NURS 550 Mid Term Complete Solutions

NURS 550 Mid Term Complete Solutions Differential Diagnosis ️• In deciding which disease to include in the differential, consider: - What's the most life-threatening disease the patient could have? - Could this be a common disease presenting with unusual features? - What diseases present with misleading symptoms? - What rare diseases could be causing these signs and symptoms? Develop a Complete, Framed Differential Diagnosis (Hypothesis) ️• Not all diagnoses in a given differential are: - equally likely - equally important • You must select: - a leading (working) hypothesis - a must not miss hypothesis - An active alternative hypothesis SOAP stands for: ️• Subjective • Objective • Assessment • Plan Subjective ️The subjective section is what the patient tells you about their current condition and past conditions. Chief Complaint ️• What brought the patient to the office • Example: Sore throat for 2 days History of Present Illness/Injury ️- Onset - When did the symptoms and/or signs begin, what was the mechanism of injury - Chronology - episodic, variable, constant, etc - Quality - sharp, dull, ache, sudden, insidious - Severity - pain rating, 0-10 pain scale, interferes with daily activities - Modifying factors - aggravating and alleviating factors - Additional symptoms - unrelated or significant symptoms - Treatment - medications, herbs, "home remedies", rest, activity, splint, etc - Use "OLDCART" to assist you (Onset, Location, Duration, Character , Aggravating factors, Relieving factors, Treatments" History ️Allergies - list of allergies to food, medication, and products with type of reaction - Medical - past and present medical conditions (i.e. asthma, hypertension, malaria, etc.) - Surgical - past surgeries (i.e. appendectomy, CABG, craniotomy, etc.) - Family - mother, father, siblings, etc. - Social - occupation, alcohol, drug, tobacco use, risky behavior - Immunizations - current and past received with dates - Screenings/Health Promotion - mammography, testicular exams, dental, vision - Review of Systems - systemic symptoms related to the current problem(s) including pertinent positives and negatives Review of Systems ️General - fever (subjective) with chills and sweats, denies fatigue, weakness, weight loss, or malaise - Skin - denies rashes, lesions, discolorations - HEENT - positive for generalized headache, sore throat, pain with swallowing and rhinorrhea. Denies difficulty swallowing saliva, earache, sinus congestion, sinus pain, visual or auditory aura - Neck - denies lump, pain, stiffness, or decreased range of motion - Cardiac - denies chest pain, pressure, tightness, palpitations - Pulmonary - denies cough, wheeze, hemoptysis - GI - denies nausea, vomiting, abdominal pain - GU - denies missed menses, urinary frequency, urgency or hematuria - MS - denies cramping, pain, - Neuro - denies unilateral weakness, numbness, tingling Review of Systems ️• Should elaborate on the chief complaint and HPI • Don't ask questions that the patient may not know Review of Systems Do you have a problem with your prostate? Do have anemia, heart failure, cancer? Do you frequently urinate during the night? Have you noticed a change in the stream of your urine? Do you avoid drinking fluids during work? Do you feel tired often? Are you short of breath? Have you had any weight loss recently? Objective ️In this section you document what you observe during the examination and visit. Physical Examination ️- Vital signs - Physical examination findings - the use of "normal", "within normal limits", "unremarkable" and other phrases are NOT acceptable. - Diagnostic results - Measurements including height, weight, screening tools, etc. - Mental Status -Weight 50 Kg previously documented height 5'3" -Vital signs - BP 118/76, HR 104, RR 16, T 38.2C, pulse Ox 99% RA -Diagnostic results •Rapid strep test positive -Physical examination findings ️• General -Well nourished and hydrated 28 yo female. Awake, alert and orient; appropriately dressed for season. Pleasant and cooperative. *Skin - hot, dry and pink. No rashes or lesions including petechiae noted • HEENT - normocephalic, symmetric face features. No tenderness in scalp, face, ethmoid/maxillary/frontal sinuses. Negative transillumination. External ears without deviations, ear canal clear bilaterally, tympanic membranes pearly grey with cone of light, bony landmarks visualized bilaterally. Nasal mucosa pink and moist turbinates with no edema or erythema. Oral mucosa pink and moist, dentition without obvious caries; no lesions oral cavity. Pharynx with moderate erythema tonsillar pillars ¼ bilaterally. No exudate. Uvula midline gag reflex present. • Neck - supple. Anterior cervical lymphadenopathy with mobile, tender nodes bilaterally all less than 1 cm diameter. No JVD - Cardiac - S1 S2 with no murmurs, gallops, or clicks. PMI 5th ICS mid-clavicular line - Pulmonary - lungs clear to auscultation bilaterally in all fields. Negative tactile fremitus, egophony, bronchophony, and whispered pectoriloquy - GI - no masses or pulsations. Bowel sounds normoactive all 4 quadrants. No organomegaly no bruits. -GU- denies missed menses, urinary frequency, urgency or hematuria - MS - Strength 4/5 bilateral upper and lower extremities. Gait steady - Neuro - awake, alert, and oriented to name, place, date, and surroundings. No nuchal rigidity, Kernigs or Brudzinski signs Assessment ️This section is where the diagnosis and differential diagnosis are listed for the d