NSG 6020 Week 3 Questions.

NSG 6020 Week 3 Questions. Complete only the History, Physical Exam, and Assessment sections of the Aquifer virtual case: Family Medicine 28: 58-year-old male with shortness of breath. Discussion Question 1 Based on your performance and the expert feedback in your HISTORY collection, describe two missed questions and your understanding of why they were important to collect for this case history. Use specific references from your text to explain. The first question I would like to address in the initial history would be to ask if he has noticed any swelling in his legs or feet? It is crucial to assess edema with shortness of breath (SOB) to help determine if it may be a cardiac problem such as heart failure. The common symptoms of HF are dyspnea with exertion or rest, orthopnea, and edema. Patients also may complain of nonproductive cough and fatigue. Signs include ankle or pretibial edema, rapid weight gain caused by fluid retention, bibasilar crackles, tachycardia. Another important question will be to ask if he has noticed any change in sputum's color. Chronic cough with blood-tinged or bloody can be related to pulmonary TB and many health problems; it is essential to collect data during the history to narrow down the problem to make sure that you do not miss any critical details (Bickley, 2016). Discussion Question 2 Based on your performance and the expert feedback in your PHYSICAL EXAM collection, describe two errors in your exam performance or documentation. Use specific references from your text to explain the importance of these findings in correct assessment of this client. During the physical exam, one exam that I would like to address is assessing the laryngeal height and inspecting the legs for pretibial edema. The laryngeal height is shorter in This study source was downloaded by from CourseH on :10:27 GMT -06:00 COPD due to two reasons: clavicles and sternum are placed at a higher level due to hyperinflation. Second, the forceful diaphragmatic contraction may pull the trachea abnormally downward. Laryngeal descent is the difference between maximum and minimum laryngeal heights. Maximum laryngeal height is measured at the end of expiration, and minimum laryngeal height is measured at the end of inspiration. It is vital to assess the laryngeal height when assessing a patient with respiratory problems to look for COPD (Sarkar, Bhardwaz, Madabhavi, & Modi, 2019). The edema location is also a good indicator to determine what is going on in the body and where. It is important to assess the extent and magnitude of the edema. Is it confined to the ankles, or does it extend to the leg to include pretibial edema or higher? Grade the edema on a scale of 1+ to 4+, or mild to pitting (Bickley, 2016). Elevated pressure in the capillary bed with transduction of fluid into the interstitial, spaces causes increased lung stiffness which in turn causes increased work of breathing Discussion Question 3 Based on your performance on the PHYSICAL EXAM collection, describe one key finding that you included in your list and describe a specific physical exam that you can perform at the pointof-care to further evaluate the finding. Use specific references from your text. A key finding during the physical exam is to do a PFT to help rule out COPD. Pulmonary function testing (PFT) is the gold standard for diagnosing COPD. In pulmonary function testing, either an FEV1/FVC ratio less than the 5th percentile, or less than 70%, confirms COPD diagnosis (Cheepsattayakorn, 2016). Dyspnea can be very nonspecific, and COPD is ubiquitous, especially in smokers or those that are exposed to irritants and chemicals. It is important to do a PFT to help rule it out. This study source was downloaded by from CourseH on :10:27 GMT -06:00 Discussion Question 4 Based on your performance and the expert feedback in your ASSESSMENT identification of problem categories, choose one missed/incorrect category and use specific references from your text to explain the importance of this category in arriving at correct differential diagnoses for this client. During the assessment, an incorrect category that was selected would be choosing a chest x-ray to rule out COPD. Studies have shown that this is the wrong way to diagnose COPD. Spirometry is the gold standard office-based device for lung function testing. A spirometer is a hand-held device that can easily be used in the clinician's office by a patient with a technician (Scanlon & Waller, 2018). However, current literature does not support using a chest x-ray to rule in or out COPD. Also, the chest X-ray may aid in abnormal findings such as TB or lung mass (Bickley, 2016). Discussion Question 5 Based on your performance and the expert feedback in your ASSESSMENT of differential diagnoses, describe one incorrect/missed differential diagnosis and use specific references from your text to support the inclusion of the diagnosis for this client. Another missed assessment would be to ensure that he is up to date on all his immunizations. With the patient coming in for cough and SOB, you are not thinking of immunizations. It is crucial to make it part of your screening to ensure that the patients are up to date on vaccines. Influenza and pneumococcal vaccines and Tdap are recommended for adults with COPD (Bickley, 2016).