and ears for 5 days. As you check his ears and throat for redness and inflammation, you notice him touch his fingers to the bridge of his nose to press and rub there. He says he's taken Mucinex OTC the past two nights to help him breathe while he sleeps. When you ask if the Mucinex has helped at all, he sneers slightly and gestures that the improvement is only minimal. Richard is alert and oriented. He has pale, boggy nasal mucosa with clear thin secretions and enlarged nasal turbinates, which obstruct airway flow but his lungs are clear. His tonsils are not enlarged but his throat is mildly erythematous.
Case 2:
Focused Throat Exam
Lily is a 20-year-old student at the local community college. When some of her friends and classmates told her about an outbreak of flu-like symptoms sweeping her campus over the past two weeks, Lily figured she shouldn't take her three-day sore throat lightly. Your clinic has treated a few cases similar to Lily's. All the patients reported decreased appetite, headaches, and pain with swallowing. As Lily recounts these symptoms to you, you notice that she has a runny nose and a slight hoarseness in her voice but doesn't sound congested.
Case.
CASE STUDY 2 Focused Throat Exam Lily is a 20-year-old student .docxmoggdede
CASE STUDY 2: Focused Throat Exam Lily is a 20-year-old student at the local community college. When some of her friends and classmates told her about an outbreak of flu-like symptoms sweeping her campus during the past 2 weeks, Lily figured she shouldn't take her 3-day sore throat lightly. Your clinic has treated a few cases similar to Lily's. All the patients reported decreased appetite, headaches, and pain with swallowing. As Lily recounts these symptoms to you, you notice that she has a runny nose and a slight hoarseness in her voice but doesn't sound congested.
To Prepare
· By Day 1 of this week, you will be assigned to a specific case study for this Case Study Assignment. Please see the “Course Announcements” section of the classroom for your assignment from your Instructor.
· Also, your Case Study Assignment should be in the Episodic/Focused SOAP Note format rather than the traditional narrative style format. Refer to Chapter 2 of the Sullivan text and the Episodic/Focused SOAP Template in the Week 5 Learning Resources for guidance. Remember that all Episodic/Focused SOAP Notes have specific data included in every patient case.
With regard to the case study you were assigned:
· Review this week's Learning Resources and consider the insights they provide.
· Consider what history would be necessary to collect from the patient.
· Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient's condition. How would the results be used to make a diagnosis?
· Identify at least five possible conditions that may be considered in a differential diagnosis for the patient.
The Assignment
Use the Episodic/Focused SOAP Template and create an episodic/focused note about the patient in the case study to which you were assigned using the episodic/focused note template provided in the Week 5 resources. Provide evidence from the literature to support diagnostic tests that would be appropriate for each case. List five different possible conditions for the patient's differential diagnosis and justify why you selected each.
Episodic/Focused SOAP Note Template
– (delete information on this template and input one related to the patient in the case study above).
Patient Information:
Initials, Age, Sex, Race
S.
CC
(chief complaint) a BRIEF statement identifying why the patient is here - in the patient’s own words - for instance "headache", NOT "bad headache for 3 days”.
HPI
: This is the symptom analysis section of your note. Thorough documentation in this section is essential for patient care, coding, and billing analysis. Paint a picture of what is wrong with the patient. Use LOCATES Mnemonic to complete your HPI. You need to start EVERY HPI with age, race, and gender (e.g., 34-year-old AA male). You must include the seven attributes of each principal symptom in paragraph form not a list. If the CC was “headache”, the LOCATES for the HPI might look like the following example:
Location: h.
Make a SOAP Note Assessing Ear, Nose, and ThroatMost ear, nose, a.docxeubanksnefen
Make a SOAP Note: Assessing Ear, Nose, and Throat
Most ear, nose, and throat conditions that arise in non-critical care settings are minor in nature. However, subtle symptoms can sometimes escalate into life-threatening conditions that require prompt assessment and treatment. Nurses conducting assessments of the ears, nose, and throat must be able to identify the small differences between life-threatening conditions and benign ones. For instance, if a patient with a sore throat and a runny nose also has inflamed lymph nodes, the inflammation is probably due to the pathogen causing the sore throat rather than a case of throat cancer. With this knowledge and a sufficient patient health history, a nurse would not need to escalate the assessment to a biopsy or an MRI of the lymph nodes, but would probably perform a simple strep test.
In this Discussion, you consider case studies of abnormal findings from patients in a clinical setting. You determine what history should be collected from the patients, what physical exams and diagnostic tests should be conducted, and formulate a differential diagnosis with several possible conditions.
Note:
By Day 1 of this week, your instructor will have assigned you to one of the following case studies to review for this Discussion. Also, your Discussion post should be in the SOAP Note format, rather than the traditional narrative style Discussion posting format. Refer to Chapter 2 of the Sullivan text and the Comprehensive SOAP Template in the Week 4 Learning Resources for guidance.
Remember that not all comprehensive SOAP data are included in every patient case.
Case 1:
Nose Focused Exam
Richard is a 50-year-old male with nasal congestion, sneezing, rhinorrhea, and postnasal drainage. Richard has struggled with an itchy nose, eyes, palate, and ears for 5 days. As you check his ears and throat for redness and inflammation, you notice him touch his fingers to the bridge of his nose to press and rub there. He says he's taken Mucinex OTC the past two nights to help him breathe while he sleeps. When you ask if the Mucinex has helped at all, he sneers slightly and gestures that the improvement is only minimal. Richard is alert and oriented. He has pale, boggy nasal mucosa with clear thin secretions and enlarged nasal turbinates, which obstruct airway flow but his lungs are clear. His tonsils are not enlarged but his throat is mildly erythematous.
Case 2:
Focused Throat Exam
Lily is a 20-year-old student at the local community college. When some of her friends and classmates told her about an outbreak of flu-like symptoms sweeping her campus over the past two weeks, Lily figured she shouldn't take her three-day sore throat lightly. Your clinic has treated a few cases similar to Lily's. All the patients reported decreased appetite, headaches, and pain with swallowing. As Lily recounts these symptoms to you, you notice that she has a runny nose and a slight hoarseness in her voice but doesn't sound congested.
Case.
CASE STUDY 2 Focused Throat Exam Lily is a 20-year-old student .docxmoggdede
CASE STUDY 2: Focused Throat Exam Lily is a 20-year-old student at the local community college. When some of her friends and classmates told her about an outbreak of flu-like symptoms sweeping her campus during the past 2 weeks, Lily figured she shouldn't take her 3-day sore throat lightly. Your clinic has treated a few cases similar to Lily's. All the patients reported decreased appetite, headaches, and pain with swallowing. As Lily recounts these symptoms to you, you notice that she has a runny nose and a slight hoarseness in her voice but doesn't sound congested.
To Prepare
· By Day 1 of this week, you will be assigned to a specific case study for this Case Study Assignment. Please see the “Course Announcements” section of the classroom for your assignment from your Instructor.
· Also, your Case Study Assignment should be in the Episodic/Focused SOAP Note format rather than the traditional narrative style format. Refer to Chapter 2 of the Sullivan text and the Episodic/Focused SOAP Template in the Week 5 Learning Resources for guidance. Remember that all Episodic/Focused SOAP Notes have specific data included in every patient case.
With regard to the case study you were assigned:
· Review this week's Learning Resources and consider the insights they provide.
· Consider what history would be necessary to collect from the patient.
· Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient's condition. How would the results be used to make a diagnosis?
· Identify at least five possible conditions that may be considered in a differential diagnosis for the patient.
The Assignment
Use the Episodic/Focused SOAP Template and create an episodic/focused note about the patient in the case study to which you were assigned using the episodic/focused note template provided in the Week 5 resources. Provide evidence from the literature to support diagnostic tests that would be appropriate for each case. List five different possible conditions for the patient's differential diagnosis and justify why you selected each.
Episodic/Focused SOAP Note Template
– (delete information on this template and input one related to the patient in the case study above).
Patient Information:
Initials, Age, Sex, Race
S.
CC
(chief complaint) a BRIEF statement identifying why the patient is here - in the patient’s own words - for instance "headache", NOT "bad headache for 3 days”.
HPI
: This is the symptom analysis section of your note. Thorough documentation in this section is essential for patient care, coding, and billing analysis. Paint a picture of what is wrong with the patient. Use LOCATES Mnemonic to complete your HPI. You need to start EVERY HPI with age, race, and gender (e.g., 34-year-old AA male). You must include the seven attributes of each principal symptom in paragraph form not a list. If the CC was “headache”, the LOCATES for the HPI might look like the following example:
Location: h.
This week we are covering HEENT. At this time you are assigned an TakishaPeck109
This week we are covering HEENT. At this time you are assigned an episodic/focused note. You will need this assigned case study to complete the Case Study Assignment for this week. Focused assessment means you still fill out all review of systems and as needed type “Patient denies” in the sections that you are not covering or are needed. Again, you are allowed to make up the information that is needed to fill out the episodic note.
If your LAST NAME starts with letters A – J: please proceed with Option 1.
If your LAST NAME starts with letters K – Z: please proceed with Option 2.
Option 1:
CASE STUDY: Focused Throat Exam
Lily is a 20-year-old student at the local community college. When some of her friends and classmates told her about an outbreak of flu-like symptoms sweeping her campus during the past 2 weeks, Lily figured she shouldn't take her 3-day sore throat lightly. Your clinic has treated a few cases similar to Lily's. All the patients reported decreased appetite, headaches, and pain with swallowing. As Lily recounts these symptoms to you, you notice that she has a runny nose and a slight hoarseness in her voice but doesn't sound congested.
To Prepare
· By Day 1 of this week, you will be assigned to a specific case study for this Case Study Assignment. Please see the “Course Announcements” section of the classroom for your assignment from your Instructor.
· Also, your Case Study Assignment should be in the Episodic/Focused SOAP Note format rather than the traditional narrative style format. Refer to Chapter 2 of the Sullivan text and the Episodic/Focused SOAP Template in the Week 5 Learning Resources for guidance. Remember that all Episodic/Focused SOAP Notes have specific data included in every patient case.
With regard to the case study you were assigned:
· Review this week's Learning Resources and consider the insights they provide.
· Consider what history would be necessary to collect from the patient.
· Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient's condition. How would the results be used to make a diagnosis?
· Identify at least five possible conditions that may be considered in a differential diagnosis for the patient.
The Assignment
Use the Episodic/Focused SOAP Template and create an episodic/focused note about the patient in the case study to which you were assigned using the episodic/focused note template provided in the Week 5 resources. Provide evidence from the literature to support diagnostic tests that would be appropriate for each case. List five different possible conditions for the patient's differential diagnosis and justify why you selected each.
This
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At
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you
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/
focuse
d
note.
You
will
need
this
assigned
case
study
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complete
the
Case
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Assignment
for
this
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Focused
assessment
means
you
still
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all
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systems
and
...
Comprehensive SOAP ExemplarPurpose To demonstrate what each sLynellBull52
Comprehensive SOAP Exemplar
Purpose: To demonstrate what each section of the SOAP note should include. Remember that Nurse Practitioners treat patients in a holistic manner and your SOAP note should reflect that premise.
Patient Initials: _______ Age: _______ Gender: _______
SUBJECTIVE DATA:
Chief Complaint (CC): Coughing up phlegm and fever
History of Present Illness (HPI): Sara Jones is a 65 year old Caucasian female who presents today with a productive cough x 3 weeks and fever for the last three days. She reported that the “cold feels like it is descending into her chest”. The cough is nagging and productive. She brought in a few paper towels with expectorated phlegm – yellow/brown in color. She has associated symptoms of dyspnea of exertion and fever. Her Tmax was reported to be 102.4, last night. She has been taking Ibuprofen 400mg about every 6 hours and the fever breaks, but returns after the medication wears off. She rated the severity of her symptom discomfort at 4/10.
Medications:
1.) Lisinopril 10mg daily
2.) Combivent 2 puffs every 6 hours as needed
3.) Serovent daily
4.) Salmeterol daily
5.) Over the counter Ibuprofen 200mg -2 PO as needed
6.) Over the counter Benefiber
7.) Flonase 1 spray each night as needed for allergic rhinitis symptoms
Allergies:
Sulfa drugs - rash
Past Medical History (PMH):
1.) Emphysema with recent exacerbation 1 month ago – deferred admission – RX’d with outpatient antibiotics and an hand held nebulizer treatments.
2.) Hypertension – well controlled
3.) Gastroesophageal reflux (GERD) – quiet on no medication
4.) Osteopenia
5.) Allergic rhinitis
Past Surgical History (PSH):
1.) Cholecystectomy 1994
2.) Total abdominal hysterectomy (TAH) 1998
Sexual/Reproductive History:
Heterosexual
G1P1A0
Non-menstrating – TAH 1998
Personal/Social History:
She has smoked 2 packs of cigarettes daily x 30 years; denied ETOH or illicit drug use.
Immunization History:
Her immunizations are up to date. She received the influenza vaccine last November and the Pneumococcal vaccine at the same time.
Significant Family History:
Two brothers – one with diabetes, dx at age 65 and the other with prostate CA, dx at age 62. She has 1 daughter, in her 50’s, healthy, living in nearby neighborhood.
Lifestyle:
She is a retired; widowed x 8 years; lives in the city, moderate crime area, with good public transportation. She college graduate, owns her home and receives a pension of $50,000 annually – financially stable.
She has a primary care nurse practitioner provider and goes for annual and routine care twice annually and as needed for episodic care. She has medical insurance but often asks for drug samples for cost savings. She has a healthy diet and eating pattern. There are resources and community groups in her area at the senior center and she attends regularly. She enjoys bingo. She has a good support system composed of family and friends.
Review of Systems:
General: + fatigue since the illness starte ...
Discussion: Respiratory Alterations
In clinical settings, patients often present with various respiratory symptoms such as congestion, coughing, and wheezing. While identifying a symptom’s underlying illness can be challenging, it is essential because even basic symptoms such as persistent coughing can be a sign of a more severe disorder. Advanced practice nurses must be able to differentiate between moderate and severe respiratory disorders, as well as properly diagnose and prescribe treatment for their patients. For this reason, you must have an understanding of the pathophysiology of respiratory disorders.
Consider the following three scenarios:
Scenario 1:
Ms. Teel brings in her 7-month-old infant for evaluation. She is afraid that the baby might have respiratory syncytial virus (RSV) because she seems to be coughing a lot, and Ms. Teel heard that RSV is a common condition for infants. A detailed patient history reveals that the infant has been coughing consistently for several months. It’s never seemed all that bad. Ms. Teel thought it was just a normal thing, but then she read about RSV. Closer evaluation indicates that the infant coughs mostly at night; and, in fact, most nights the baby coughs to some extent. Additionally, Ms. Teel confirms that the infant seems to cough more when she cries. Physical examination reveals an apparently healthy age- and weight-appropriate, 7-month-old infant with breath sounds that are clear to auscultation. The infant’s medical history is significant only for eczema that was actually quite bad a few months back. Otherwise, the only remarkable history is an allergic reaction to amoxicillin that she experienced 3 months ago when she had an ear infection.
Scenario 2:
Kevin is a 6-year-old boy who is brought in for evaluation by his parents. The parents are concerned that he has a really deep cough that he just can’t seem to get over. The history reveals that he was in his usual state of good health until approximately 1 week ago when he developed a profound cough. His parents say that it is deep and sounds like he is barking. He coughs so hard that sometimes he actually vomits. The cough is productive for mucus, but there is no blood in it. Kevin has had a low-grade temperature but nothing really high. His parents do not have a thermometer and don’t know for sure how high it got. His past medical history is negative. He has never had childhood asthma or RSV. His mother says that they moved around a lot in his first 2 years and she is not sure that his immunizations are up to date. She does not have a current vaccination record.
Scenario 3:
Maria is a 36-year-old who presents for evaluation of a cough. She is normally a healthy young lady with no significant medical history. She takes no medications and does not smoke. She reports that she was in her usual state of good health until approximately 3 weeks ago when she developed a “really bad cold.” The cold is characterized by a profound, deep, mucus-produci.
Phil 2230 Philosophy of ReligionFinal Essay AssignmentThe A.docxmattjtoni51554
Phil 2230: Philosophy of Religion
Final Essay Assignment
The Assignment: An argumentative essay (defending a thesis) evaluating an argument or view we have discussed in the second portion of the course – from the midterm essay through the end of the course. In using the word “evaluate” I mean to give you a lot of freedom with respect to constructing your thesis. You could argue that C. Stephen Evans’ criteria for identifying revelation suggest that the Qu’ran is in fact more likely to be revelation from God than the Bible is (or the opposite). Or you could argue that Evans’s criteria are not actually good ways to identify revelation. Or you could argue that Freud’s objection to religious belief succeeds – or fails. Or that Manis’s view of Hell is better than the alternatives. Or that no view of hell avoids objections, and so we shouldn’t believe in hell. And so forth – you have a lot of freedom. Just make sure that you are making, and defending, a claim about one of the views or arguments we have discussed.
Grading: I will grade for these factors:
· There must be a clear thesis and well-structured, clear arguments supporting the thesis. (This is by far the most important element of the grade.)
· Your statement of the argument or view which you are evaluating should be clear and fair; you should indicate understanding of the issues involved.
· Grammar and writing should be free of errors.
If you do everything right – you have a good thesis, solid arguments, good composition – you will get an A-. A full A requires that you do something outstanding – most likely an interesting original argument or view, or perhaps a really outstanding and insightful way of stating a problem, or something of that sort. So a full A is a significant achievement. An A+ means that the paper could, with work, be a publishable piece – this is graduate-quality work, and undergraduates almost never receive this grade.
Here is a complete statement of my grading scale:
A+: The idea is an original contribution to the debate and is the sort of paper that may be published in a professional journal or presented at a professional conference. This is graduate-level work, and undergraduates rarely receive this grade.
A: You did everything right, and had something extra special, most likely interesting and original arguments or ideas, or perhaps a particularly insightful way of putting a problem or some especially brilliant writing.
A-: You did everything right – good, clear thesis and organization, good arguments, and good writing – but you are missing the extra originality or creativity to make this an A.
B+: You did what was asked of you (pretty clear thesis, pretty good writing, and decent arguments), but something on that list (thesis, writing, arguments) is quite good, above the B level.
B: You did what was asked of you – you have a pretty clear thesis, pretty good writing, and decent arguments.
B-: You pretty much did what was asked of you, but something import.
Heres another one. It is only a discussion but I need to reference t.docxhoward4little59962
Heres another one. It is only a discussion but I need to reference the text and one outside source at least. You may choose any factor you like.
Discussion: Respiratory Alterations
In clinical settings, patients often present with various respiratory symptoms such as congestion, coughing, and wheezing. While identifying a symptom’s underlying illness can be challenging, it is essential because even basic symptoms such as persistent coughing can be a sign of a more severe disorder. Advanced practice nurses must be able to differentiate between moderate and severe respiratory disorders, as well as properly diagnose and prescribe treatment for their patients. For this reason, you must have an understanding of the pathophysiology of respiratory disorders.
Consider the following three scenarios:
Scenario 1:
Ms. Teel brings in her 7-month-old infant for evaluation. She is afraid that the baby might have respiratory syncytial virus (RSV) because she seems to be coughing a lot, and Ms. Teel heard that RSV is a common condition for infants. A detailed patient history reveals that the infant has been coughing consistently for several months. It’s never seemed all that bad. Ms. Teel thought it was just a normal thing, but then she read about RSV. Closer evaluation indicates that the infant coughs mostly at night; and, in fact, most nights the baby coughs to some extent. Additionally, Ms. Teel confirms that the infant seems to cough more when she cries. Physical examination reveals an apparently healthy age- and weight-appropriate, 7-month-old infant with breath sounds that are clear to auscultation. The infant’s medical history is significant only for eczema that was actually quite bad a few months back. Otherwise, the only remarkable history is an allergic reaction to amoxicillin that she experienced 3 months ago when she had an ear infection.
Scenario 2:
Kevin is a 6-year-old boy who is brought in for evaluation by his parents. The parents are concerned that he has a really deep cough that he just can’t seem to get over. The history reveals that he was in his usual state of good health until approximately 1 week ago when he developed a profound cough. His parents say that it is deep and sounds like he is barking. He coughs so hard that sometimes he actually vomits. The cough is productive for mucus, but there is no blood in it. Kevin has had a low-grade temperature but nothing really high. His parents do not have a thermometer and don’t know for sure how high it got. His past medical history is negative. He has never had childhood asthma or RSV. His mother says that they moved around a lot in his first 2 years and she is not sure that his immunizations are up to date. She does not have a current vaccination record.
Scenario 3:
Maria is a 36-year-old who presents for evaluation of a cough. She is normally a healthy young lady with no significant medical history. She takes no medications and does not smoke. She reports that she was in her usual state .
CASE STUDYRichard is a 50-year-old male with nasal congestion, s.docxtroutmanboris
CASE STUDY
Richard is a 50-year-old male with nasal congestion, sneezing, rhinorrhea, and postnasal drainage. Richard has struggled with an itchy nose, eyes, palate, and ears for 5 days. As you check his ears and throat for redness and inflammation, you notice him touch his fingers to the bridge of his nose to press and rub there. He says he's taken Mucinex OTC the past 2 nights to help him breathe while he sleeps. When you ask if the Mucinex has helped at all, he sneers slightly and gestures that the improvement is only minimal. Richard is alert and oriented. He has pale, boggy nasal mucosa with clear thin secretions and enlarged nasal turbinates, which obstruct airway flow but his lungs are clear. His tonsils are not enlarged but his throat is mildly erythematous.
Use the Episodic/Focused SOAP Template and create an episodic/focused note about the patient in the case study to which you were assigned using the episodic/focused note template provided in the Week 5 resources. Provide evidence from the literature to support diagnostic tests that would be appropriate for each case. List five different possible conditions for the patient's differential diagnosis and justify why you selected each.
.
Running Head Comparison and contrast2Comparison and contras.docxhealdkathaleen
Running Head: Comparison and contrast 2
Comparison and contrast 2
Post Concussive Syndrome and Traumatic Brain Injury
Student’s Name
Instructor Affiliation
Date
Requirements:
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: 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 ...
Most ear, nose, and throat conditions that arise in non-critical car.docxssuserf9c51d
Most ear, nose, and throat conditions that arise in non-critical care settings are minor in nature. However, subtle symptoms can sometimes escalate into life-threatening conditions that require prompt assessment and treatment.
Nurses conducting assessments of the ears, nose, and throat must be able to identify the small differences between life-threatening conditions and benign ones. For instance, if a patient with a sore throat and a runny nose also has inflamed lymph nodes, the inflammation is probably due to the pathogen causing the sore throat rather than a case of throat cancer. With this knowledge and a sufficient patient health history, a nurse would not need to escalate the assessment to a biopsy or an MRI of the lymph nodes but would probably perform a simple strep test.
In this Case Study Assignment, you consider case studies of abnormal findings from patients in a clinical setting. You determine what history should be collected from the patients, what physical exams and diagnostic tests should be conducted, and formulate a differential diagnosis with several possible conditions.
To Prepare
By Day 1 of this week, you will be assigned to a specific case study for this Case Study Assignment. Please see the “Course Announcements” section of the classroom for your assignment from your Instructor.
· Also, your Case Study Assignment should be in the Episodic/Focused SOAP Note format rather than the traditional narrative style format. Refer to Chapter 2 of the Sullivan text and the Episodic/Focused SOAP Template in the Week 5 Learning Resources for guidance. Remember that all Episodic/Focused SOAP Notes have specific data included in every patient case.
With regard to the case study you were assigned:
· Review this week's Learning Resources and consider the insights they provide.
· Consider what history would be necessary to collect from the patient.
· Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient's condition. How would the results be used to make a diagnosis?
· Identify at least five possible conditions that may be considered in a differential diagnosis for the patient.
The Assignment:
CASE STUDY 4:
Focused Thyroid Exam Chantal, a 32-year-old female, comes into your office with complaints of “feeling tired” and “hair falling out”. She has gained 30 pounds in the last year but notes markedly decreased appetite. On ROS, she reports not sleeping well and feels cold all the time. She is still able to enjoy her hobbies and does not believe that she is depressed.
Use the Episodic/Focused SOAP Template and create an episodic/focused note about the patient in the case study to which you were assigned using the episodic/focused note template provided in the Week 5 resources. Provide evidence from the literature to support diagnostic tests that would be appropriate for each case. List five different possible conditions for the patient's differential diagnosis and.
Lily is a 20-year-old student at the local community college. When s.docxmanningchassidy
Lily is a 20-year-old student at the local community college. When some of her friends and classmates told her about an outbreak of flu-like symptoms sweeping her campus during the past 2 weeks, Lily figured she shouldn't take her 3-day sore throat lightly. Your clinic has treated a few cases similar to Lily's. All the patients reported decreased appetite, headaches, and pain with swallowing. As Lily recounts these symptoms to you, you notice that she has a runny nose and a slight hoarseness in her voice but doesn't sound congested.
Use the Episodic/Focused SOAP Template and create an episodic/focused note about the patient in the case study to which you were assigned using the episodic/focused note template provided in the Week 5 resources. Provide evidence from the literature to support diagnostic tests that would be appropriate for each case. List five different possible conditions for the patient's differential diagnosis and justify why you selected each.
.
Patient Documentation Analysis Due Date Sunday 1159 pm MT.pdfaccess2future1
Patient Documentation Analysis
Due Date
Sunday 11:59 p.m. MT (Try to make your first post by Wednesday.)
Instructions
(Required) Select the tabs to review the patient medical report. Detailed discussion questions
follow below.
Identify one or two medical terms in this report. Deconstruct the components of specific medical
terms to identify their meanings. In addition, please pay attention to the spelling and pronunciation
of the words.
Case Study #1
Discharge Summary
The patient, John Madison, is an 8-month old white male presenting a viral type syndrome.
Admission Diagnosis
Bronchiolitis with hyperpyrexia; history of premature delivery with one hospitalization for lung
immaturity at time of birth.
Discharge Diagnosis
Bronchiolitis with fever and poor fluid intake.
Summary
John Madison is an 8-month-old white male seen by Dr. White at the Lofty Pines Health Center for
a viral-type syndrome. The mother states that the baby had a temperature over the weekend,
going up to 103 and 104 the night prior to admission. The baby has progressively gotten more
worked up, more short of breath, and has had respiratory disease. The patient was hospitalized for
his respiratory distress and lower respiratory disease.
Positive physical exam on admission included both lung fields filled with rhonchi and occasional
rales. There were no signs of consolidation. The patient was put in a croup tent during his hospital
stay and was placed on Ampicillin four times a day for his two-day course. He tolerated the croup
tent well and the antibiotics. His lungs progressively cleared, and the patient was discharged on
02-11-2018. He was discharged on the instructions to force fluids, saline nose drops, and bulb
suction as needed, Amoxicillin 125 milligrams three times a day, and to return to the clinic in one
week to see Dr. Swisher.
Lab Data
White count was 10.7, hemoglobin was 12.2, hematocrit was 37.7, 13 segmented cells, 77
lymphocytes, 10 monocytes. Chest x-ray was within normal limits.
Discussion Questions
Question 1
Review the Inpatient Discharge Summary of John Madison (Case Study 1) and provide the
following in your post.
Conduct research on bronchiolitis, using available library resources and trustworthy medical
websites such as the Mayo Clinic. Post a one-paragraph summary on bronchiolitis, and cite your
source. Use the information youve gathered from your research to address the following questions
in b. and c. below.
What is bronchiolitis, and what are its symptoms and some risk factors for developing it? In the
discharge summary, the baby was seen for a "viral-type" syndrome. What is the likely name for
this virus, which causes most cases of bronchiolitis?
Differentiate between the terms "rhonchi" and "rales" that are referred to in the discharge
summary. What is a croup tent and why was Ampicillin given to the baby?.
NURSE 6501N WK 6 DISCUSSIONConsider the following three scen.docxgabriellabre8fr
NURSE 6501N WK 6 DISCUSSION
Consider the following three scenarios:
Scenario 1:
Ms. Teel brings in her 7-month-old infant for evaluation. She is afraid that the baby might have respiratory syncytial virus (RSV) because she seems to be coughing a lot, and Ms. Teel heard that RSV is a common condition for infants. A detailed patient history reveals that the infant has been coughing consistently for several months. It’s never seemed all that bad. Ms. Teel thought it was just a normal thing, but then she read about RSV. Closer evaluation indicates that the infant coughs mostly at night; and, in fact, most nights the baby coughs to some extent. Additionally, Ms. Teel confirms that the infant seems to cough more when she cries. Physical examination reveals an apparently healthy age- and weight-appropriate, 7-month-old infant with breath sounds that are clear to auscultation. The infant’s medical history is significant only for eczema that was actually quite bad a few months back. Otherwise, the only remarkable history is an allergic reaction to amoxicillin that she experienced 3 months ago when she had an ear infection.
Scenario 2:
Kevin is a 6-year-old boy who is brought in for evaluation by his parents. The parents are concerned that he has a really deep cough that he just can’t seem to get over. The history reveals that he was in his usual state of good health until approximately 1 week ago when he developed a profound cough. His parents say that it is deep and sounds like he is barking. He coughs so hard that sometimes he actually vomits. The cough is productive for mucus, but there is no blood in it. Kevin has had a low-grade temperature but nothing really high. His parents do not have a thermometer and don’t know for sure how high it got. His past medical history is negative. He has never had childhood asthma or RSV. His mother says that they moved around a lot in his first 2 years and she is not sure that his immunizations are up to date. She does not have a current vaccination record.
Scenario 3:
Maria is a 36-year-old who presents for evaluation of a cough. She is normally a healthy young lady with no significant medical history. She takes no medications and does not smoke. She reports that she was in her usual state of good health until approximately 3 weeks ago when she developed a “really bad cold.” The cold is characterized by a profound, deep, mucus-producing cough. She denies any rhinorrhea or rhinitis—the primary problem is the cough. She develops these coughing fits that are prolonged, very deep, and productive of a lot of green sputum. She hasn’t had any fever but does have a scratchy throat. Maria has tried over-the-counter cough medicines but has not had much relief. The cough keeps her awake at night and sometimes gets so bad that she gags and dry heaves.
To prepare:
Review the three scenarios, as well as Chapter 26 and Chapter 27 in the Huether and McCance text.
Select one of the scenarios and consider the respiratory.
This week we are covering HEENT. At this time you are assigned an TakishaPeck109
This week we are covering HEENT. At this time you are assigned an episodic/focused note. You will need this assigned case study to complete the Case Study Assignment for this week. Focused assessment means you still fill out all review of systems and as needed type “Patient denies” in the sections that you are not covering or are needed. Again, you are allowed to make up the information that is needed to fill out the episodic note.
If your LAST NAME starts with letters A – J: please proceed with Option 1.
If your LAST NAME starts with letters K – Z: please proceed with Option 2.
Option 1:
CASE STUDY: Focused Throat Exam
Lily is a 20-year-old student at the local community college. When some of her friends and classmates told her about an outbreak of flu-like symptoms sweeping her campus during the past 2 weeks, Lily figured she shouldn't take her 3-day sore throat lightly. Your clinic has treated a few cases similar to Lily's. All the patients reported decreased appetite, headaches, and pain with swallowing. As Lily recounts these symptoms to you, you notice that she has a runny nose and a slight hoarseness in her voice but doesn't sound congested.
To Prepare
· By Day 1 of this week, you will be assigned to a specific case study for this Case Study Assignment. Please see the “Course Announcements” section of the classroom for your assignment from your Instructor.
· Also, your Case Study Assignment should be in the Episodic/Focused SOAP Note format rather than the traditional narrative style format. Refer to Chapter 2 of the Sullivan text and the Episodic/Focused SOAP Template in the Week 5 Learning Resources for guidance. Remember that all Episodic/Focused SOAP Notes have specific data included in every patient case.
With regard to the case study you were assigned:
· Review this week's Learning Resources and consider the insights they provide.
· Consider what history would be necessary to collect from the patient.
· Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient's condition. How would the results be used to make a diagnosis?
· Identify at least five possible conditions that may be considered in a differential diagnosis for the patient.
The Assignment
Use the Episodic/Focused SOAP Template and create an episodic/focused note about the patient in the case study to which you were assigned using the episodic/focused note template provided in the Week 5 resources. Provide evidence from the literature to support diagnostic tests that would be appropriate for each case. List five different possible conditions for the patient's differential diagnosis and justify why you selected each.
This
week
we
are
covering
HEENT.
At
this
time
you
are
assigned
an
episodic
/
focuse
d
note.
You
will
need
this
assigned
case
study
to
complete
the
Case
Study
Assignment
for
this
week.
Focused
assessment
means
you
still
fill
out
all
review
of
systems
and
...
Comprehensive SOAP ExemplarPurpose To demonstrate what each sLynellBull52
Comprehensive SOAP Exemplar
Purpose: To demonstrate what each section of the SOAP note should include. Remember that Nurse Practitioners treat patients in a holistic manner and your SOAP note should reflect that premise.
Patient Initials: _______ Age: _______ Gender: _______
SUBJECTIVE DATA:
Chief Complaint (CC): Coughing up phlegm and fever
History of Present Illness (HPI): Sara Jones is a 65 year old Caucasian female who presents today with a productive cough x 3 weeks and fever for the last three days. She reported that the “cold feels like it is descending into her chest”. The cough is nagging and productive. She brought in a few paper towels with expectorated phlegm – yellow/brown in color. She has associated symptoms of dyspnea of exertion and fever. Her Tmax was reported to be 102.4, last night. She has been taking Ibuprofen 400mg about every 6 hours and the fever breaks, but returns after the medication wears off. She rated the severity of her symptom discomfort at 4/10.
Medications:
1.) Lisinopril 10mg daily
2.) Combivent 2 puffs every 6 hours as needed
3.) Serovent daily
4.) Salmeterol daily
5.) Over the counter Ibuprofen 200mg -2 PO as needed
6.) Over the counter Benefiber
7.) Flonase 1 spray each night as needed for allergic rhinitis symptoms
Allergies:
Sulfa drugs - rash
Past Medical History (PMH):
1.) Emphysema with recent exacerbation 1 month ago – deferred admission – RX’d with outpatient antibiotics and an hand held nebulizer treatments.
2.) Hypertension – well controlled
3.) Gastroesophageal reflux (GERD) – quiet on no medication
4.) Osteopenia
5.) Allergic rhinitis
Past Surgical History (PSH):
1.) Cholecystectomy 1994
2.) Total abdominal hysterectomy (TAH) 1998
Sexual/Reproductive History:
Heterosexual
G1P1A0
Non-menstrating – TAH 1998
Personal/Social History:
She has smoked 2 packs of cigarettes daily x 30 years; denied ETOH or illicit drug use.
Immunization History:
Her immunizations are up to date. She received the influenza vaccine last November and the Pneumococcal vaccine at the same time.
Significant Family History:
Two brothers – one with diabetes, dx at age 65 and the other with prostate CA, dx at age 62. She has 1 daughter, in her 50’s, healthy, living in nearby neighborhood.
Lifestyle:
She is a retired; widowed x 8 years; lives in the city, moderate crime area, with good public transportation. She college graduate, owns her home and receives a pension of $50,000 annually – financially stable.
She has a primary care nurse practitioner provider and goes for annual and routine care twice annually and as needed for episodic care. She has medical insurance but often asks for drug samples for cost savings. She has a healthy diet and eating pattern. There are resources and community groups in her area at the senior center and she attends regularly. She enjoys bingo. She has a good support system composed of family and friends.
Review of Systems:
General: + fatigue since the illness starte ...
Discussion: Respiratory Alterations
In clinical settings, patients often present with various respiratory symptoms such as congestion, coughing, and wheezing. While identifying a symptom’s underlying illness can be challenging, it is essential because even basic symptoms such as persistent coughing can be a sign of a more severe disorder. Advanced practice nurses must be able to differentiate between moderate and severe respiratory disorders, as well as properly diagnose and prescribe treatment for their patients. For this reason, you must have an understanding of the pathophysiology of respiratory disorders.
Consider the following three scenarios:
Scenario 1:
Ms. Teel brings in her 7-month-old infant for evaluation. She is afraid that the baby might have respiratory syncytial virus (RSV) because she seems to be coughing a lot, and Ms. Teel heard that RSV is a common condition for infants. A detailed patient history reveals that the infant has been coughing consistently for several months. It’s never seemed all that bad. Ms. Teel thought it was just a normal thing, but then she read about RSV. Closer evaluation indicates that the infant coughs mostly at night; and, in fact, most nights the baby coughs to some extent. Additionally, Ms. Teel confirms that the infant seems to cough more when she cries. Physical examination reveals an apparently healthy age- and weight-appropriate, 7-month-old infant with breath sounds that are clear to auscultation. The infant’s medical history is significant only for eczema that was actually quite bad a few months back. Otherwise, the only remarkable history is an allergic reaction to amoxicillin that she experienced 3 months ago when she had an ear infection.
Scenario 2:
Kevin is a 6-year-old boy who is brought in for evaluation by his parents. The parents are concerned that he has a really deep cough that he just can’t seem to get over. The history reveals that he was in his usual state of good health until approximately 1 week ago when he developed a profound cough. His parents say that it is deep and sounds like he is barking. He coughs so hard that sometimes he actually vomits. The cough is productive for mucus, but there is no blood in it. Kevin has had a low-grade temperature but nothing really high. His parents do not have a thermometer and don’t know for sure how high it got. His past medical history is negative. He has never had childhood asthma or RSV. His mother says that they moved around a lot in his first 2 years and she is not sure that his immunizations are up to date. She does not have a current vaccination record.
Scenario 3:
Maria is a 36-year-old who presents for evaluation of a cough. She is normally a healthy young lady with no significant medical history. She takes no medications and does not smoke. She reports that she was in her usual state of good health until approximately 3 weeks ago when she developed a “really bad cold.” The cold is characterized by a profound, deep, mucus-produci.
Phil 2230 Philosophy of ReligionFinal Essay AssignmentThe A.docxmattjtoni51554
Phil 2230: Philosophy of Religion
Final Essay Assignment
The Assignment: An argumentative essay (defending a thesis) evaluating an argument or view we have discussed in the second portion of the course – from the midterm essay through the end of the course. In using the word “evaluate” I mean to give you a lot of freedom with respect to constructing your thesis. You could argue that C. Stephen Evans’ criteria for identifying revelation suggest that the Qu’ran is in fact more likely to be revelation from God than the Bible is (or the opposite). Or you could argue that Evans’s criteria are not actually good ways to identify revelation. Or you could argue that Freud’s objection to religious belief succeeds – or fails. Or that Manis’s view of Hell is better than the alternatives. Or that no view of hell avoids objections, and so we shouldn’t believe in hell. And so forth – you have a lot of freedom. Just make sure that you are making, and defending, a claim about one of the views or arguments we have discussed.
Grading: I will grade for these factors:
· There must be a clear thesis and well-structured, clear arguments supporting the thesis. (This is by far the most important element of the grade.)
· Your statement of the argument or view which you are evaluating should be clear and fair; you should indicate understanding of the issues involved.
· Grammar and writing should be free of errors.
If you do everything right – you have a good thesis, solid arguments, good composition – you will get an A-. A full A requires that you do something outstanding – most likely an interesting original argument or view, or perhaps a really outstanding and insightful way of stating a problem, or something of that sort. So a full A is a significant achievement. An A+ means that the paper could, with work, be a publishable piece – this is graduate-quality work, and undergraduates almost never receive this grade.
Here is a complete statement of my grading scale:
A+: The idea is an original contribution to the debate and is the sort of paper that may be published in a professional journal or presented at a professional conference. This is graduate-level work, and undergraduates rarely receive this grade.
A: You did everything right, and had something extra special, most likely interesting and original arguments or ideas, or perhaps a particularly insightful way of putting a problem or some especially brilliant writing.
A-: You did everything right – good, clear thesis and organization, good arguments, and good writing – but you are missing the extra originality or creativity to make this an A.
B+: You did what was asked of you (pretty clear thesis, pretty good writing, and decent arguments), but something on that list (thesis, writing, arguments) is quite good, above the B level.
B: You did what was asked of you – you have a pretty clear thesis, pretty good writing, and decent arguments.
B-: You pretty much did what was asked of you, but something import.
Heres another one. It is only a discussion but I need to reference t.docxhoward4little59962
Heres another one. It is only a discussion but I need to reference the text and one outside source at least. You may choose any factor you like.
Discussion: Respiratory Alterations
In clinical settings, patients often present with various respiratory symptoms such as congestion, coughing, and wheezing. While identifying a symptom’s underlying illness can be challenging, it is essential because even basic symptoms such as persistent coughing can be a sign of a more severe disorder. Advanced practice nurses must be able to differentiate between moderate and severe respiratory disorders, as well as properly diagnose and prescribe treatment for their patients. For this reason, you must have an understanding of the pathophysiology of respiratory disorders.
Consider the following three scenarios:
Scenario 1:
Ms. Teel brings in her 7-month-old infant for evaluation. She is afraid that the baby might have respiratory syncytial virus (RSV) because she seems to be coughing a lot, and Ms. Teel heard that RSV is a common condition for infants. A detailed patient history reveals that the infant has been coughing consistently for several months. It’s never seemed all that bad. Ms. Teel thought it was just a normal thing, but then she read about RSV. Closer evaluation indicates that the infant coughs mostly at night; and, in fact, most nights the baby coughs to some extent. Additionally, Ms. Teel confirms that the infant seems to cough more when she cries. Physical examination reveals an apparently healthy age- and weight-appropriate, 7-month-old infant with breath sounds that are clear to auscultation. The infant’s medical history is significant only for eczema that was actually quite bad a few months back. Otherwise, the only remarkable history is an allergic reaction to amoxicillin that she experienced 3 months ago when she had an ear infection.
Scenario 2:
Kevin is a 6-year-old boy who is brought in for evaluation by his parents. The parents are concerned that he has a really deep cough that he just can’t seem to get over. The history reveals that he was in his usual state of good health until approximately 1 week ago when he developed a profound cough. His parents say that it is deep and sounds like he is barking. He coughs so hard that sometimes he actually vomits. The cough is productive for mucus, but there is no blood in it. Kevin has had a low-grade temperature but nothing really high. His parents do not have a thermometer and don’t know for sure how high it got. His past medical history is negative. He has never had childhood asthma or RSV. His mother says that they moved around a lot in his first 2 years and she is not sure that his immunizations are up to date. She does not have a current vaccination record.
Scenario 3:
Maria is a 36-year-old who presents for evaluation of a cough. She is normally a healthy young lady with no significant medical history. She takes no medications and does not smoke. She reports that she was in her usual state .
CASE STUDYRichard is a 50-year-old male with nasal congestion, s.docxtroutmanboris
CASE STUDY
Richard is a 50-year-old male with nasal congestion, sneezing, rhinorrhea, and postnasal drainage. Richard has struggled with an itchy nose, eyes, palate, and ears for 5 days. As you check his ears and throat for redness and inflammation, you notice him touch his fingers to the bridge of his nose to press and rub there. He says he's taken Mucinex OTC the past 2 nights to help him breathe while he sleeps. When you ask if the Mucinex has helped at all, he sneers slightly and gestures that the improvement is only minimal. Richard is alert and oriented. He has pale, boggy nasal mucosa with clear thin secretions and enlarged nasal turbinates, which obstruct airway flow but his lungs are clear. His tonsils are not enlarged but his throat is mildly erythematous.
Use the Episodic/Focused SOAP Template and create an episodic/focused note about the patient in the case study to which you were assigned using the episodic/focused note template provided in the Week 5 resources. Provide evidence from the literature to support diagnostic tests that would be appropriate for each case. List five different possible conditions for the patient's differential diagnosis and justify why you selected each.
.
Running Head Comparison and contrast2Comparison and contras.docxhealdkathaleen
Running Head: Comparison and contrast 2
Comparison and contrast 2
Post Concussive Syndrome and Traumatic Brain Injury
Student’s Name
Instructor Affiliation
Date
Requirements:
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: 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 ...
Most ear, nose, and throat conditions that arise in non-critical car.docxssuserf9c51d
Most ear, nose, and throat conditions that arise in non-critical care settings are minor in nature. However, subtle symptoms can sometimes escalate into life-threatening conditions that require prompt assessment and treatment.
Nurses conducting assessments of the ears, nose, and throat must be able to identify the small differences between life-threatening conditions and benign ones. For instance, if a patient with a sore throat and a runny nose also has inflamed lymph nodes, the inflammation is probably due to the pathogen causing the sore throat rather than a case of throat cancer. With this knowledge and a sufficient patient health history, a nurse would not need to escalate the assessment to a biopsy or an MRI of the lymph nodes but would probably perform a simple strep test.
In this Case Study Assignment, you consider case studies of abnormal findings from patients in a clinical setting. You determine what history should be collected from the patients, what physical exams and diagnostic tests should be conducted, and formulate a differential diagnosis with several possible conditions.
To Prepare
By Day 1 of this week, you will be assigned to a specific case study for this Case Study Assignment. Please see the “Course Announcements” section of the classroom for your assignment from your Instructor.
· Also, your Case Study Assignment should be in the Episodic/Focused SOAP Note format rather than the traditional narrative style format. Refer to Chapter 2 of the Sullivan text and the Episodic/Focused SOAP Template in the Week 5 Learning Resources for guidance. Remember that all Episodic/Focused SOAP Notes have specific data included in every patient case.
With regard to the case study you were assigned:
· Review this week's Learning Resources and consider the insights they provide.
· Consider what history would be necessary to collect from the patient.
· Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient's condition. How would the results be used to make a diagnosis?
· Identify at least five possible conditions that may be considered in a differential diagnosis for the patient.
The Assignment:
CASE STUDY 4:
Focused Thyroid Exam Chantal, a 32-year-old female, comes into your office with complaints of “feeling tired” and “hair falling out”. She has gained 30 pounds in the last year but notes markedly decreased appetite. On ROS, she reports not sleeping well and feels cold all the time. She is still able to enjoy her hobbies and does not believe that she is depressed.
Use the Episodic/Focused SOAP Template and create an episodic/focused note about the patient in the case study to which you were assigned using the episodic/focused note template provided in the Week 5 resources. Provide evidence from the literature to support diagnostic tests that would be appropriate for each case. List five different possible conditions for the patient's differential diagnosis and.
Lily is a 20-year-old student at the local community college. When s.docxmanningchassidy
Lily is a 20-year-old student at the local community college. When some of her friends and classmates told her about an outbreak of flu-like symptoms sweeping her campus during the past 2 weeks, Lily figured she shouldn't take her 3-day sore throat lightly. Your clinic has treated a few cases similar to Lily's. All the patients reported decreased appetite, headaches, and pain with swallowing. As Lily recounts these symptoms to you, you notice that she has a runny nose and a slight hoarseness in her voice but doesn't sound congested.
Use the Episodic/Focused SOAP Template and create an episodic/focused note about the patient in the case study to which you were assigned using the episodic/focused note template provided in the Week 5 resources. Provide evidence from the literature to support diagnostic tests that would be appropriate for each case. List five different possible conditions for the patient's differential diagnosis and justify why you selected each.
.
Patient Documentation Analysis Due Date Sunday 1159 pm MT.pdfaccess2future1
Patient Documentation Analysis
Due Date
Sunday 11:59 p.m. MT (Try to make your first post by Wednesday.)
Instructions
(Required) Select the tabs to review the patient medical report. Detailed discussion questions
follow below.
Identify one or two medical terms in this report. Deconstruct the components of specific medical
terms to identify their meanings. In addition, please pay attention to the spelling and pronunciation
of the words.
Case Study #1
Discharge Summary
The patient, John Madison, is an 8-month old white male presenting a viral type syndrome.
Admission Diagnosis
Bronchiolitis with hyperpyrexia; history of premature delivery with one hospitalization for lung
immaturity at time of birth.
Discharge Diagnosis
Bronchiolitis with fever and poor fluid intake.
Summary
John Madison is an 8-month-old white male seen by Dr. White at the Lofty Pines Health Center for
a viral-type syndrome. The mother states that the baby had a temperature over the weekend,
going up to 103 and 104 the night prior to admission. The baby has progressively gotten more
worked up, more short of breath, and has had respiratory disease. The patient was hospitalized for
his respiratory distress and lower respiratory disease.
Positive physical exam on admission included both lung fields filled with rhonchi and occasional
rales. There were no signs of consolidation. The patient was put in a croup tent during his hospital
stay and was placed on Ampicillin four times a day for his two-day course. He tolerated the croup
tent well and the antibiotics. His lungs progressively cleared, and the patient was discharged on
02-11-2018. He was discharged on the instructions to force fluids, saline nose drops, and bulb
suction as needed, Amoxicillin 125 milligrams three times a day, and to return to the clinic in one
week to see Dr. Swisher.
Lab Data
White count was 10.7, hemoglobin was 12.2, hematocrit was 37.7, 13 segmented cells, 77
lymphocytes, 10 monocytes. Chest x-ray was within normal limits.
Discussion Questions
Question 1
Review the Inpatient Discharge Summary of John Madison (Case Study 1) and provide the
following in your post.
Conduct research on bronchiolitis, using available library resources and trustworthy medical
websites such as the Mayo Clinic. Post a one-paragraph summary on bronchiolitis, and cite your
source. Use the information youve gathered from your research to address the following questions
in b. and c. below.
What is bronchiolitis, and what are its symptoms and some risk factors for developing it? In the
discharge summary, the baby was seen for a "viral-type" syndrome. What is the likely name for
this virus, which causes most cases of bronchiolitis?
Differentiate between the terms "rhonchi" and "rales" that are referred to in the discharge
summary. What is a croup tent and why was Ampicillin given to the baby?.
NURSE 6501N WK 6 DISCUSSIONConsider the following three scen.docxgabriellabre8fr
NURSE 6501N WK 6 DISCUSSION
Consider the following three scenarios:
Scenario 1:
Ms. Teel brings in her 7-month-old infant for evaluation. She is afraid that the baby might have respiratory syncytial virus (RSV) because she seems to be coughing a lot, and Ms. Teel heard that RSV is a common condition for infants. A detailed patient history reveals that the infant has been coughing consistently for several months. It’s never seemed all that bad. Ms. Teel thought it was just a normal thing, but then she read about RSV. Closer evaluation indicates that the infant coughs mostly at night; and, in fact, most nights the baby coughs to some extent. Additionally, Ms. Teel confirms that the infant seems to cough more when she cries. Physical examination reveals an apparently healthy age- and weight-appropriate, 7-month-old infant with breath sounds that are clear to auscultation. The infant’s medical history is significant only for eczema that was actually quite bad a few months back. Otherwise, the only remarkable history is an allergic reaction to amoxicillin that she experienced 3 months ago when she had an ear infection.
Scenario 2:
Kevin is a 6-year-old boy who is brought in for evaluation by his parents. The parents are concerned that he has a really deep cough that he just can’t seem to get over. The history reveals that he was in his usual state of good health until approximately 1 week ago when he developed a profound cough. His parents say that it is deep and sounds like he is barking. He coughs so hard that sometimes he actually vomits. The cough is productive for mucus, but there is no blood in it. Kevin has had a low-grade temperature but nothing really high. His parents do not have a thermometer and don’t know for sure how high it got. His past medical history is negative. He has never had childhood asthma or RSV. His mother says that they moved around a lot in his first 2 years and she is not sure that his immunizations are up to date. She does not have a current vaccination record.
Scenario 3:
Maria is a 36-year-old who presents for evaluation of a cough. She is normally a healthy young lady with no significant medical history. She takes no medications and does not smoke. She reports that she was in her usual state of good health until approximately 3 weeks ago when she developed a “really bad cold.” The cold is characterized by a profound, deep, mucus-producing cough. She denies any rhinorrhea or rhinitis—the primary problem is the cough. She develops these coughing fits that are prolonged, very deep, and productive of a lot of green sputum. She hasn’t had any fever but does have a scratchy throat. Maria has tried over-the-counter cough medicines but has not had much relief. The cough keeps her awake at night and sometimes gets so bad that she gags and dry heaves.
To prepare:
Review the three scenarios, as well as Chapter 26 and Chapter 27 in the Huether and McCance text.
Select one of the scenarios and consider the respiratory.
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1. 6512 Discussion wk 5 – My Nursing Experts
Discussion: Assessing the Ears, Nose, and ThroatMost ear, nose, and throat conditions that
arise in non-critical care settings are minor in nature. However, subtle symptoms can
sometimes escalate into life-threatening conditions that require prompt assessment and
treatment. Nurses conducting assessments of the ears, nose, and throat must be able to
identify the small differences between life-threatening conditions and benign ones. For
instance, if a patient with a sore throat and a runny nose also has inflamed lymph nodes, the
inflammation is probably due to the pathogen causing the sore throat rather than a case of
throat cancer. With this knowledge and a sufficient patient health history, a nurse would not
need to escalate the assessment to a biopsy or an MRI of the lymph nodes, but would
probably perform a simple strep test.In this Discussion, you consider case studies of
abnormal findings from patients in a clinical setting. You determine what history should be
collected from the patients, what physical exams and diagnostic tests should be conducted,
and formulate a differential diagnosis with several possible conditions.Note: By Day 1 of
this week, your Instructor will have assigned you to one of the following specific case
studies for this Discussion. Also, your Discussion post should be in the Episodic/Focused
SOAP Note format, rather than the traditional narrative style Discussion posting format.
Refer to Chapter 2 of the Sullivan text and the Episodic/Focused SOAP Template in the
Week 5 Learning Resources for guidance. Remember that all Episodic/Focused SOAP notes
have specific data included in every patient case.Case 1: Nose Focused ExamRichard is a 50-
year-old male with nasal congestion, sneezing, rhinorrhea, and postnasal drainage. Richard
has struggled with an itchy nose, eyes, palate, and ears for 5 days. As you check his ears and
throat for redness and inflammation, you notice him touch his fingers to the bridge of his
nose to press and rub there. He says he’s taken Mucinex OTC the past two nights to help him
breathe while he sleeps. When you ask if the Mucinex has helped at all, he sneers slightly
and gestures that the improvement is only minimal. Richard is alert and oriented. He has
pale, boggy nasal mucosa with clear thin secretions and enlarged nasal turbinates, which
obstruct airway flow but his lungs are clear. His tonsils are not enlarged but his throat is
mildly erythematous.Case 2: Focused Throat ExamLily is a 20-year-old student at the local
community college. When some of her friends and classmates told her about an outbreak of
flu-like symptoms sweeping her campus over the past two weeks, Lily figured she shouldn’t
take her three-day sore throat lightly. Your clinic has treated a few cases similar to Lily’s. All
the patients reported decreased appetite, headaches, and pain with swallowing. As Lily
recounts these symptoms to you, you notice that she has a runny nose and a slight
2. hoarseness in her voice but doesn’t sound congested.Case 3: Focused Ear ExamMartha
brings her 11-year old grandson, James, to your clinic to have his right ear checked. He has
complained to her about a mild earache for the past two days. His grandmother believes
that he feels warm but did not verify this with a thermometer. James states that the pain
was worse while he was falling asleep and that it was harder for him to hear. When you
begin basic assessments, you notice that James has a prominent tan. When you ask him how
he’s been spending his summer, James responds that he’s been spending a lot of time in the
pool.To prepare:With regard to the case study you were assigned:ú Review this week’s
Learning Resources and consider the insights they provide.ú Consider what history would
be necessary to collect from the patient.ú Consider what physical exams and diagnostic tests
would be appropriate to gather more information about the patient’s condition. How would
the results be used to make a diagnosis?ú Identify at least 5 possible conditions that may be
considered in a differential diagnosis for the patient.Note: Before you submit your initial
post, replace the subject line (?Week 5 Discussion?) with ?Review of Case Study ___,?
identifying the number of the case study you were assigned.Post an episodic/focused note
about the patient in the case study to which you were assigned using the episodic/focused
note template provided in week 5 resources. Provide evidence from the literature to
diagnostic tests that would be appropriate for each case. List five different possible
conditions for the patient’s differential diagnosis and justify why you selected each. Do you
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