Tag: Clinical-Nursing

R. W. is a 64-year-old Caucasian postal clerk who has smoked a pack of cigarettes a day for the past 35 years

N521- Advanced Pharmacology Assignment 2

R. W. is a 64-year-old Caucasian postal clerk who has smoked a pack of cigarettes a day for the past 35 years. He reports to his CNP in his family practice clinic. He presents with progressive difficulty getting his breath while doing simple tasks. He is having difficulty doing any manual work, but he has no symptoms when working behind his desk. He also reports a cough, fatigue, and weight loss. He has been treated for three respiratory infections a year for the past 3 years and feels like another one is developing now. On physical examination, you notice clubbing of his fingers, use of accessory muscles for respiration, wheezing in the lungs, and hyperresonance on percussion of the lungs. Pulmonary function studies show an FEV1 of 58%. R. W. is a 64-year-old Caucasian postal clerk who has smoked a pack of cigarettes a day for the past 35 years.

BUY A PLAGIARISM-FREE PAPER HELP HERE

In a paper not to exceed six pages, excluding title and reference pages, please answer the following:

What is R. W.’s likely diagnosis?

What stage of disease does RW have?

List specific pharmacotherapeutic treatment goals for R. W.

What drug therapy would the CNP likely prescribe? Why?

What are the parameters for monitoring the success of the therapy?

Describe specific patient education based on the prescribed therapy.

List one or two adverse reactions for the selected agent that would cause the CNP to change therapy.

What would be the choice for second-line therapy?

What health promotion activities should be recommended for this patient?

If RW was currently taking metoprolol for “headaches” would a change be recommended?

R. W. is a 64-year-old Caucasian postal clerk who has smoked a pack of cigarettes a day for the past 35 years

Please use the Case Study Analysis rubric provided to guide you in completing this assignment. It will be used to evaluate your submitted work.

Competency

40

36

33

0

Points Earned

Case Study questions completely and thoroughly answered with accurate evidence-based supported rationales

Accurate and well defined discussion of all 10 questions for the case study using current evidence-based resources.

Accurate discussion of nine case study questions  presented with use of  current evidence-based resources.

 

Accurate discussion of 8 questions using current evidence-based resources

Missing response to questions or inappropriate answers to questions. No use of evidence-based resources.

/40

R. W. is a 64-year-old Caucasian postal clerk who has smoked a pack of cigarettes a day for the past 35 years

40

36

33

0

Evidence of

critical thinking

therapeutic decision-making in drug selection and evaluation of patient care

pathophysiology and current pharmacological research

assessment of the effectiveness of drug therapy

formulation of clinical care and teaching plans for persons from diverse populations

Well-defined evidence of

critical thinking

therapeutic decision-making in drug selection and evaluation of patient care

pathophysiology and current pharmacological research

assessment of the effectiveness of drug therapy

formulation of clinical care and teaching plans for persons from diverse populations

 

Evidence of critical thinking in prescriptive therapy, monitoring and adverse events.  May have lacked a teaching plan or pathophysiologic discussion.

 

Evidence of critical thinking but incompletely described therapeutic decision making and omitted teaching plan and pathophysiology.

Multiple bulleted points are absent or poorly defined in the assignment. There is no demonstration of critical thinking.

R. W. is a 64-year-old Caucasian postal clerk who has smoked a pack of cigarettes a day for the past 35 years

/40

 

10

9

8

0

Points Earned

Grammar, spelling, and punctuation

There are no errors in grammar, spelling, and punctuation

There are a few minor errors in grammar, spelling, and punctuation that do not detract from the meaning (1-3 errors)

There are major errors in grammar, spelling, and punctuation .(4-5 errors)

No content or more than 5 errors

/10

10

9

8

0

APA Compliance

The paper meets APA formatting guidelines

There are a few minor errors (1-3 errors)

There are significant errors in the format of the paper (4-5 errors)

No content or more than 5 errors

/10

Total Points

R. W. is a 64-year-old Caucasian postal clerk who has smoked a pack of cigarettes a day for the past 35 years

/100

N521-Attention-Deficit Hyperactive Disorder (ADHD) Discussion 7

J. T., who is a Native American male, age 8, is always interrupting his teacher, jumping out of his seat in class, fidgeting relentlessly, and butting into other children’s games. At home, he runs around recklessly and is uncontrollable. His mother comes to the CNP in the Pediatric Clinic and wonders why he will not listen. She is concerned because his grades at school are dropping. After medical evaluation, you find nothing wrong with J. T. physically, and he is taking no other medications. Through questioning, you determine that he has trouble concentrating on his homework, often forgets he has homework, loses pieces of games frequently, and hates to sit and read. His mother is unsure of the time frame over which these behaviors developed, but she thinks it has been since her second child was born 5 years ago. N521-Attention-Deficit Hyperactive Disorder (ADHD) . While in your office, J. T. did not seem to be hyperactive or inattentive, but you notice he is easily distracted by people passing in the hallway because the door is slightly ajar.

BUY A PLAGIARISM-FREE PAPER HELP HERE

Diagnosis: Attention-Deficit Hyperactive Disorder (ADHD)

In this discussion forum:

Discuss specific goals for pharmacotherapy for treating J. T.’s ADHD.

Discuss the first-line drug therapy for J. T., and why.

Discuss monitoring parameters you would institute for J. T.’s parents and his teachers.

Discuss specific patient education you would provide to J. T.’s parents based on the prescribed therapy.

Remember to respond to at least two of your peers. Please see the Course Syllabus for Discussion Participation Requirements and Grading Criteria. N521-Attention-Deficit Hyperactive Disorder (ADHD)

Pharmacotherapy of Mental & CNS Disorders Essay

Module 7 Overview

Introduction

This week we will focus on the pharmacotherapeutics of mental and CNS disorders, including commonly occurring conditions and their commonly prescribed medications.

Learning Objectives

BUY A PLAGIARISM-FREE PAPER HELP HERE

After completing this module, you will be able to:

Utilize advanced nursing and pharmacological interventions in mental and CNS disorders to resolve complex and biological, psychological, physiological and pathophysiologic conditions.

Teach patients, family members, and others from diverse populations regarding safe and effective use of drugs and natural products in mental and CNS disorders. Pharmacotherapy of Mental & CNS Disorders Essay

Reading & Resources

Read Chapters 38-45. In Arcangelo, V. P., & Peterson, A. M. (2017). Pharmacotherapeutics for advanced practice: A practical approach (4th ed.). Philadelphia, PA: Wolters Kluwer/Lippincott Williams & Wilkins.

Learning Activities

Discussion: 
Participate in Discussion 7.

Assignment: 
Complete & Submit Assignment 3. Click on the Assignment 3 link for more details.

Discussion 7

J. T., who is a Native American male, age 8, is always interrupting his teacher, jumping out of his seat in class, fidgeting relentlessly, and butting into other children’s games. At home, he runs around recklessly and is uncontrollable. His mother comes to the CNP in the Pediatric Clinic and wonders why he will not listen. She is concerned because his grades at school are dropping. After medical evaluation, you find nothing wrong with J. T. physically, and he is taking no other medications. Through questioning, you determine that he has trouble concentrating on his homework, often forgets he has homework, loses pieces of games frequently, and hates to sit and read. His mother is unsure of the time frame over which these behaviors developed, but she thinks it has been since her second child was born 5 years ago. Pharmacotherapy of Mental & CNS Disorders Essay While in your office, J. T. did not seem to be hyperactive or inattentive, but you notice he is easily distracted by people passing in the hallway because the door is slightly ajar.

Diagnosis: Attention-Deficit Hyperactive Disorder (ADHD)

In this discussion forum:

Discuss specific goals for pharmacotherapy for treating J. T.’s ADHD.

Discuss the first-line drug therapy for J. T., and why.

Discuss monitoring parameters you would institute for J. T.’s parents and his teachers.

Discuss specific patient education you would provide to J. T.’s parents based on the prescribed therapy.

Remember to respond to at least two of your peers. Please see the Course Syllabus for Pharmacotherapy of Mental & CNS Disorders Essay Discussion Participation Requirements and Grading Criteria.

Anti-infective Medications Essay

Module 6 Overview

Introduction

This week we will focus on the pharmacotherapeutics of anti-infective medications, including their use in commonly occurring conditions and the more commonly prescribed medications.  The presence of infection may occur in any body system and include causative agents such as bacteria, viruses, fungi, and protozoans Anti-infective Medications Essay.  The evidence-based treatment will vary with the cause and area of infection.

Learning Objectives

After completing this module, you will be able to:

BUY A PLAGIARISM-FREE PAPER HELP HERE

Utilize advanced nursing and pharmacological interventions in the use of anti-infective medications to resolve complex and biological, psychological, physiological and pathophysiologic conditions. Anti-infective Medications Essay.

Synthesize evidence-based clinical practice guidelines to develop pharmacotherapeutics plans for common infections such as pneumonia, otitis, urinary tract infections, sexually transmitted infections, skin infections, dental infections, gastroenteritis, and sepsis.

Teach patients, family members, and others from diverse populations regarding safe and effective use of drugs and natural products within the anti-infective medication classifications.

Reading & Resources

Read Chapters 8, 17, 18, 24, 27, 31, 32, & 35 In Arcangelo, V. P., & Peterson, A. M. (2017). Pharmacotherapeutics for advanced practice: A practical approach (4th ed.). Philadelphia, PA: Wolters Kluwer/Lippincott Williams & Wilkins. Anti-infective Medications Essay

Visit Infectious Disease Society of America (IDSA) Practice guidelines at 
https://www.idsociety.org/PracticeGuidelines/

Learning Activities

Discussion: 
Participate in Discussion 6.(Remember to use the IDSA resource)

Discussion 6

J. P. is a 36-year-old Caucasian gay male who was diagnosed with HIV infection 2 years ago. He and his male partner, T. R., were married shortly after his diagnosis. T. R. is not HIV positive. Anti-infective Medications Essay He has been feeling well for the past 2 years, and he maintains a healthy, active lifestyle by exercising three to four times a week and eating a balanced diet. His medications include a multiple vitamin and occasional omeprazole for heartburn. He has never received antiretroviral therapy. He comes to your office for a routine physical exam and blood work. The physical examination is unremarkable, and the laboratory results are as follows: Electrolytes, serum creatinine, liver function tests: within normal limits; Complete blood count with differential: within normal limits, CD4+ T-cell count: 210 cells/mm3; Viral load: 10,000 copies/mL, Genotype: No resistance mutations detected Anti-infective Medications Essay

Diagnosis: Asymptomatic HIV Infection

In this discussion forum:

Discuss specific goals for pharmacotherapy for treating J. P.’s asymptomatic HIV infection.

Discuss when prophylaxis for infection is indicated ie daily bactrim Anti-infective Medications Essay

Discuss the drug therapy a CNP would likely prescribe and why.

Discuss the parameters for monitoring success of the therapy.

Discuss health promotion recommendations you would consider for J. P.

Remember to respond to at least two of your peers. Please see the Course Syllabus for Discussion Participation Requirements and Grading Criteria Anti-infective Medications Essay.

Asymptomatic HIV Infection Essay Discussion 6

J. P. is a 36-year-old Caucasian gay male who was diagnosed with HIV infection 2 years ago. He and his male partner, T. R., were married shortly after his diagnosis. T. R. is not HIV positive. He has been feeling well for the past 2 years, and he maintains a healthy, active lifestyle by exercising three to four times a week and eating a balanced diet. His medications include a multiple vitamin and occasional omeprazole for heartburn. He has never received antiretroviral therapy Asymptomatic HIV Infection Essay. He comes to your office for a routine physical exam and blood work. The physical examination is unremarkable, and the laboratory results are as follows: Electrolytes, serum creatinine, liver function tests: within normal limits; Complete blood count with differential: within normal limits, CD4+ T-cell count: 210 cells/mm3; Viral load: 10,000 copies/mL, Genotype: No resistance mutations detected Asymptomatic HIV Infection Essay

BUY A PLAGIARISM-FREE PAPER HELP HERE

Diagnosis: Asymptomatic HIV Infection

In this discussion forum:

Discuss specific goals for pharmacotherapy for treating J. P.’s asymptomatic HIV infection.

Discuss when prophylaxis for infection is indicated ie daily bactrim

Discuss the drug therapy a CNP would likely prescribe and why. Asymptomatic HIV Infection Essay

Discuss the parameters for monitoring success of the therapy.

Discuss health promotion recommendations you would consider for J. P.

Remember to respond to at least two of your peers. Please see the Course Syllabus for Discussion Participation Requirements and Grading Criteria Asymptomatic HIV Infection Essay.

Acute Pericarditis Jackie Johnson diagnosis Discussion 2

Jackie Johnson, a 35 y.o. African-American, married female, advertising executive, presents to the emergency department with complaints of chest pain. The pain is described as 8 on a scale ranging from 1 to 10, retrosternal, and sharp in nature. It radiates to the back, is worse with taking a deep breath, and is improved by leaning forward. Acute Pericarditis Jackie Johnson diagnosis On review of systems, she has noted a “flulike illness” over the last several days, including fever, rhinorrhea, and cough. She has no medical history and is taking no medications. She denies tobacco, alcohol, or drug use. On physical examination, she appears in moderate distress from pain, with a blood pressure of 125/85 mm Hg, heart rate 105 bpm, respiratory rate 18/min, and oxygen saturation of 98% on room air. She is currently afebrile. Her head and neck examination is notable for clear mucus in the nasal passages and a mildly erythematous oropharynx. The neck is supple, with shotty anterior cervical lymphadenopathy. The chest is clear to auscultation. Jugular veins are not distended. Cardiac examination is tachycardic with a three-component high-pitched squeaking sound. Abdominal and extremity examinations are normal Acute Pericarditis Jackie Johnson diagnosis.

In this discussion:

Provide and discuss this patient’s likely diagnosis with your colleagues. Why do you support this “likely” diagnosis?

Discuss your differential diagnoses clinical reasoning. Why do you support this list of potential differential diagnoses?

Provide and discuss what the most common causes of this disease are, and which is most likely in this patient?

Identify the pathophysiologic mechanism for her chest pain.

Acute Pericarditis Jackie Johnson diagnosis

Develop a plan of care post-discharge based upon your recommendations living arrangements and social supports.

Support your discussion with citations from the external literature and your textbook.

Remember to respond to at least two of your peers. Please refer to the Course Syllabus for Participation Guidelines & Grading Criteria.

JJ has chest pain that is sharp and retrosternal. This pain radiates to her back and is pleuritic in nature, as it is worse when she takes a deep breath. This pain is improved when she leans forward. The driving factor towards the likely diagnosis is the three-component high pitched squeaking sound with cardiac auscultation. This is a pericardial rub. With all these factors combined, JJ likely has acute pericarditis Acute Pericarditis Jackie Johnson diagnosis.

Continual inflammation of the pericardium can often lead to fibrosis and can eventually lead to constrictive pericarditis. Jugular vein distention and an increase in the jugular vein pressure can be noted. Due to these symptoms, a differential diagnoses can include items such as constrictive pericarditis, pneumonia, GI reflux issues and even a pulmonary embolism, according to Hammer and McPhee (2019) Acute Pericarditis Jackie Johnson diagnosis.

ORDER A PLAGIARISM-FREE PAPER HERE

The most common causes of pericarditis are infections. Coxsackievirus is the most prominent viral cause, according to Hammer and McPhee (2019). Other causes can be bacterial, such as tuberculosis, pneumococcal, or staphylococcal, protozoal, such as amebiasis, or mycotic (fungal), such as actinomycosis, or coccidioidomycosis (Hammer & McPhee, 2019) Acute Pericarditis Jackie Johnson diagnosis. Tests should be ran such as an EKG, CBC, BMP, troponin and lipase levels, and a CXR. I would suspect she has a viral case, due to her flu-like symptoms and an erythematous oropharynx. She also has clear mucus in her nasal passages. If these tests were to be ran, it would be likely she would an elevated WBC, erythrocyte sedimentation rate, or CRP level. Her EKG would be typical. The CXR can be helpful in ruling out other causes in the differential.

According to Hammer and McPhee (2019), pericarditis is an inflammation of the pericardium, and this inflammation affects the adjacent pleura. This can inflict pain when deep breathing or coughing.

Post-discharge, she should take good care of herself to prevent constrictive pericarditis or recurrent pericarditis. According to Imazio et al. (2016), 20-50% of all patients who are treated for pericarditis get it a subsequent time. She should continue to take all medications that she was prescribed, which can be colchicine or steroids, making sure to taper off these medications appropriately Acute Pericarditis Jackie Johnson diagnosis. According to Rahman (2017), low doses of colchicine can be safe, while higher doses or prolonged use can be toxic. She can also take NSAIDs, which can provide symptom control, faster remission rates, and reduction of subsequent recurrences, according to Imazio et al. (2016). These should only be taken if it is not contraindicated to take with her other medications. She should make follow up appointments to make sure this issue is solved.

Interestingly enough, there was a recent study done in 2020 by Fox et al. They found that multiple people who have had no past medical history who have had COVID-19 ended up having either pericarditis, effusive pericarditis, myopericarditis, or pericardial effusion when it was all said and done. There are no current recommendations for managing this, except colchicine, hydroxychloroquine, steroids or antivirals. If this case study is happening in present-day, it would be important to monitor signs and symptoms of pericarditis if the patent had COVID-19. 
Acute Pericarditis Jackie Johnson diagnosis

References:

Fox, K., Prokup, J. A., Butson, K., & Jordan, K. (2020). Acute effusive pericarditis: A Late complication of COVID-19. Cereus, 12(7).

Hammer, G., & McPhee, S. (2019). Pathophysiology of disease: An introduction to clinical medicine (8th ed.). New York, NY: McGraw-Hill Medical.

Imazio, M., Lazaros, G., Brucato, A., & Gaita, F. (2016). Recurrent pericarditis: new and emerging therapeutic options. Nature Reviews: Cardiology, 16.

Rahman, A. (2017). Pericarditis. AFP, 46(11). Acute Pericarditis Jackie Johnson diagnosis

Jackie Johnson Acute Pericarditis discussion

Jackie Johnson is described as a married 35-year-old African American female who has presented to the emergency room with: Chest pain, which she rates 8 out of 10 on a scale ranging from 1 to 10 Jackie Johnson Acute Pericarditis discussion. The pain is verbalized to be sharp in nature, worsens with deep breaths, is retrosternal, and is improved when “leaning forward”. In addition, she also indicates having had “flu like illness” within the past few days such as fever, rhinorrhea, and cough. She denies any additional medical history and is not taking any medication. Also, she denies any alcohol, tobacco, or drug use. Of note, she is reported to work as an Advertising Executive. Jackie Johnson Acute Pericarditis discussion

Upon physical examination findings she appears in moderate distress from pain, with a blood pressure of 125/85 mm Hg, heart rate 105 bpm, respiratory rate 18/min, and oxygen saturation of 98% on room air. She is currently afebrile. Her head and neck examination are notable for clear mucus in the nasal passages and a mildly erythematous oropharynx. The neck is supple, with shotty anterior cervical lymphadenopathy. The chest is clear to auscultation. Jugular veins are not distended. Jackie Johnson Acute Pericarditis discussion Cardiac examination is tachycardic with a three-component high-pitched squeaking sound. Abdominal and extremity examinations are normal.

ORDER A PLAGIARISM-FREE PAPER HERE

Given the patients report and the physical examination obtained, factors aside from medical findings to keep in mind when moving forward are: A highly stressful job, her sex, her race, and her marital status, which may contribute to stress levels as well Jackie Johnson Acute Pericarditis discussion.

After assessment of the findings presented, J.J’s likely Diagnosis is Acute Pericarditis, which is an inflammation of the pericardium,
 caused by the sac’s layers becoming inflamed and possibly rubbing against the heart (American Heart Association, 2016). A client with acute pericarditis will complain of chest pain that worsens with deep breaths or while coughing when lying down and is relieved by positional changes, such as leaning forward or sitting up (Hammer & McPhee, 2014). Also, a clinical finding in patients with acute pericarditis is a high-pitched squeaking sound upon cardiac auscultation, which may be indicative of pericardial rub (
Hammer & McPhee, 2014
) Jackie Johnson Acute Pericarditis discussion. The presence of pericardial rub often indicates complications of pericarditis such as an increase in fluid between the layers of the pericardium which causes the rubbing between the pericardium and heart, pericardial effusion (Hammer & McPhee, 2014), this best explains the pathophysiological mechanism causing the chest pain for J.J currently.  J.J’s cardiac exam shows tachycardia, as evidenced by a heart rate of 105, with a three-component high pitched squeaking sound, which is a finding indicative of acute pericarditis, but may also be indicative of complications related to pericarditis (American Heart Association, 2016). Jackie Johnson Acute Pericarditis discussion

Causes of pericarditis include viral, bacterial, protozoal, and mycotic infections (Hammer & McPhee, 2014) or its cause can be idiopathic. Per J.J’s report of  “flu like illness for the past few days” which include fever, rhinorrhea, and cough lead me to believe that a likely cause of the pericarditis is a virus. The mild erythematous oropharynx, and shotty anterior cervical lymphadenopathy noted during the physical exam are also indicative of viral cause.

Though acute pericarditis is the likely diagnosis for J.J given her relatively healthy history, further assessment and diagnostic testing should be obtained to confirm and or rule out other cardiac related illnesses that may present with similar symptoms. In the case of J.J, the symptoms presented do not coincide with clinical manifestations exhibited in other cardiac related illnesses. Her blood pressure is within normal limits, her respirations are normal, O2 Sat is WNL, jugular veins are not distended, and is not experiencing dyspnea. The clinical findings exhibited: elevated heart rate, mild erythematous oropharynx, shotty anterior cervical lymphadenopathy, tachycardia with 3-component high pitched squeaking sound are all symptoms that point to pericarditis. However, we must also take into consideration that there are non-cardiac related conditions that can also present in the form of chest pain 
(
Fass, R., & Achem, S.R, 2011). Jackie Johnson Acute Pericarditis discussion Psychological disorders such as panic, anxiety, and depression can also clinically manifest with chest pain (Huffman, J., Pollack, M., & Stern, T., 2002). Given J.J’s high demanding job, we can suspect that she experiences high levels of stress that can contribute to anxiety, but in order to further diagnose this, more information needs to be obtained Jackie Johnson Acute Pericarditis discussion.

Considering that, “Heart disease and stroke are the No. 1 killers in women, and affects African American women disproportionately, making diabetes, smoking, high blood pressure, high cholesterol, physical inactivity, obesity and a family history of heart disease all greatly prevalent among African-Americans and are major risk factors for heart disease” (American Heart Association, 2016), I would want to investigate further into family history, and monitoring of cholesterol as well as potential for hypertension. Jackie Johnson Acute Pericarditis discussion

In order to increase J.J’s prognosis, a thorough assessment should be completed including an ECG, Chest X-ray, echocardiogram, and obtaining labs for signs of inflammation (American Heart Association, 2016). In addition, perhaps also including cholesterol screening would be helpful collateral information to better treat J.J. Currently, her blood pressure appears to be within normal limits, but I would want to monitor this as well. Lastly, I’d also want to examine J.J’s psychological and mental status to rule out anxiety related disorders, which could have also contributed to her chest pain.

Acute Pericarditis has been known to clear up on its own with simple treatment (American Heart Association, 2016).  Treatment, however, will be dependent on the cause (American Heart Association, 2016). Upon discharge, the recommendation for J.J will likely be anti-inflammatory medication in higher doses than usual, such as Motrin, or Aleve in order to alleviate the pain, and rest (American Heart Association, 2016), since she has no other known medical history and is relatively young. She should follow up with a cardiologist to monitor for recurrenceJackie Johnson Acute Pericarditis discussion.

 

References:

American Heart Association (2016, March 31)
. Retrieved from

https://www.heart.org/en/health-topics/pericarditis/what-is-pericarditis

Fass, R., Achem, S.R. (2011).  
Noncardiac Chest Pain: Epidemiology, Natural Course and            Pathogenesis
.
  
Journal of Neurogastroenterology and Motility,
17:110-

123.
https://doi.org/10.5056/jnm.2011.17.2.110

Hammer, G., & McPhee, S. (2014). 
Pathophysiology of disease: An introduction to clinical                    medicine 
 (8
th
 ed.). New York, NY: McGraw-Hill Medical.

Huffman, J., Pollack, M., & Stern, T. (2002). 
Panic Disorder and Chest Pain: Mechanisms,

Morbidity, and Management. 
Primary Care Companion to The Journal of Clinical

            Psychiatry
, 4(2):54-62.doi: 10.4088/pcc.v04n0203 Jackie Johnson Acute Pericarditis discussion

Jackie Johnson Acute Pericarditis Discussion 2

Jackie Johnson, a 35 y.o. African-American, married female, advertising executive, presents to the emergency department with complaints of chest pain. The pain is described as 8 on a scale ranging from 1 to 10, retrosternal, and sharp in nature. It radiates to the back, is worse with taking a deep breath, and is improved by leaning forward. On review of systems, she has noted a “flulike illness” Jackie Johnson Acute Pericarditis discussion over the last several days, including fever, rhinorrhea, and cough. She has no medical history and is taking no medications. She denies tobacco, alcohol, or drug use. On physical examination, she appears in moderate distress from pain, with a blood pressure of 125/85 mm Hg, heart rate 105 bpm, respiratory rate 18/min, and oxygen saturation of 98% on room air. She is currently afebrile. Her head and neck examination is notable for clear mucus in the nasal passages and a mildly erythematous oropharynx. The neck is supple, with shotty anterior cervical lymphadenopathy. The chest is clear to auscultation. Jugular veins are not distended. Jackie Johnson Acute Pericarditis discussion Cardiac examination is tachycardic with a three-component high-pitched squeaking sound. Abdominal and extremity examinations are normal.

In this discussion:

Provide and discuss this patient’s likely diagnosis with your colleagues. Why do you support this “likely” diagnosis?

Discuss your differential diagnoses clinical reasoning. Why do you support this list of potential differential diagnoses?

Provide and discuss what the most common causes of this disease are, and which is most likely in this patient?

Identify the pathophysiologic mechanism for her chest pain. Jackie Johnson Acute Pericarditis discussion

Develop a plan of care post-discharge based upon your recommendations living arrangements and social supports.

Support your discussion with citations from the external literature and your textbook.

Remember to respond to at least two of your peers. Please refer to the Course Syllabus for Participation Guidelines & Grading Criteria.

Discussion 2 – Pleuritic Chest Pain

ORDER A PLAGIARISM-FREE PAPER NOW

Case: Jackie Johnson, a 35 y.o. African-American, married female, advertising executive, presents to the emergency department with complaints of chest pain. The pain is described as 8 on a scale ranging from 1 to 10, retrosternal, and sharp in nature. It radiates to the back, is worse with taking a deep breath, and is improved by leaning forward. Jackie Johnson Acute Pericarditis discussion On review of systems, she has noted a “flu-like illness” over the last several days, including fever, rhinorrhea, and cough. She has no medical history and is taking no medications. She denies tobacco, alcohol, or drug use. On physical examination, she appears in moderate distress from pain, with a blood pressure of 125/85 mm Hg, heart rate 105 bpm, respiratory rate 18/min, and oxygen saturation of 98% on room air. She is currently afebrile. Her head and neck examination are notable for clear mucus in the nasal passages and a mildly erythematous oropharynx. The neck is supple, with shotty anterior cervical lymphadenopathy. The chest is clear to auscultation. Jugular veins are not distended. Cardiac examination is tachycardic with a three-component high-pitched squeaking sound. Abdominal and extremity examinations are normal. Jackie Johnson Acute Pericarditis discussion

Provide and discuss this patient’s likely diagnosis with your colleagues. Why do you support this “likely” diagnosis?

Upon initial presentation, a clue that the chest pain may be pleuritic in nature is related to the symptoms the patient describes as sharp pain that increases while taking a deep breath, and the pain is located retrosternal with movement of the chest pain to the back. These are classic symptoms of pleuritic chest pain (Hammer & McPhee, 2019; Reamy, Williams, & Odom, 2017). Upon further examination with a repositioning test, the patient voices improvement of chest pain when leaning forward which validates that somatic nerves of the parietal pleura are sensitized with inflammation that is commonly seen in pleuritic chest pain. Further assessment of a “pericardial rub” (an audible high-pitched or squeaking noise as sticky inflammatory fluid in the pericardial sac moves between the visceral and parietal pericardial layers) lends another layer of confirmation, that the patient’s chest pain is pleuritic and possibly due to pericarditis because a pericardial rub is also found to be a classic sign used in developing a diagnosis of pericarditis (Gupta, 2019; Hammer & McPhee, 2019) Jackie Johnson Acute Pericarditis discussion.

Discuss your differential diagnoses clinical reasoning. Why do you support this list of potential differential diagnoses?

Pleuritic chest pain can be caused by other conditions. The most serious and life-threatening conditions such as pulmonary embolism, myocardial infarction, aortic dissection, pneumonia, and pneumothorax, have similar signs and symptoms, and diagnostic clinically reasoning can help the practitioner discern, contrast and compare between them quickly to anticipate and plan for life saving interventions. For example, approximately 5% to 21% of emergency department patients are found to have a pleuritic chest discomfort with a pulmonary embolism. In fact, 66% of patients experienced pleuritic chest pain which was associated with a pulmonary embolism (Reamy, Williams, & Odom, 2017, 306). On the other hand, sharp chest pain is usually not cardiac. Also, if you have a pretty good clue of the diagnosis, such as in this case, pericarditis, then you would want to consider the possible related complications such as pericardial effusion, constrictive pericarditis and cardiac tamponade. However, over 80% of pericarditis cases have good outcomes, so searching for other causes may not always be warranted (Imazio, 2020) Jackie Johnson Acute Pericarditis discussion.

It is important to look at other causes, associated signs and symptoms, and complete tests that can help you validate a definitive diagnosis. 
For instance, an EKG may show occasional ST elevation in pericarditis, whereas, in contrast, adjacent leads will show consistent ST elevation along with elevated cardiac enzymes in myocardial infarction. Jackie Johnson Acute Pericarditis discussion And a chest x-ray is often normal with myocardial infarction, but may show cardiomegaly in pericarditis (Reamy, Williams, & Odom, 2017, p. 310).

The working diagnoses, I would probably consider, after a through physical exam and history is pericarditis. Differential diagnoses of a new or old myocardial infarction,  pulmonary embolism, or pneumonia could possibly be considered. Diagnostic evidence such as a chest x-ray will help to identify the size of the heart, the condition of the pericardium, and the condition of the lungs which will aid in discerning a probable diagnosis.

Provide and discuss what the most common causes of this disease are, and which is most likely in this patient? Jackie Johnson Acute Pericarditis discussion

The most common causes of  pericarditis is inflammation caused by 
infections
 from virus (primarily the coxsackievirus), bacteria, protozoal, and mycotic; 
collagen-vascular related diseases
, such as systemic lupus erythematosus, rheumatoid arthritis; 
neoplasm
;
 metabolic,
 such as renal failure; 
injury
 such as myocardial infarction, post myocardial infarction, and trauma; 
idiopathic 
in which the disease presents itself without a defining reason (Hammer & McPhee, 2019, p. 320). Since the patient has had recent flu symptoms and anterior cervical lymphadenopathy with symptoms classic for pericarditis, her condition is mostly likely caused by a viral infection Jackie Johnson Acute Pericarditis discussion.

Identify the pathophysiologic mechanism for her chest pain.

Pericarditis is caused by inflammation of the pericardial sac. The inflammation builds up sticky fluid that grinds against the pericardial surfaces of the visceral and parietal surfaces. The inflammation will initiate growth of polymorphonuclear leukocytes, cause pus type accumulation, and buildup of fibrin material (Hammer & McPhee, 2019). There are no pain receptors in the visceral pleura; however, in response to inflammation, the parietal pleura’s pain receptors are stimulated, and the parietal pleurae and lateral hemidiaphragm can sensitize cutaneous nerves towards the surface of the skin. Swelling and inflammation to these innervated areas can cause increased pain such as with respiratory movement (Reamy, Williams, & Odom, 2017) Jackie Johnson Acute Pericarditis discussion.

Develop a plan of care post-discharge based upon your recommendations living arrangements and social supports.

Ms. Johnson is a young and currently working a successful job. It would be good to explore with Ms. Johnson her support system at home, and consider involving a significant other in the education related to her diagnosis and treatment plan. With an unremarkable work-up, discussing with Ms. Johnson home self-care options would probably be safe if she is agreeable to following the home care guidelines, and follow-up for re-evaluation as scheduled. Home therapy would possibly include activity restrictions to include no strenuous exercise, treatment regimen with NSAIDs and colchicine for one to two weeks. Jackie Johnson Acute Pericarditis discussion Follow-up with the patient via a phone conference in one week, and then a follow-up office visit in two weeks would be a good way to monitor if she is responding to the therapy (Imazio, 2020).

References:

Gupta, J. (2019, June). 
Cardiac Auscultation
. Retrieved from https://www.merckmanuals.com/professional/cardiovascular-disorders/approach-to-the-cardiac-patient/cardiac-auscultation

Hammer, G. D., & McPhee, S. (2019). 
Pathophysiology of Disease: An Introduction to Clinical Medicine
(8 ed.). New Youk: McGraw-Hill Education Medical. Jackie Johnson Acute Pericarditis discussion

Imazio, M. (2020, February 21). 
Acute pericarditis: Treatment and prognosis
. Retrieved https://www.uptodate.com/contents/acute-pericarditis-treatment-and-prognosis

Reamy, B. V., Williams, P. M., & Odom, M. R. (2017, September 1). Pleuritic chest pain: Sorting through the differential diagnosis. 
American Family Physician
, 306-312. Retrieved from https://www.aafp.org/afp/2017/0901/p306.html Jackie Johnson Acute Pericarditis discussion

Type 1 Diabetes Chelsea Warren Shadow health Transcript

Transcript

Started:
 Jan 27, 2021 | 
Total Time:
 118 min

All Lines (121)
Interview Questions (71)
Statements (27)
Exam Actions (23)

 Checked ID band

Exam Action

01/27/21 5:21 PM PST

 Assessed vitals

Exam Action

01/27/21 5:21 PM PST

 Checked ID band

Exam Action

01/27/21 5:21 PM PST

Hello, I am nurse xxx. What is your name? Type 1 Diabetes Chelsea Warren Shadow health Transcript

Question

01/27/21 5:32 PM PST

Hiiiii.

What is your name?

Question

01/27/21 5:32 PM PST

Chelsea Warren.

Nice. Welcome to the clinic Chelsea

Empathize

01/27/21 5:32 PM PST

Thank you.

What brought you to the clinic today?

Question

01/27/21 5:33 PM PST

Duh. Diabetes.

Sorry about that

Empathize

01/27/21 5:33 PM PST

Thanks, I appreciate it.

How do you feel?

Question

01/27/21 5:34 PM PST

I feel way better now. I am super ready to go home.

Good to hear

ORDER A PLAGIARISM-FREE PAPER OR SHADOW HEALTH HELP HERE

Empathize

01/27/21 5:34 PM PST

Ummmm thanks.

Are you having pain right now?

Question

01/27/21 5:35 PM PST

No. No pain.

That is great Chelsea

Empathize

01/27/21 5:36 PM PST

Thank you.

Do you feel comfortable?

Question

01/27/21 5:38 PM PST

Yeah, I feel comfortable. I just wanna go home. I’m way better now.

Why were you admitted?

Question

01/27/21 5:38 PM PST

Like . . . two days ago I was at a riding lesson and I felt really bad all of a sudden. Me and Ms. Saint George thought I got too hot, but then I puked — er, threw up. I don’t remember the rest very well, but my dad brought me here, and then the doctors said I had DKA or whatever.

Sorry about that incident

Empathize

01/27/21 5:39 PM PST

Ummmm thanks.

What was the duration of the symptoms? (No matching questions found.)

Question

01/27/21 5:40 PM PST

how long did the symptoms last?

Question

01/27/21 5:40 PM PST

I guess I felt bad for like, 10 days before the DKA.

Have you been urinating more often?

Question

01/27/21 5:41 PM PST

I was going a lot before the DKA thing. But it seems back to normal now.

Were you almost more thirsty?

Question

01/27/21 5:42 PM PST

I’m not super thirsty very often, but for like 10 days before the diabetic key-do . . . the DKA thing, before that I was soooo thirsty. I could not drink enough water. I literally could not.

Have you been feeling more thirsty?

Question

01/27/21 5:42 PM PST

Well, before the DKA, I was super duper thirsty for like . . . 10 days. I didn’t know what was wrong, I just started drinking so much water. It felt like my mouth was always dry.

Excessive thirst is a symptom of DKA

Educate

01/27/21 5:43 PM PST

Oh, ok. I think I get it.

Are you fatigued?

Question

01/27/21 5:43 PM PST

I feel way better now, but before the DKA I was really tired. I didn’t wanna do anything. I felt like a slug. That happened for like . . . I dunno. Like 10 days before the DKA. It was super weird.

Are you always feeling fatigued?

Question

01/27/21 5:44 PM PST

I mean I’m not normally tired. I was super tired before the DKA, but I didn’t know that’s what was wrong with me.

Any appetite changes?

Question

01/27/21 5:44 PM PST

My appetite is fine now, but before the diabetic key . . . the DKA thing . . . I didn’t want to eat, like, anything. My mom thought maybe I was getting sick or hitting a growth spurt or something.

Am glad your appetite is back Chelsea.

Empathize

01/27/21 5:45 PM PST

Thanks, I appreciate it.

When did you start feeling sick?

Question

01/27/21 5:45 PM PST

I’ve been feeling pretty bad for a while. Since like ten days ago. I started feeling really bad right before dad took me to the hospital. That was two days ago.

What type of diabetes do you have?

Question

01/27/21 5:46 PM PST

Type 1. The kid kind.

That is correct.

Educate

01/27/21 5:46 PM PST

There’s so much to learn. I feel like my brain is full! But thanks for telling me.

What is your favorite diet? (No matching questions found.)

Question

01/27/21 5:47 PM PST

What is your typical diet?

Question

01/27/21 5:47 PM PST

My mom, Nora, is like, a total health nut. Breakfast is yogurt and fruit, lunch on the weekends is salad and chicken, and then she always does some kind of healthy grilled meat and veggies. Dad . . . well, he’s a little more chill about it. I mean, he’s a lot busier so he can’t cook as much.

Well, it is good to have high intake of fruits and vegetables

Educate

01/27/21 5:48 PM PST

This is a lot to take in, but I think I get it.

What is your usual breakfast?

Question

01/27/21 5:48 PM PST

When I’m staying with my mom, normally we eat yogurt and fruit for breakfast. When I stay with Dad, he likes to make pancakes or waffles sometimes.

What do you usually eat for lunch?

Question

01/27/21 5:49 PM PST

Well, I eat lunch at school. Shadow Academy has pretty good food, actually. When I’m staying with mom, on the weekends she’ll make a big salad with chicken. For lunch with my dad, we usually go out for a sandwich.

It is good to follow the recommended diet for people with diabetes

Educate

01/27/21 5:50 PM PST

Ok. Ok. I got it.

Do you exercise?

Question

01/27/21 5:50 PM PST

Yeah. I ride horses a few times a week, and there’s also gym class at school. Sometimes on the weekends Dad wants me to go running with him, but I hate it.

That is nice. Exercise is very important for your health

Educate

01/27/21 5:50 PM PST

There’s so much to learn. I feel like my brain is full! But thanks for telling me.

Don’t worry about that

Empathize

01/27/21 5:51 PM PST

Thank you.

D o you smoke tobacco?

Question

01/27/21 5:51 PM PST

No way! What would Sparkle think of me?

Yeah, smoking is bad for your health

Educate

01/27/21 5:52 PM PST

Ok. Ok. I got it.

Have you ever vaped or used an ecigarette?

Question

01/27/21 5:52 PM PST

Puff on a USB stick that turns your lungs into popcorn? I’ll pass.

Do you drink alcohol?

Question

01/27/21 5:53 PM PST

OMG I dunno. I’m 11! I’ve never tried it.

Yeah, alcohol is bad for your health

Educate

01/27/21 5:53 PM PST

This is a lot to take in, but I think I get it.

Do you have a headache?

Question

01/27/21 5:54 PM PST

Headaches? I don’t really get those.

Did your nausea improve?

Question

01/27/21 5:54 PM PST

Yup — I don’t feel nauseated anymore.

That is nice.

Empathize

01/27/21 5:56 PM PST

Ummmm thanks.

Are you feeling sick?

Question

01/27/21 5:56 PM PST

I feel way better now. I felt really bad two days ago, but I’m back to normal now.

Are you going to be sick?

Question

01/27/21 5:56 PM PST

I don’t feel like that anymore. I haven’t thrown up in two days.

Are you feeling constipated?

Question

01/27/21 5:57 PM PST

Nope. That’s normal, thanks.

How long have you been urinating more frequently?

Question

01/27/21 5:58 PM PST

I was peeing a lot more like . . . 10 days before I had the diabetic key . . . the DKA thing.

Do you feel dizzy?

Question

01/27/21 5:58 PM PST

Nuh uh.

Do you feel tingling anywhere?

Question

01/27/21 5:58 PM PST

No, nothing like that.

Do you have a wound?

Question

01/27/21 5:58 PM PST

Uh, I don’t think so. I don’t really get hurt that often, though.

What is your relationship to the patient?

Question

01/27/21 5:59 PM PST

Chelsea is my daughter.

What is your daughter’s diagnosis?

Question

01/27/21 6:00 PM PST

She’s been diagnosed with type 1 diabetes.

WHEN WAS YOUR DAUGHTER DIAGNOSED WITH DIABETES?

Question

01/27/21 6:00 PM PST

Well, when I took Chelsea to the emergency room the doctors ran some tests and asked me about her symptoms. She was confused and disoriented. Honestly, I didn’t know what was going on with her until the doctors told us she has type 1 diabetes. Type 1 Diabetes Chelsea Warren Shadow health Transcript

Oooh, sorry about that

Empathize

01/27/21 6:00 PM PST

Uh, thanks.

When was your daughter hospitalized?

Question

01/27/21 6:01 PM PST

We came to the hospital two days ago. She had diabetic ketoacidosis when we came in, but I think she’s feeling a lot better now.

Did your daughter have complications with her diabetes?

Question

01/27/21 6:01 PM PST

We came to the hospital two days ago. She had diabetic ketoacidosis when we came in, but I think she’s feeling a lot better now.

How was your daughter feeling?

Question

01/27/21 6:02 PM PST

Chelsea was feeling pretty bad when we first got here. I thought maybe she had a stomach bug, because she was throwing up. She was also kind of confused — just not herself. She was pretty out of it. Type 1 Diabetes Chelsea Warren Shadow health Transcript

Sorry about that. Its hard seeing your child unwell

Empathize

01/27/21 6:02 PM PST

Thank you.

Has your daughter’s weight changed lately?

Question

01/27/21 6:03 PM PST

Well, her horseback riding lesson two days ago was the first time I’d seen her in two weeks. She was staying with her Mom. When I saw her at her riding lesson, I thought she looked a little thinner than normal.

How much weight has your daughter lost?

Question

01/27/21 6:04 PM PST

I think she lost around five pounds. It happened in the last two weeks, when she was staying with her mom. She’s not normally this thin.

Do you know anything about type 1 diabetes?

Question

01/27/21 6:05 PM PST

Just what I’ve learned here in the hospital. We’ve had a lot of different people come in and talk to us . . . and I’ve been reading a lot of articles on my phone. I’ve been reading about insulin, and uh, carb counting, but I don’t think it’s all sunk in.

It is good to have good knowledge about the disease so that you can manage your daughter’s condition effectively

Educate

01/27/21 6:05 PM PST

I see.

What is your daughter’s typical diet? (Clarified to What is your daughter’s diet like?.)

Question

01/27/21 6:06 PM PST

It’s actually pretty normal, I suppose. Pancakes and fruit for breakfast are my speciality. I’ll either fix a sandwich and chips for lunch or she’ll get lunch at school. Dinner varies between take-out or my world famous chili. (Clarified to what my daughter’s diet is like.) Type 1 Diabetes Chelsea Warren Shadow health Transcript

It is recommended to avoid high intake of carbs and fatty foods. Please follow the appropriate debates diet.

Educate

01/27/21 6:07 PM PST

Okay.

How many carbohydrates does your daughter eat a day?

Question

01/27/21 6:08 PM PST

I . . . I don’t think she eats many carbs. I haven’t counted yet, but we stick to pretty healthy foods. We don’t eat a lot of sugar.

What medications does your daughter take for her diabetes? (No matching questions found.)

Question

01/27/21 6:09 PM PST

What medications does your daughter take? (No matching questions found.)

Question

01/27/21 6:09 PM PST

Any treatment? (No matching questions found.)

Question

01/27/21 6:10 PM PST

Are you married?

Question

01/27/21 6:10 PM PST

Chelsea’s mom, Nora, and I are divorced. We split custody 50/50, so Chelsea stays with me for two weeks at a time, and then stays with her mom for two weeks. We try to set a good example and, you know, do the civil co-parenting thing.

Okay, I know divorce is hard even for the kids. But it is good to see Chelsea has the love of both her parents even after the divorce

Empathize

01/27/21 6:11 PM PST

Mmmhmmm.

How is your daughter’s relationship with her mother? Type 1 Diabetes Chelsea Warren Shadow health Transcript

Question

01/27/21 6:12 PM PST

Chelsea and Nora are really close.

That is great

Empathize

01/27/21 6:13 PM PST

Uh, thanks.

Has your daughter been hospitalized before?

Question

01/27/21 6:13 PM PST

This is Chelsea’s first visit to a hospital. No surgeries . . . I mean, she hasn’t even broken a bone before.

Does any one in your family have diabetes?

Question

01/27/21 6:14 PM PST

Well, Mother has type 2 diabetes. She was diagnosed a little bit after Chelsea was born. Other than that, nothing else.

Do you take medications?

Empathize

01/27/21 6:14 PM PST

Thanks, I appreciate it.

Do you take medications?

Question

01/27/21 6:15 PM PST

Um, I mean, I guess I take insulin every day, if that’s what you mean.

Do you monitor your blood glucose levels? (Clarified to Do you check your blood sugar at home?.)

Question

01/27/21 6:15 PM PST

Other people have been checking it for me. I haven’t done it myself yet. (Clarified to if I check my blood sugar.)

Okay. It is good to closely monitor your glucose levels

Educate

01/27/21 6:16 PM PST

Oh, ok. I think I get it.

thanks for answering the questions Chelsea. Type 1 Diabetes Chelsea Warren Shadow health Transcript

Empathize

01/27/21 6:16 PM PST

Thank you.

Do you have a high heart beat?

Educate

01/27/21 6:17 PM PST

There’s so much to learn. I feel like my brain is full! But thanks for telling me.

Do you have a high heart beat? (Clarified to Does your heart race?.)

Question

01/27/21 6:17 PM PST

Nope, my heart feels fine. (Clarified to if my heart races.)

Do you have fever?

Question

01/27/21 6:17 PM PST

No, I don’t think I have a fever.

I will now perform a physical assessment

Educate

01/27/21 6:18 PM PST

Oh, ok. I think I get it.

 Checked ID band

Exam Action

01/27/21 6:18 PM PST

 Assessed vitals

Exam Action

01/27/21 6:18 PM PST

Do you feel any pain?

Question

01/27/21 6:30 PM PST

No. No pain.

 Assessed growth

Exam Action

01/27/21 6:30 PM PST

 Assessed growth

Exam Action

01/27/21 6:31 PM PST

 Inspected IV site

Exam Action

01/27/21 6:31 PM PST

 Assessed vitals

Exam Action

01/27/21 6:32 PM PST

Do you have any needs right now? (Clarified to Do you need anything?.)

Question

01/27/21 7:01 PM PST

I guess, uh . . . I guess I need to know more about this diabetes stuff. I find it all kinda confusing, but I want to know more. (Clarified to if I need anything.)

Diabetes is a metabolic disease. With the right diet, appropriate exercise and adherence to medication and close monitoring of the blood glucose levels, the condition can be managed very well.

Educate

01/27/21 7:02 PM PST

Ok. Ok. I got it.

 Inspected IV site

Exam Action

01/27/21 7:02 PM PST

 Educate Chelsea in the most therapeutic manner on what supplies she will need to administer insulin.

Exam Action

01/27/21 7:03 PM PST

Chelsea, before you administer insulin, you will need a new, packaged syringe, a vial of insulin, alcohol wipes, and access to a special container for storing your used syringe. Do you have any questions? Type 1 Diabetes Chelsea Warren Shadow health Transcript

Question

01/27/21 7:06 PM PST

Okay, got it.

Actually, what do you mean by a special container?

It is called a sharps container. Before you go home, we will make sure that each of your parents gets one, and that you know where to find one at school.

Question

01/27/21 7:07 PM PST

Okay, thanks.

 Educate in the most therapeutic manner on how to prepare a syringe for injection.

Exam Action

01/27/21 7:07 PM PST

Ned, take the syringe out of its packaging, and pull the cap off of the needle on the syringe. Pull the plunger of the syringe back until it is level with the correct dose. The numbers are printed on the side of the syringe.

Question

01/27/21 7:08 PM PST

Understood. This is how I will prep Chelsea’s syringe when I am going to administer Chelsea’s insulin.

Hey, I thought I was going to be doing that.

 You have not selected the most therapeutic way to deliver this information. The incorrect response you selected has been removed. Try again with the remaining responses.

Exam Action

01/27/21 7:08 PM PST

 Educate in the most therapeutic manner on how to prepare a syringe for injection.

Exam Action

01/27/21 7:08 PM PST

Chelsea, take the syringe out of its packaging, and pull the cap off of the needle on the syringe. Pull the plunger of the syringe back until it is level with the correct dose. The numbers are printed on the side of the syringe.

Question

01/27/21 7:09 PM PST

Take the syringe out of the package, get the cap off the needle, pull the plunger back to my correct dose. Roger, dodger.

 Educate Chelsea on the first steps in filling the syringe with insulin.

Exam Action

01/27/21 7:09 PM PST

Put the bottle of insulin on a flat surface, and hold it steady with one hand. With your other hand, push the needle straight into the insulin bottle and slowly push the plunger down. This will inject the air in the syringe into the bottle. Don’t pull the syringe out yet. Any questions?

Question

01/27/21 7:10 PM PST

No questions. So far, so good.

 Educate Chelsea on completing the process of filling the syringe with insulin.

Exam Action

01/27/21 7:10 PM PST

With the needle still in the insulin vial, turn both upside down, so that the bottom of the vial is pointing at the ceiling. Slowly draw the plunger down so that insulin fills the syringe. Keep the tip of the needle in the insulin, and make sure you don’t bend the needle. Do you have any questions? Type 1 Diabetes Chelsea Warren Shadow health Transcript

Question

01/27/21 7:10 PM PST

I still get it.

 Educate Chelsea on how to evacuate air bubbles from the syringe.

Exam Action

01/27/21 7:10 PM PST

The needle is still in the bottle at this point. Tap the side of the syringe with your finger to make any bubbles rise to the top. Then, you can push the plunger just enough to force the air out through the needle.

Question

01/27/21 7:11 PM PST

Makes sense to me.

Now that I think about it, what’s wrong with air?

Injecting yourself with insulin is safe, but if there are bubbles in the syringe, they will take up space, and you won’t inject enough insulin.

Question

01/27/21 7:11 PM PST

Understood.

 Educate Chelsea on prepping the insulin injection site.

Exam Action

01/27/21 7:11 PM PST

After removing the needle from the vial, use an alcohol pad to clean the injection site. Let the site dry, otherwise it might sting a little. Pinch approximately 1 inch of skin, not too hard. Insert the needle into the pinched skin at the proper angle and slowly push the plunger in until it is empty. Leave the needle in your skin for five seconds. Any questions?

Question

01/27/21 7:12 PM PST

Huh, okay.

 Educate Chelsea on how to complete the injection process.

Exam Action

01/27/21 7:12 PM PST

Once you take the needle out, keep an eye on the area you injected. If you see any bleeding, use a tissue to clean it up. If you see any insulin leak out, check back with your provider to go over the injection process again.

Question

01/27/21 7:12 PM PST

Watch out for leaks, and clean up the blood. I got it.

 Now it’s time for Chelsea to demonstrate what she’s learned.

Exam Action

01/27/21 7:12 PM PST

Ok, Chelsea, do you feel ready to practice injecting insulin? We’re going to use sterile saline to practice, since you don’t need a dose of insulin right now.

Question

01/27/21 7:12 PM PST

Yep! Let’s do this.

Are you sure you’re ready for this, sweetie?

I got it, Dad. Don’t worry.

 Chelsea demonstrates the proper technique for how to prep and fill a syringe. Type 1 Diabetes Chelsea Warren Shadow health Transcript

Exam Action

01/27/21 7:13 PM PST

Next.

Question

01/27/21 7:13 PM PST

 Chelsea demonstrates the proper technique for giving herself an injection.

Exam Action

01/27/21 7:13 PM PST

Next.

Question

01/27/21 7:13 PM PST

 You complete education with Chelsea on how to effectively manage her diabetes, having successfully covered areas such as glucose monitoring using a glucometer, how to manage risk factors such as hypoglycemia and hyperglycemia, how her diet impacts her diabetes, what to do on sick days, and how to create an action plan at her school. Chelsea and Ned both verbalize that they feel ready to manage Chelseas new chronic illness. Ned says he feels confident that he and his ex-wife will be able to manage Chelsea’s diabetes for the next few days, until their appointment with an endocrinologist. Type 1 Diabetes Chelsea Warren Shadow health Transcript

Low-grade Cervical Dysplasia -cellular alteration & prognosis

A common finding with Papanicolaou tests (aka pap smear or pap test) is low-grade cervical dysplasia, most often occurring in the squamocolumnar junction, the area of the cervix where the squamous and columnar cells meet (Lim, Lee, Cho, Hong, Lim, 2016) Low-grade Cervical Dysplasia -cellular alteration & prognosis. Low-grade Cervical Dysplasia -cellular alteration & prognosis Alterations expected at the cellular level would show chaotic, non-uniform growth of cervical cells, as well as loss of organization of grouped cells (Hammer & McPhee, 2019) Low-grade Cervical Dysplasia -cellular alteration & prognosis.

ORDER A PLAGIARISM-FREE PAPER HERE

Low-grade cervical dysplasia, otherwise referred to as low-grade squamous epithelial lesions,  are most often attributed to human papillomavirus (HPV), with more than 90% of cases, regardless of etiology, spontaneously regressing (Tornesello, Buonaguro, Giorgi-Rossi, & Buonaguro, 2013). Specific high-risk serotypes of HPV have a more significant impact on cervical cells, increasing risk for malignancy if left untreated (Hammer & McPhee, 2019). With more than 100 strains, HPV is broken into “low risk” and “high risk” categories Low-grade Cervical Dysplasia -cellular alteration & prognosis. Low-grade Cervical Dysplasia -cellular alteration & prognosis The difference between the two seems to be how the HPV genome encodes oncoproteins, E6 and E7, and the level of expression of each (Hammer & McPhee, 2019). Low-grade Cervical Dysplasia -cellular alteration & prognosis

For the best odds at the most favorable prognosis, options and suggested screenings should be discussed with S.V., with a personalized plan in alignment with her needs and preferences, considering her personal and familial health history Low-grade Cervical Dysplasia -cellular alteration & prognosis. Possible options could include an HPV screen to determine if this is a factor (Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, 2019). If HPV is present and deemed to be “low risk” to cervical health, a 6 month repeat pap smear (Behnamfar, Zafarbakhsh, & Allameh, 2015), an HPV screen, or a combination of both may be scheduled Low-grade Cervical Dysplasia -cellular alteration & prognosis (Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, 2019) Low-grade Cervical Dysplasia -cellular alteration & prognosis. With negative findings at that time, based on S.V.’s age of 35, screening could be resumed at the CDC recommendation of every three years for just a pap smear, or every 5 years for a negative primary HPV or negative co-testing (Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, 2019). Low-grade Cervical Dysplasia -cellular alteration & prognosis

References:

Behnamfar, F., Zafarbakhsh, A., & Allameh, T. (2015). Study of 2 years follow-up of referral patients with abnormal pap smear.
 Journal of Research in Medical Sciences, 20
(12) doi:http://dx.doi.org.americansentinel.idm.oclc.org/10.4103/1735-1995.172981 Low-grade Cervical Dysplasia -cellular alteration & prognosis

Division of Cancer Prevention and Control, Centers for Disease Control and Prevention (2019 August 20). 
Cervical Cancer: What should I know about screening?
 Retrieved from Centers for Disease Control and Prevention: https://www.cdc.gov/cancer/cervical/basic_info/screening.htm

Hammer, G. & McPhee, S. (2019). 
Pathophysiology of disease: An introduction to clinical medicine
 (8th ed.). New York, NY: McGraw-Hill Education /Medical

Lim, S., Lee, M. J., Cho, I., Hong, R., & Lim, S. C. (2016). Efficacy of p16 and ki-67 immunostaining in the detection of squamous intraepithelial lesions in a high-risk HPV group.
 Oncology Letters, 11
(2), 1447. doi:http://dx.doi.org.americansentinel.idm.oclc.org/10.3892/ol.2015.407

Tornesello, M. L., Buonaguro, L., Giorgi-Rossi, P., & Buonaguro, F. M. (2013). Viral and cellular biomarkers in the diagnosis of cervical intraepithelial neoplasia and cancer. 
BioMed research international
, 
2013
, 519619. https://doi.org/10.1155/2013/519619 Low-grade Cervical Dysplasia -cellular alteration & prognosis Low-grade Cervical Dysplasia -cellular alteration & prognosis

 

Low-grade Cervical Dysplasia -cellular alteration & prognosis
Discussion 1

See Van, a 35-year-old married Hmong-American woman recently underwent an annual Papanicolaou test (Pap smear) at her Certified Nurse Midwife’s practice, and the results were abnormal.  Her provider diagnosed her with low-grade cervical dysplasia.  What alterations at the cellular level would you expect to see with this diagnosis? Provide and discuss with your colleagues S. V.’s prognosis. Support your discussion with citations from the textbook, external credible literature and/or reliable electronic sources.

Remember to respond to at least two of your peers. Please refer to the Course Syllabus for Participation Guidelines & Grading Criteria. Low-grade Cervical Dysplasia -cellular alteration & prognosis

The terms cervical dysplasia and cervical intraepithelial neoplasia can be used interchangeably. Malignancies of the epithelial region are termed carcinomas. Dysplasia is a broad term that can refer to the abnormal development of cells. Cervical dysplasia is a pathologic finding associated with a predisposition and can progress further, according to Hammer and McPhee (2019). This disease can be found with a cervical biopsy or examination.

There are some alterations at the cellular level with this disease. It can start with either genomic instability, impaired DNA repair, or lack of cell cycle checkpoint control. It then turns to enhanced proliferation, abnormal cell cycle control, and autonomous growth. This leads to an evasion of the immune system and later, tissue. There is enhanced cell motility and the ability to gain access to blood vessels, which can eventually lead to the ability to recruit vascularization to support the growth of a tumor (Hammer & McPhee, 2019) Low-grade Cervical Dysplasia -cellular alteration & prognosis.

S.V’s prognosis is fairly good. Cervical intraepithelial neoplasia is graded by levels 1, 2 and 3. Level 1 is considered low grade. Because of this, S.V. has the highest rate of spontaneous regression, according to Flagg et al. (2016). Since she caught it early, she should have access to aggressive treatment early on.

There is a 40% incidence rate in women with HPV related cervical dysplasia. Without proper treatment and screening, this can progress to invasive cervical carcinoma, according to Hammer and McPhee (2019). Low-grade Cervical Dysplasia -cellular alteration & prognosis This means that the basement membrane has been broken and can now metastasize to other areas of the body. Usually, epithelial neoplasms spread to regional nodes. Receiving the HPV vaccine is a valuable tool considering the prognosis of this disease, according to Hong et al. (2016). High-grade lesions are less likely to form if the vaccine is given. According to Flagg et al. (2016), declines in cervical dysplasia are most noted in countries with higher insurance coverage, thus leading more people to receive the vaccine. Low-grade Cervical Dysplasia -cellular alteration & prognosis

 

References:

Flagg, E. W., Torrone, E. A., & Weinstock. H. (2016). Ecological association of human papillomavirus vaccination with cervical dysplasia prevalence in the United States. American Journal of Public Health, 106(12). Low-grade Cervical Dysplasia -cellular alteration & prognosis

Hammer, G.D. & McPhee, S.J., (2019). Pathophysiology of disease: An introduction to clinical medicine (8
th
 ed.). New York, NY: McGraw-Hill Education/Medical.

Hong. C., Liu, X., & Xu, L. (2016). Incisal margin condition after LEEP for cervical intraepithelial neoplasia patients and prognosis. Experimental and therapeutic medicine, 12 (1).

ORDER A PLAGIARISM-FREE PAPER HERE

See Van does have a heightened risk for cervical cancer based on her ethnicity. Cervical cancer is among the top 5 cancers affecting Asian-American and Pacific Islander (AAPI) women (Hee Yun et al, 2015). Noting this factor before discussing her results and treatment plan is important because it could impact her decision for future testing. This patients Pap smear showed dysplasia which shows, a reversion to more immature cells without a committed identity (Hammer & McPhee, 2019). There are several ways that this diagnosis can be handled, some of the treatment methods depend on what the patient wants and what options are provided for them to choose from.  In the Hmong-American culture it is important to note that, spiritually-based health beliefs can be a barrier to cancer screening because the individual will try to turn to spiritual remedies instead of seeking preventive Western care, such as a Pap test (Hee Yun et al, 2015) Low-grade Cervical Dysplasia -cellular alteration & prognosis. See Van may already have a predisposition to avoid modern testing and medicine due to her cultural beliefs. Cervical dysplasia, without proper screening for early detection and treatment, can progress to invasive cervical carcinoma (Hammer & McPhee, 2019). Low-grade Cervical Dysplasia -cellular alteration & prognosis This is important to share with the patient as one of the options is to wait and see if new changes occur on the next Pap smear. If a pap test is positive recommendations can include an immediate colposcopy, repeat cytology at 6 and 12 months, or HPV testing with a referral for colposcopy (Rebar et al. 2019). If further testing revealed a need for treatment then there are other options including cryosurgery, laser ablation, and loop electrosurgical excisional procedure for preinvasive lesions. Overall, her prognosis could be very good if she chooses to undergo further testing and treatment, however, if she chooses to wait or not seek treatment then the cervical dysplasia may progress into cervical cancer leading to further complications and poorer prognosis. Low-grade Cervical Dysplasia -cellular alteration & prognosis

References:

Hammer, G., & McPhee, S. (2019). Pathophysiology of disease: An introduction to clinical medicine 8e (8th ed.). Mcgraw-hill Education / Medical.

Hee Yun Lee, Pa Nhia Yang, Do Kyung Lee, & Rahel Ghebre. (2015). Cervical Cancer Screening Behavior among Hmong-American Immigrant Women. American Journal of Health Behavior, 39(3), 301–307. https://doi-org.americansentinel.idm.oclc.org/10.5993/AJHB.39.3.2

Rebar Cherie R., Heimgartner Nicole M., Gersch Carolyn J, (2019). Pathophysiology made incredibly easy! (6th ed.). Wolters Kluwer. Low-grade Cervical Dysplasia -cellular alteration & prognosis

Gabriel Martinez Asthma Exacerbation Shadow health Transcript

Transcript

Started:
 Jan 23, 2021 | 
Total Time:
 185 min

All Lines (135)
Interview Questions (76)
Statements (29)
Exam Actions (30)

Begin by confirming the patient’s name and date of birth. Which of the following is the most appropriate way to do so?

Hello. I’ll be taking care of you tonight. Can you tell me your name and when you were born?

Question

01/23/21 6:33 PM PST

Hey . . . Gabriel . . . I’m 8 . . .”

His name is Gabriel Martinez. Gabriel is 8. Gabriel Martinez Asthma Exacerbation Shadow health Transcript

You should also confirm Ms. Martinez’s relationship with Gabriel. Which of the following questions is the most appropriate way to do so?

Hello. Are you Gabriel’s guardian?

ORDER A PLAGIARISM-FREE PAPER OR SHADOW HEALTH HELP HERE

Question

01/23/21 6:34 PM PST

Yes. I’m his mother.

Which of the following actions should you perform first?

I want to interview the patient and guardian to establish Chief Complaint.

Question

01/23/21 6:37 PM PST

What brings you in today?

Question

01/23/21 6:38 PM PST

It’s really hard to breathe . . . I have asthma . . .

Yes, my son started having difficulty breathing after school today. It’s been about 4 hours or so.

What should you do next?

Now that I have established Gabriel’s chief complaint, I need to take his vitals and conduct a pediatric asthma severity (PAS) score to better understand the severity of the patient’s condition.

Question

01/23/21 6:39 PM PST

Perform all of the following assesments and record the vitals in your EHR. Use the PAS Score tab in the EHR to calculate Gabriel’s total score and choose the appropriate exacerbation severity for Assessed PAS – PreIntervention in the Objective Data tab. Gabriel Martinez Asthma Exacerbation Shadow health Transcript

 Auscultated breath sounds: expiratory and inspiratory wheezing

Exam Action

01/23/21 6:40 PM PST

Select your next course of action.

 Inpected chest: Mild intercostal retractions visible

Exam Action

01/23/21 6:43 PM PST

Select your next course of action.

 You observe so far during the assessment that Gabriel is speaking in partial sentences before having to take a breath.

Exam Action

01/23/21 6:44 PM PST

Select your next course of action.

 Assessed vitals

Exam Action

01/23/21 6:45 PM PST

Select your next course of action.

Now choose the corresponding severity description under Assessed PAS-PreIntervention in the Objective Data tab.

You now know the patient’s chief complaint, and you have collected his vitals and determined a PAS score. What should you do next?

Now that I have determined Gabriel’s chief complaint, vitals, and PAS score, I have enough information to initiate the Asthma Exacerbation Protocol and finally relieve Gabriel’s respiratory distress.

Question

01/23/21 7:14 PM PST

Unfortunately, you have not collected enough information about Gabriel’s condition to initiate a protocol at this time.

You have not selected the most critical and necessary action. The incorrect response you selected has been removed. Try again with the remaining responses.

You now know the patient’s chief complaint, and you have collected his vitals and determined a PAS score. What should you do next?

I want to get a spirometer reading to confirm my findings so far. Gabriel Martinez Asthma Exacerbation Shadow health Transcript

Question

01/23/21 7:14 PM PST

I did one before we came in.

Your second choice is not the most critical and necessary action, either. The incorrect responses you have selected have been removed. Select the correct response, and you will move on to the next question.

You now know the patient’s chief complaint, and you have collected his vitals and determined a PAS score. What should you do next?

I want to ask about allergies to medication.

Question

01/23/21 7:15 PM PST

No, he doesn’t have medicine allergies.

You’ve determined the patient’s chief complaint, collected vitals and a PAS score, and inquired about medicine allergies. What should you do next?

In order to rule out additional respiratory complications, I need to ask a handful of key history of present illness questions.

Question

01/23/21 7:15 PM PST

At this stage you have collected the necessary and critical information to safely initiate the asthma exacerbation protocol. Any other assessments or tests are unnecessary at this time.

You have not selected the most critical and necessary action. The incorrect response you selected has been removed. Try again with the remaining responses.

You’ve determined the patient’s chief complaint, collected vitals and a PAS score, and inquired about medicine allergies. What should you do next?

I want to inform the patient and his guardian that I have determined that Gabriel is experiencing a moderate asthma exacerbation and am ready to begin treatment. I will ask them if they have any questions or anything else they’d like to tell me before I order the initiation of the Shadowville General Hospital Asthma Exacerbation Protocol. Gabriel Martinez Asthma Exacerbation Shadow health Transcript

Question

01/23/21 7:16 PM PST

No. No questions, thank you.

Your assessment of Gabriel has determined he is currently experiencing a moderate asthma exacerbation. Your protocol order is approved and you administer albuterol via nebulizer and prednisone orally.

Hello Gabriel, I am Nurse xxxx and I will be interviewing you and later perform a physical assessment

Greet

01/23/21 7:23 PM PST

Hey.

How are you feeling?

Question

01/23/21 7:24 PM PST

I feel better now . . . I can definitely breathe better, but my chest is kinda sore.

Sorry about your chest being sore

Empathize

01/23/21 7:25 PM PST

Everyone is really nice here. Thank you very very very much!

How does your chest feel?

Question

01/23/21 7:26 PM PST

My chest doesn’t feel as tight now. It’s still a little sore though. Gabriel Martinez Asthma Exacerbation Shadow health Transcript

Do you feel any wheezing?

Question

01/23/21 7:26 PM PST

My breath was squeaky earlier, but I can’t hear it anymore.

Okay, got it

Empathize

01/23/21 7:26 PM PST

Thanks, that makes me feel better.

When did the breathing problem start?

Question

01/23/21 7:27 PM PST

My attack started after kickball . . . and it got worse and worse when we got home.

Sorry about that Gabriel

Empathize

01/23/21 7:27 PM PST

Oh wow, thanks.

What worsens the breathing problem?

Question

01/23/21 7:27 PM PST

Ummmm smokers. Smoke makes my breathing a lot worse.

Sorry about that

Empathize

01/23/21 7:28 PM PST

Ok, thanks.

Are you normally around smoke?

Question

01/23/21 7:28 PM PST

I try to stay away from it. But these new kids were smoking by the kickball field after school today.

It is good to stay away from anyone smoking

Educate

01/23/21 7:29 PM PST

I guess that makes sense.

What triggers your asthma?

Question

01/23/21 7:29 PM PST

Smoke bothers me a lot. I try to stay away from it. But today some kids I’ve never seen before were smoking at my afterschool program.

What action did you take after the asthma attacK

Question

01/23/21 7:30 PM PST

Well I . . . I guess I’m supposed to take my emergency inhaler, but . . . I threw it away. So we don’t have it anymore.

Ooh, you should always ensure you have the inhaler at a safe and accessible place

Educate

01/23/21 7:31 PM PST

Ohhh, yeah. Good . . . to . . . know.

What is the name of the inhaler you were using?

Question

01/23/21 7:31 PM PST

I dunno. I think my mom does.

Why did you throw away the inhaler?

Question

01/23/21 7:32 PM PST

I hate the way that inhaler makes me all . . . shaky. It makes my heart beat too fast. That’s why, when my mom told me to clean out my backpack, I threw it in the trash.

Sometimes I give him an over the counter antihistamine, when his allergies are bad or the pollen count is high.

What are some of your son’s allergies? (No matching questions found.)

Question

01/23/21 8:09 PM PST

alleges? (No matching questions found.) Gabriel Martinez Asthma Exacerbation Shadow health Transcript

Question

01/23/21 8:09 PM PST

Any allergies?

Question

01/23/21 8:09 PM PST

I don’t, no. Just my son does. [AUDIO COMING SOON]

What allergies does your son have?

Question

01/23/21 8:10 PM PST

Pets, dust, pollen. He’s not allergic to any of the other obvious stuff. No food or medicine or latex or anything.

How does your son’s environmental allergies impact his asthma?

Question

01/23/21 8:11 PM PST

Gabriel’s allergies always make his asthma worse. I can and do keep dust and dander out of the house, but pollen is a different story. The last time he had trouble with his asthma like this was during pollen season.

It is always good to keep the allergy triggers away

Educate

01/23/21 8:12 PM PST

Yeah . . . Yeah, I get it. We’ll work on that.

Has your son been hospitalized before?

Question

01/23/21 8:13 PM PST

Yes, he went to the hospital a year ago, because of his asthma.

Sorry about that. Being hospitalized can really take a toll on any parent Gabriel Martinez Asthma Exacerbation Shadow health Transcript

Empathize

01/23/21 8:14 PM PST

Thank you for saying that.

Why was your son last hospitalized?

Question

01/23/21 8:14 PM PST

He was hospitalized last year because of his asthma. The night before, he was around some smoke — cigarette smoke, and maybe smoke from fireworks . . . We tried his rescue inhaler at home, but it wasn’t working, so I brought him to the ER. Kind of similar to this time, actually.

Sorry about that ordeal.

Empathize

01/23/21 8:15 PM PST

Thank you. I’m . . . I’m just doing the best I can.

Please let him always keep away from triggers such as smoke

Educate

01/23/21 8:16 PM PST

Alright, I understand.

How does exercise impact your son’s asthma?

Question

01/23/21 8:16 PM PST

Too much exercise could trigger an asthma attack. He knows the rules. He can walk, but he isn’t supposed to run.

Does anyone in your family use tobacco?

Question

01/23/21 8:17 PM PST

No, none of us do.

That is great. Smoking is really bad for health, especially in people with respiratory problems such as asthma

Educate

01/23/21 8:18 PM PST

That makes a lot of sense, thank you.

What is your childcare situation?

Question

01/23/21 8:18 PM PST

I work 55 hours a week. Gabriel goes to after-school clubs, so I pick him up around 5:30. He’s really close to my parents, so sometimes on the weekends he spends the night with his Lito and Lita. Gabriel Martinez Asthma Exacerbation Shadow health Transcript

Raising a child alone is really challenging. I know you are a great parent. Even Gabriel really appreciates you. But I am aware being a single parent can be difficult. You are really doing a great job by taking care of your son alone

Empathize

01/23/21 8:22 PM PST

Thank you for saying that.

What is your childcare situation?

Question

01/23/21 8:23 PM PST

I work 55 hours a week. Gabriel goes to after-school clubs, so I pick him up around 5:30. He’s really close to my parents, so sometimes on the weekends he spends the night with his Lito and Lita.

What health problems run in your family?

Question

01/23/21 8:23 PM PST

There’s nothing like asthma in the family. But my father has heart disease and my brother has diabetes.

Sorry about your father and brother’s conditions.

Empathize

01/23/21 8:24 PM PST

Thank you. I’m . . . I’m just doing the best I can.

Also sorry about your son’s asthma. He will get better.

Empathize

01/23/21 8:24 PM PST

Thanks, I appreciate that.

 Checked ID band

Exam Action

01/23/21 8:27 PM PST

 Assessed vitals

Exam Action

01/23/21 8:27 PM PST

 Auscultated top right chest breath sounds: normal breathing

Exam Action

01/23/21 11:10 PM PST

 Auscultated top left chest breath sounds: normal breathing

Exam Action

01/23/21 11:10 PM PST

 Auscultated upper right chest breath sounds: normal breathing

Exam Action

01/23/21 11:10 PM PST

 Auscultated upper left chest breath sounds: normal breathing

Exam Action

01/23/21 11:10 PM PST

 Auscultated lower right chest breath sounds: normal breathing

Exam Action

01/23/21 11:10 PM PST

 Auscultated lower left chest breath sounds: normal breathing

Exam Action

01/23/21 11:10 PM PST

 Auscultated top left back breath sounds: normal breathing

Exam Action

01/23/21 11:10 PM PST

 Auscultated top right back breath sounds: normal breathing

Exam Action

01/23/21 11:10 PM PST

 Auscultated upper left back breath sounds: normal breathing

Exam Action

01/23/21 11:11 PM PST

 Auscultated upper right back breath sounds: normal breathing

Exam Action

01/23/21 11:11 PM PST

 Auscultated lower left back breath sounds: normal breathing

Exam Action

01/23/21 11:11 PM PST

 Auscultated lower right back breath sounds: normal breathing

Gabriel Martinez Asthma Exacerbation Shadow health Transcript

Exam Action

01/23/21 11:11 PM PST

 Auscultated lower left chest breath sounds: normal breathing

Exam Action

01/23/21 11:11 PM PST

 Auscultated lower right chest breath sounds: normal breathing

Exam Action

01/23/21 11:11 PM PST

 Auscultated upper right chest breath sounds: normal breathing

Exam Action

01/23/21 11:11 PM PST

 Auscultated upper left chest breath sounds: normal breathing

Exam Action

01/23/21 11:11 PM PST

 Auscultated top left chest breath sounds: normal breathing

Exam Action

01/23/21 11:11 PM PST

 Auscultated top right chest breath sounds: normal breathing

Exam Action

01/23/21 11:11 PM PST

 No abnormal findings

Exam Action

01/23/21 11:11 PM PST

 Assessed dyspnea

Exam Action

01/23/21 11:13 PM PST

 PAS Score: determine the PAS Score using the EHR tab

Exam Action

01/23/21 11:19 PM PST

 Assessed growth

Exam Action

01/23/21 11:21 PM PST

 Assessed vitals Gabriel Martinez Asthma Exacerbation Shadow health Transcript

Exam Action

01/23/21 11:23 PM PST