NR 601 Week 1 Case Study Discussions Physical Examination (Part 1) NEW
NR 601 Week 1 Case Study Discussions Physical Examination (Part 1) NEW
Discussion Part One (graded)
You meet your first patient of the morning. A.K. is a 65-year-old Caucasian male who you are seeing for the first time. Both wife and daughter are present.
Background
He reports that he has had an 18-pound unintentional weight loss in the last 2 months “I am just not hungry anymore, and when I do eat, I get full so fast. In fact, it is really hard to eat, and I don’t eat nearly as much as usual, even though I eat 3 times every day”. He also reports feeling more tired than usual. “I am not sleeping very well. My wife wakes me up when I am snoring, or when she thinks I am not breathing. I used to have sleep apnea, but I don’t think I have it anymore. Besides, that mask is so horrible to wear.” He reports day time somnolence. He reports that he is at the clinic today because of his wife and daughter’s concern about his weight loss and loss of appetite.
PMH
Mr. A.K. has a history of hypertension, cataracts, and osteoarthritis. Current medications:
Ibuprofen 600 mg po TID
Lisinopril 20 mg po QD
Hydrochlorothiazide 25 mg PO QD
Simvastatin 20 mg po QD
Vitamin D3 50,000 units po weekly
Omeprazole 40 mg po QD
Sudafed 50 mg po TID prn
Surgeries
April 2010-Right cataract extraction with Intraocular Lens Placement June 2010- Left cataract extraction with Intraocular Lens Placement November 2011-Left total knee arthroplasty
Allergies: No known drug or food allergies. Allergies to latex causing difficulty breathing and to bee stings, causing widespread edema and airway obstruction.
Vaccination History
He receives annual flu shots “most of the time”. His last one was 18 months ago.
Received a Pneumovax “the day I turned 65”.
His last TD was greater than 10 years ago.
Has not had the herpes zoster vaccine.
Social history
He has an 8th grade education and is a retired concrete finisher. He lives with his wife of 45 years and his daughter lives next door. He enjoys working in his back yard garden and recently tripped over the garden hose last week where his neighbor had to come and help him up.
Family history
Both parents are deceased. Father died of a heart attack at the age of 80; mother died of breast cancer at the age of 76. He has one daughter who is 45 years old and has hypertension. Hypertension, coronary artery disease, and cancer runs in the family.
Habits
He drinks one 4 ounce glass of red wine nightly; previous smoker of 30 years; he quit for 10 years, and is now smoking ¼ pack per day for the last 6 months.
Discussion Part One:
Provide the differential diagnoses (DD) with rationale
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NR 601 Week 4 Case Study Discussions Physical Examination (Part-2) NEW
Discussion Part Two (graded)
Physical examination:
Vital Signs:
Height: 5’8” Weight: 188 pounds BMI: 28.58 BP: 130/70 T: 99.0 oral P: 72 regular R: 24, pursed-lip breathing; Pain level-7-right shoulder HEENT: Normocephalic, symmetric. PERRLA, EOMI, cerumen impaction bilateral ears.
NECK: Neck supple; non-palpable lymph nodes; no carotid bruits. LUNGS: Labored respirations; posterior RLL, LLL, RML, LML diminished breath sounds. Rhonchi right and left anterior chest.
HEART: RRR with regular without S3, S4, murmurs or rubs. ABDOMEN: Normal contour; active bowel sounds, LLQ tenderness.
PV: Diminished pedal pulses; hair loss noted over extremities.
NEUROLOGIC: Negative
GENITOURINARY: Urinary dribbling, urgency, gets up 4 times during the night, distended bladder.
MUSCULOSKELETAL: Limited ROM in right shoulder. Crepitus in knees bilaterally.
PSYCH: Negative
SKIN: Negative
Discussion Part Two:
Summarize the history and results of the physical exam. Discuss the differential diagnosis and rationale for choosing the primary diagnosis. Include one evidence-based journal article that supports your rationale and include a complete treatment plan that includes medications, possible referrals, patient education, ICD 10 Codes, and plan for follow up.
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PSY 490 Week 1 Individual The Diverse Nature of Psychology Paper
Write a 700- to 1,050-word paper in which you analyze the diverse nature of psychology as a discipline.
Address the following items as a part of your analysis:
· Evaluate the influence of diversity on psychology’s major concepts.
· Identify two examples of subdisciplines and two examples of subtopics within psychology. Examples of major concepts and their subtopics include the following:
o Motivation: theory of emotion, and approach and avoidance
o Behaviorism: aggression, cheating, and binge drinking
o Cognition: cognitive dissonance and false memories
· How can the subdisciplines and subtopics you identified be applied to other disciplines and venues in contemporary society?
· Relate the subdisciplines and subtopics to your theoretical perspective.
· Include your psychological contribution to society in the areas of work, education
PSY 490 Week 1 Individual The Diverse Nature of Psychology Paper
Write a 700- to 1,050-word paper in which you analyze the diverse nature of psychology as a discipline.
Address the following items as a part of your analysis:
· Evaluate the influence of diversity on psychology’s major concepts.
· Identify two examples of subdisciplines and two examples of subtopics within psychology. Examples of major concepts and their subtopics include the following:
o Motivation: theory of emotion, and approach and avoidance
o Behaviorism: aggression, cheating, and binge drinking
o Cognition: cognitive dissonance and false memories
· How can the subdisciplines and subtopics you identified be applied to other disciplines and venues in contemporary society?
· Relate the subdisciplines and subtopics to your theoretical perspective.
· Include your psychological contribution to society in the areas of work, education, health, and leisure.
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PSY 330 Week 5 DQ 1 Triadic Theory
Select a mental illness that you are interested in learning more about. Provide a brief overview of this mental illness. Discuss how Triadic Theory would likely describe the cause of this illness. What would a therapist, employing this approach in his or her practice, suggest as a possible treatment for this disorder? Do you think that this theory is more appropriate for the diagnosis and treatment of some disorders, more than others?
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NR 601 Week 2 Case Study Discussions Physical Examination (Part-1) NEW
Discussion Part One (graded)
B.J., a 70-year-old Caucasian female has been seen in the clinic several times over the last 3 years. However, she missed her last annual appointment-last appointment was 18 months ago and today you are the nurse practitioner seeing her. She arrived to the clinic alone and states she is “here for my check-up”.
Background:
The patient reports that “my feet just burn and tingle all the time and it is so much worse at night that I can hardly sleep at all”. She also indicates that “I need some new pillows; I use 3 of them now to just get comfortable at night to sleep. Those pillows help me catch my breath so I can sleep better”. She also reports dyspnea just walking to the bathroom, but it only happens when her legs are “swole up” and also states, “the coughing also keeps me up at night”. To be honest, “I’m just tired in general whether my feet are “swole” or not”. She also indicates that she cannot see well, especially at night. She also reported that at her last visit to the clinic, she was told that she had a “heart beat problem” and that she is supposed to be taking aspirin every day. She said she thinks all of her “heart pains” went away after she started taking the aspirin and “putting that pill under the tongue”. One of her concerns she has today is that since her husband died last year, she tells you, “I just don’t like doing things that I liked to do before my husband died. We used to like to do all sorts of stuff, but anymore….I just feel blue all the time”.
PMH:
Chronic back pain
Hypertension
Previous history of MI in 2010
Diabetes?
Hypothyroidism?
Constipation?
Congestive Heart Failure?
Current medications:
Coreg 6.25 mg PO BID
Colace 100 mg PO BID
Glucotrol XL 10 mg PO daily
Lantus insulin 20 units at HS
K-dur 20 mEq PO QD
Furosemide 40 mg PO QD
L-Thyroxine 112 mcg PO QD
Aspirin?
Nitroglycerine?
Surgeries:
2010-Left Anterior Descending (LAD) cardiac stent placement Allergies: Amoxicillin
Vaccination History:
She receives an annual flu shot. Last flu shot was this year Has never had a Pneumovax
Has not had a Td in over 20 years
Has not had the herpes zoster vaccine
Other:
Has not seen a dentist in over 15 years, the time she got her dentures
Last colorectal screening was 11 years ago
Last mammogram was 5 years ago
Has never had a DEXA/Bone Density Test
Last dilated eye exam was 4 years ago
Labs from last year’s visit: Hgb 12.2, Hct 37%, Hgb A1C 8.2%, K+ 4.2, Na+140,Cholesterol 186, Triglycerides 188, HDL 37, LDL 98, TSH 3.7, ALT/AST WNL.
Social history:
She graduated from high school, and thought about college, but got married right away and then had kids a short time later. Her two sons and their wives live with her, take her to church and to the local senior center; they do all the cleaning, run errands, and do grocery shopping. Family history:
Both parents are deceased. Father died of a heart attack; mother died of natural causes. She had one brother who died of a heart attack 20 years ago at the age of 52.
Habits:
Patient is a current tobacco user and has smoked 1 pack of cigarettes daily for the last 50 years and reports having no desire to quit. She uses occasional chew. She drinks one 4 ounce glass of red wine daily.
Discussion Part One:
Provide differential diagnoses (DD) with rationale.
Further ROS questions needed to develop DD.
Based on the patient data provided, choose geriatric assessment tools that would be appropriate to use in conducting a thorough geriatric assessment. Provide a rationale on why you are choosing these particular tools.
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