Health History Results | Turned In Advanced Health Assessment - August 2019, N5544

Health History Results | Turned In Advanced Health Assessment - August 2019, N5544 Return to Assignment Your Results Reopen Lab Pass This study source was downloaded by 100 Information Processing : 20 of 40 (50.0%) Each relevant diagnosis is scored on a four-point scale: Priority (1 point): the correct priority of the diagnosis was chosen Evidence (up to 2 points): the strength of the patient cue(s) selected as evidence for the identified diagnosis Required Evidence: selecting at least one cue that directly indicates the presence of a problem or risk is worth 2 points Supporting Evidence: selecting at least one cue that is a contributing factor or cause of a problem or risk, without the presence of Required Evidence, is worth 1 point Planning (1 point): the plan proposed to address the diagnosis includes at least one correct component Relevant Diagnoses T 3. Uncontrolled type 2 diabetes mellitus 4 of 4 points Priority 1 / 1 Student Response: High Correct Priority: High Priority Pro Tip: Tina's uncontrolled diabetes will delay her wound healing and places her at risk for end organ damage. The need to provide better glucose control for Tina makes this a high priority. Evidence 2 / 2 Relevant "Random blood glucose: 238" Required Evidence Irrelevant "Well...I guess I was noticing the other day that the skin around my neck is looking weird. Like the skin is getting darker. And my skin's breaking out, but that's how it is." Evidence Pro Tip: Tina's current blood glucose level supports a diagnosis of uncontrolled type 2 DM. Tina reports symptoms consistent with poor control such as polyuria, polydipsia, and nocturia. Planning 1 / 1 Relevant Intervene - Labs: Order a hemoglobin A1C test to establish baseline. Intervene - Prescribe: Prescribe a first-line drug for blood glucose control, such as metformin. Educate - Medication: Educate the patient on diabetes medication action, dose, and schedule. Educate - Disease Process: Educate the patient on diabetes pathophysiology, risks of morbidity and mortality, importance of self- care. Educate - Disease Process: Educate the patient on the signs and symptoms of hyper- and hypoglycemia. Irrelevant Intervene - Labs: Order a fasting plasma glucose test. Educate - Medication: Educate the patient on medications used for pain relief. Educate - Medication: Educate the patient on non-pharmaceutical methods to reduce pain intensity. Educate - Disease Process: Educate the patient on the role of diabetes mellitus in the healing of wounds. Planning Pro Tip: Assess for impacts of Tina's uncontrolled diabetes including diminished peripheral pulses, peripheral and sensory neuropathy, and retinopathy, and order labs to check for renal function and abnormal lipid levels. Establish a baseline fasting glucose level and educate Tina on the need to monitor her blood glucose and be aware of symptoms of hyperglycemia. Provide better control by prescribing a first-line drug for glucose control. As Tina's diabetes is uncontrolled, educate her on appropriate diet, monitoring, and treatment regimens. Educate - Disease Process: Educate the patient regarding the relationship of diabetes mellitus and peripheral vascular disease. This study source was downloaded by from CourseH on :06:15 GMT -05:00 4. Asthma 4 of 4 points Priority 1 / 1 Student Response: Low Correct Priority: Low Evidence 2 / 2 Relevant "The only thing I've been hospitalized for is asthma attacks." Required Evidence Irrelevant (None provided) Planning 1 / 1 Relevant Intervene - Other: Develop an asthma action plan with the patient. Irrelevant (None provided) Priority Pro Tip: Although Tina requires education to better manage her asthma, she does not report active respiratory complaints, making this a lower priority diagnosis. Evidence Pro Tip: Tina reports a personal history of asthma, including past hospitalizations for asthma attacks, as well as her use of an albuterol inhaler. Her sibling's asthma is of interest, given the strong genetic and environmental factors in the development of asthma. Planning Pro Tip: Because Tina does not report treatment for maintenance of her asthma, instead relying on a rescue inhaler for sporadic attacks, educate her on developing and enacting a proactive plan to manage the disease. Though Tina does not report an active respiratory complaint, it is valuable to assess for abnormal findings that she may not report. 5. Dysmenorrhea 0 of 4 points Priority 0 / 1 Student Response: (No Priority Selected) Correct Priority: Low Evidence 0 / 2 Relevant (None provided) Irrelevant (None provided) Planning 0 / 1 Relevant (None provided) Irrelevant (None provided) Priority Pro Tip: This is a lower priority diagnosis for Tina because she is not currently menstruating; her current pain must be addressed immediately, but it is due to her foot wound. Evidence Pro Tip: Dysmenorrhea is the symptom of excessive pain with menstruation, which Tina directly reports when asked about the characteristics of her periods. Planning Pro Tip: Menstrual pain can be reduced by the use of NSAIDs and/or oral contraceptives, so you should provide these options to Tina and educate her on their pros and cons. Urinalysis and a manual pelvic exam are useful tools to rule out causes other than her metabolic and endocrine issues. 08 from CourseH on :06:15 GMT -05:00 6. Hypertension 0 of 4 points Priority 0 / 1 Student Response: Correct Priority: Low Evidence 0 / 2 Relevant (None provided) Irrelevant (None provided) Planning 0 / 1 Relevant (None provided) Irrelevant (None provided) (No Priority Selected) Priority Pro Tip: Tina's hypertension should be addressed in this visit, as reducing her blood pressure may reduce her risks relating to cardiovascular sequelae. However it is lower priority than her acute complaints as her hypertension will not be significantly improved in a single visit. Evidence Pro Tip: Hypertension is established via measurement of elevated blood pressure (systolic > 140 or diastolic > 90) on two separate occasions. Tina's records reveal an elevated BP at the time of her ER visit, so the elevated BP at today's visit establishes Tina's diagnosis of hypertension. Tina's risk factors include: race, family history of hypertension, diet, and diabetes. Planning Pro Tip: Tina should be educated regarding hypertension (pathophysiology, associated risks relating to morbidity and mortality, and lifestyle interventions). It is important to consider Tina's risk for secondary hypertension. Auscultate for renal artery bruits as they may be present in renal artery stenosis. Other causes of secondary hypertension should also be considered including hyperaldosteronism, pheochromocytoma, etc. 7. Menorrhagia 4 of 4 points Priority 1 / 1 Student Response: Low Priority Pro Tip: Menorrhagia is a secondary issue caused by Tina's endocrine and metabolic disorders Correct Priority: Low and thus is a lower priority diagnosis. Evidence 2 / 2 Relevant "I'd say it's heavy. I use the like, extra Evidence Pro Tip: Tina reports menstruation absorbent tampons, and I still have to lasting longer than 7 days, with heavy bleeding. Tina change it every two or three hours." reports no recent sexual activity or potential for Required Evidence pregnancy, ruling out a common cause of irregular bleeding. Other potential causes ruled out by Tina's Irrelevant history are hormone use, oral contraceptives, and intrauterine devices. (None provided) Planning 1 / 1 Relevant Planning Pro Tip: Endocrine disorders are the cause of Tina's heavy and irregular menstruation, so Intervene - Labs: Order a pap smear. order labs to evaluate for poly-cystic ovarian syndrome and thyroid disease. Inspect for both hair Intervene - Labs: Order a pelvic ultrasound. growth indicative of excessive androgen production and that indicative of deficient production, and 08 from CourseH on :06:15 iGnMspTec-0t 5fo:0r0acanthosis nigricans. Educate your Educate - Medication: Educate the patient on the use of NSAIDs to reduce menstrual blood flow. Educate - Medication: Educate the patient on the use of oral contraceptives to reduce menstrual flow and regulate the menstrual cycle. Irrelevant Assess - Genitourinary: Perform pelvic exam. Intervene - Other: Refer to ob/gyn for further evaluation and management. Educate - Disease Process: Educate the patient on the pathophysiology of polycystic ovarian syndrome. patient on keeping a menstrual calendar to more precisely identify irregularities in her cycle, and using oral medications to reduce symptoms. 8. Obesity 0 of 4 points Priority 0 / 1 Student Response: (No Priority Selected) Correct Priority: Low Evidence 0 / 2 Relevant (None provided) Irrelevant (None provided) Planning 0 / 1 Relevant (None provided) Irrelevant (None provided) Priority Pro Tip: Although Tina's obesity should be addressed in this office visit, addressing it cannot appreciably alter the patient's health in a single visit. Evidence Pro Tip: Based on the WHO's BMI based classification, Tina's BMI of 31 identifies her as obese. Planning Pro Tip: Tina should be advised during this visit regarding diet and exercise interventions to reduce her body weight. Educate her on the risks of obesity and comorbidities. Assess Tina for the presence of comorbidities, such as hirsutism, acanthosis nigricans, sleep apnea, dyslipidemia, and non-alcoholic fatty liver disease. Test the patient's thyroid function to rule out hypothyroidism as a contributing factor. 9. Oligomenorrhea 4 of 4 points Priority 1 / 1 Student Response: Low Priority Pro Tip: Oligomenorrhea is a secondary issue caused by Tina's endocrine and metabolic Correct Priority: Low disorders and thus is a lower priority diagnosis. Evidence 2 / 2 08 from CourseH on :06:15 GMT -05:00 Relevant "It's not regular. Sometimes it's every month, but sometimes it's more like every two months. I don't write it down or anything. I probably get...six periods a year." Required Evidence Irrelevant (None provided) Planning 1 / 1 Relevant Assess - Genitourinary: Perform pelvic exam. Irrelevant Intervene - Labs: Order a pap smear. Intervene - Labs: Order a pelvic ultrasound. Intervene - Other: Refer to ob/gyn for further evaluation and management. Educate - Disease Process: Educate the patient on the pathophysiology of polycystic ovarian syndrome. Evidence Pro Tip: Tina reports having about 6 periods per year, meeting the criteria for oligomenorrhea, which are periods more than 35 days apart or 9 per year. Her periods occur fewer than 90 days apart, making oligomenorrhea the correct diagnosis rather than amenorrhea. Planning Pro Tip: Endocrine disorders are the cause of Tina's irregular menstruation, so order labs to evaluate for poly-cystic ovarian syndrome and thyroid disease. Inspect for both hair growth indicative of excessive androgen production and that indicative of deficient production, and inspect for acanthosis nigricans. Educate your patient on keeping a menstrual calendar to more precisely identify irregularities in her cycle. 10. Polycystic ovarian syndrome 0 of 4 points Priority 0 / 1 Student Response: (No Priority Selected) Correct Priority: Low Evidence 0 / 2 Relevant (None provided) Irrelevant (None provided) Planning 0 / 1 Relevant (None provided) Irrelevant (None provided) Priority Pro Tip: PCOS is the root cause of several of Tina's symptoms and should be addressed. However it is lower priority than Tina's acute problems; addressing her pain and hyperglycemia are more immediate needs to improve her status. Evidence Pro Tip: The Rotterdam criteria should be used to establish a diagnosis of PCOS. At least two of the following must be present: ovulatory dysfunction (Tina reports infrequent menstruation), androgen excess (Tina reports excess hair in a male pattern), or poly-cystic ovaries. Diabetes, obesity, and acanthosis nigricans - all reported by Tina - are common signs and symptoms of PCOS. Planning Pro Tip: A pelvic exam should be performed in order to assess for palpable enlargement of the ovaries. An ultrasound may be needed to evaluate for cysts of the ovaries. Educate Tina regarding PCOS and its relationship to diabetes. Work with Tina to assist her in establishing GYN care. Further assessment and lab work may be performed to evaluate for androgen excess. © Shadow Health®