Asthma Case Study Assignment

9) Write (document) utilizing the information, medical history, vital signs, etc. presented on this case study BELOW, to communicate to other care providers who will also care for this same patient: [Hint: SBAR (Situation, Background, Assessment, Recommendation) and SOAP (Subjective, Objective, Assessment and Plan)

A) SBAR

B) SOAP

B) SOAP

History

Ms. B is a 19 year old competitive bronco rider seen in the emergency room because of shortness of breath. The dyspnea began during a particularly hard ride, which culminated in modest dust inhalation on the rodeo floor. She states that the tightness in her chest and shortness of breath were so severe that she had to eventually leave the rodeo and see medical help. She is now very uncomfortable, even at rest. During the past week she has had a cough productive of greenish yellow sputum, mild fever, malaise, and fatigue, but she did not feel seriously ill until the onset of dyspnea at the rodeo earlier in the day. She denies previous lung problems except for mild ‘wheezing’ in her chest, which has occurred off and on during the past several years. She denies the use of any prescription medications, or any previous episodes of dyspnea, chest pain, leg pain, hemoptysis, sinusitis, or allergies. Her family history is negative for lung disease.

Physical Examination

General: 19 year old, 66 inches tall, and 140 lbs. Patient alert but restless and in moderate respiratory distress, mildly diaphoretic, sitting up on the edge of the bed leaning forward with her arms braced on her knees; cough frequent and productive of small amounts of greenish sputum.

Vital Signs: Temperature 101.1 F, Respiratory Rate 38/min, Blood Pressure 170/95 mmHg, Heart Rate 140/min, Paradoxical Pulse 25mmHg.

HEENT: Sinuses not tender to palpation; nasal flaring with inspiration

Neck: Trachea midline and mobile to palpation; no stridor; carotid pulsations + + and symmetrical bilaterally with no bruit; no lymphadenopathy, thyroidomegaly, or jugular venous distention; sternocleidomastoid muscles tensed during inspiration.

Chest: Increased anteroposterior diameter with decreased expansion during breathing and mild abdominal paradox with respiratory efforts.

Lungs: Rapid respiratory rate with prolonged expiratory phase and polyphonic wheezing heard over entire chest during inhalation and exhalation.

Heart: Regular rhythm at 140/min; no murmurs, gallops, or rubs; point of maximum impulse in normal position.

Abdomen; Soft, nontender; bowel sounds present; no masses or organomegaly.

Extremities; No clubbing, cyanosis, or edema; pulses + + and symmetrical in all areas

1. List and describe the life cycle stages of humans. Discuss the genetic, hormonal, and environmental factors influencing human growth and development. Describe the pattern of human brain growth. What is the importance of delayed brain growth in humans? What are pleiotropic genes and what do they help us to understand?

A married woman who has some reproductive problem makes up her mind to bear a baby via Artificial insemination by her husband. On the other hand , a married woman whose husband has low sperm count makes up her mind to accept sold male and female germ cells from donors at the consent of her husband via invitro fertilization. Now, is there a moral distinction between the 2 given cases? If any where does the moral distinction specifically reside?

A married man who has relative sterilization tells hi wife to have recourse to artificial insemination by donor in order to bear a child. Meanwhile, an unmarried woman who does not want to have sexual intercourse but wants to have a child resorts to artificial insemination by her boyfriend. Is there a moral distinction between the two given cases? If any what makes the moral distinction significant?

Question #3: What is the purpose of absorbing the Pt serum with Reiter organisms first prior to testing?

Question #4: What specimen is used to test for neurosyphilis?

Discuss the role of the FDA in the healthcare industry?

Research the delivery, finance, management, and sustainability methods of the U.S. health care system. Evaluate the effectiveness of one or more of these areas on quality patient care and health outcomes. Propose a potential health care reform solution to improve effectiveness in the area you evaluated and predict the expected effect. Describe the effect of health care reform on the U.S. health care system and its respective stakeholders. Support your post with a peer-reviewed journal article.

Please answer all questions and parts.

A 50 year-old Hispanic female came into your 24-hr Emergency care clinic complaining of purpuric lesions on her left and right ankles. She stated that she was being treated for rheumatoid arthritis with leflunomide and steroids.

1.What is your initial differential diagnosis? Give at least three. 3 pts.

She has lived in Coastal Texas for eight years. She is not on blood thinners. She denies use of alcohol, tobacco, or illicit drugs. She has not gone to the beach or been on the water for over five weeks. She has not eaten raw seafood in the last four weeks. She denies any known drug allergies

2a. What conditions might you now exclude? 2 pts

b. Why can you exclude these? 2 pts

The patient had rhinorrhea and myalgia. She stated she had no sore throat, shortness of breath but a sporadic cough, felt no fever or chills, no nausea, vomiting or diarrhea, no abdominal pain, no leg swelling or pain in the extremities. Examination revealed a temperature of 38.1°C, heart rate 106 beats per min, BP 126/68 mm Hg, respiratory rate 16 breaths per min, and oxygen saturation of 98%. Lungs were clear on auscultation. Lymphocyte count was 700/microliter (normal 1000-4800).

3a. Do these findings allow exclusion of some of the differential diagnosis possibilities, and suggest some other possibilities? 2 pts

3b. What other tests would you perform? 2 pts

The patient was given nucleic acid amplification tests for COVID-19, influenza A, and respiratory syncytial virus—all were negative. She returned two days later, complaining of shortness of breath. Her oxygen saturation had decreased to 94% .

4. What possibilities must now be considered? List at least four. 4 pts.

Radiography of the chest revealed a 5 cm mass in the left lower lobe. A CT scan revealed ground-glass opacity, and some left hilar lymphadenopathy.

5. What conditions from question 4 should be included? 4 pts

Patient now had a temperature of 39oC, complained of a productive cough with green sputum, weakness, nausea and vomiting. The heart rate now increased to 115 beats per minute, BP was 138/85 mm Hg. Auscultation revealed crackles in the left lower lobe. Oxygen saturation dropped to 92% within the two hour wait in the emergency room.

6.a. What are the most likely conditions the patient could have? 2 pts

b. What is your diagnosis? 2pts

Mrs. Lydia Martin, an 88-year-old widow, lives alone in her single-story home. She prides herself in being fully independent. During the middle of the night, Mrs. Martin fell in her home while walking to the bathroom. She was unable to get up, so she crawled to the telephone and dialed 911. She was transported to the emergency department and underwent diagnostic tests including hip and femur x-ray and computerized tomography (CT), which confirmed a left femoral neck hip fracture. Her past medical history reveals anxiety, osteoporosis, arthritis, and cataracts. Mrs. Martin underwent an open reduction internal fixation (ORIF) and a left hip replacement. Following surgery, she had a compression dressing with ice to the left hip, a Foley catheter, antiembolism stockings, a sequential compression device, a surgical drain and an order to use the incentive spirometer every hour while awake. Her medications included: Ampicillin 500 mg. IV q4hrs.; Morphine 1-2mg. IV q3-4 hrs. prn; hydrocodone bitartrate 7.5 mg/acetaminophen 750 mg (Vicodin ES) 2 tabs q4h po prn; and enoxaparin (Lovenox) 40 mg daily subcutaneously. On post-op day 1, the nurse and physical therapist began to work with Mrs. Martin; the goal of the session was to get her out of bed to a chair. During the attempted transfer, Mrs. Martin's surgical site was painful and her Foley catheter was pulled. She screamed in pain and refused to continue the process. Mrs. Martin was anxious and fearful of pain; she also became worried that she would never walk again and would end up in a nursing home. She was unwilling to move and declined physical therapy the next 3 days. Mrs. Martin became constipated and lost her appetite. She also developed a stage 2 pressure ulcer over her sacrum. Eventually, on post-op day 4 Mrs. Martin agreed to work with the physical therapist. By this time, she experienced significant weakness and fatigue and was unable to move independently. Mrs. Martin was later transferred to a rehabilitation center to continue regaining her mobility.

3. As the nurse, what other professionals would you collaborate with when caring for Mrs. Martin? Explain the importance of collaborating with the health care team when providing care for patients with hip fractures.

4. How would you apply principles of infection control when caring for a patient with a hip fracture?

5. Describe the nutritional needs of the patient with a healing fracture and the complications related to diet and medication use that could occur.

6. What interventions in the home would you assess to reduce the incidence of hip fractures?

7. You are planning to discharge Mrs. Martin. What community contacts and resources should you include in the teaching plan?

Oxygenation, Perfusion, fluid and electrolytes are concepts reflect normal physiological mechanism occurring inside the human body which may be affected by the pathological conditions and at the same time can lead to new pathological one.

Oxygenation concept and apply it on pneumonia showing the following:

1. Introduction about oxygenation concept
2. Brief introduction about pneumonia
3. Focus on the physiological changes on oxygenation associated with pneumonia in relation to:

1. Clinical S & S
2. Diagnostic measures
3. Management (medical, surgical & nursing management).

Which would you use RFI or RFP for a new EHR?

Oxygenation, Perfusion, fluid and electrolytes are concepts reflect normal physiological mechanism occurring inside the human body which may be affected by the pathological conditions and at the same time can lead to new pathological one.

Fluid and electrolytes concept and apply it on heart failure disease showing the following:

1. Introduction about the selected concept(s)
2. Brief introduction about heart failure
3. Focus on the physiological changes on the selected concept(s) associated with heart failure in relation to:

1. Clinical S & S
2. Diagnostic measures
3. Management (medical, surgical & nursing management).