Examination - Blog Posts
NR 601 Week 1 Case Study Discussions Physical Examination (Part 2) NEW
Discussion Part Two (graded)
Physical examination
Vital Signs:
Height: 5 feet 7 inches Weight: 170 pounds Waist Circumference – 32 inches BP 130/84 T 98.0 po P 92 regular R 22, non-labored
HEENT: normocephalic, symmetric. Evidence of prior cataract surgery in both eyes. PERRLA, EOMI, cerumen impaction bilateral ears. Several broken teeth, loose partial plate.
NECK: Neck supple; non-palpable lymph nodes; no carotid bruits.
LUNGS: Decreased breath sounds bases bilaterally, clear to auscultation HEART: RRR with regular without S3, S4, murmurs or rubs.
ABDOMEN: Bloated appearance, active bowel sounds, LLQ tenderness and 6 cm x 7 cm mass.
PV: Pulses are 2+ BL in upper and lower extremities; no edema NEUROLOGIC: Negative
GENITOURINARY: no CVA tenderness
MUSCULOSKELETAL: gait fluid and steady. No muscle atrophy or asymmetry. Full ROM all joints. Strength 5/5 and equal bilaterally. Hips: Discomfort on flexion in both hips; extensor and flexor strength symmetrical.
Knees: Left knee discomfort with weight bearing. No redness, warmth or edema. Full ROM in both knees with symmetrical extensor and flexor strength. Crepitus on extension of left knee.
Hands: No redness or swelling. Bilateral joint tenderness of the distal interphalangeal and proximal interphalangeal joints of the 2nd and 3rd digits.
Calf circumference-31 cm; Mid-arm circumference- 22 cm
PSYCH: normal affect
SKIN: Pale. Areas of healing ecchymosis: Left knee- 3 cm x 2 cm x 0 cm. Right knee -2 cm x 2.5 cm x 0 cm.
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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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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NR 601 Week 2 Case Study Discussions Physical Examination (Part-2) NEW
Discussion Part Two (graded)
Physical examination:
Vital Signs
Height: 5 feet 2 inches Weight: 163 pounds BMI: 29.8 BP 110/70 T 98.0 po P 100 R 22, non-labored; Urinalysis: Protein 2+, Glucose: 4+ HEENT: normocephalic, symmetric. Bilateral cataracts; PERRLA, EOMI; Upper and lower dentures in place a fitting well. No tinnitus NECK: Neck supple; non-palpable lymph nodes; no carotid bruits. Thyroid non-palpable
LUNGS: Decreased breath sounds in bases bilaterally with rales, expiratory wheezing with prolonged expiratory phase noted throughout all lung fields. No costovertebral angle tenderness (CVAT) noted. Increase in AP diameter noted.
HEART: Irregularly irregular rhythm; Unable to detect S3 or murmur ABDOMEN: Normal contour; active bowel sounds all four quadrants; no palpable masses.
PV: Pulses are 2+ in upper extremities and 1+ in pedal pulses bilaterally. 2+ pitting edema to her knees noted bilaterally;
NEUROLOGIC: Achilles reflexes are hypoactive bilaterally. Vibratory perception to the 128 Hz tuning fork placed at the MTP of her great toe is absent bilaterally; She is unable to discern monofilament placement in 3 locations on her left foot and 2 places on her right foot.
GENITOURINARY: no CVA tenderness; not examined
MUSCULOSKELETAL: Heberden’s nodes at the DIP joints of all fingers and crepitus of the bilateral knees on flexion and extension with tenderness to palpation medially at both knees. Kyphosis and gait slow, but steady.
PSYCH: normal affect; her Mini-Cog Score is 3. Her PHQ-9 score is 22. SKIN: Sparse hair noted on lower legs and feet bilaterally with dry skin on her ankles and feet.
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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NR 601 Week 3 Case Study Discussions Physical Examination (Part-2) NEW
Discussion Part Two (graded)
Physical examination:
Vital Signs:
Height: 5’0” Weight: 150 pounds BMI: 29.3 BP: 120/64 T: 98.0 oral P: 68 regular R: 16, non-labored
HEENT: Normocephalic, symmetric. Evidence of prior cataract surgery
in both eyes. PERRLA, EOMI, cerumen impaction bilateral ears.
NECK: Neck supple; non-palpable lymph nodes; no carotid bruits.
LUNGS: Clear to auscultation
HEART: RRR with regular without S3, S4, murmurs or rubs.
ABDOMEN: Normal contour; active bowel sounds, LLQ tenderness.
PV: Pulses are 2+ BL in upper and lower extremities; no edema. No
evidence of peripheral neuropathy.
NEUROLOGIC: Negative
GENITOURINARY: No CVA tenderness
MUSCULOSKELETAL: Gait fluid and steady. No muscle atrophy or
asymmetry. Full ROM all joints. Strength 5/5 and equal bilaterally. Joint swelling in fingers both hands.
PSYCH: Flat affect; patient declined to answer PHQ-9 and GDS
SKIN: Grossly intact without rashes or ecchymosis.
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.
for assignment help and quiz,
visit
http://www.dreamassignment.com/
NR 601 Week 4 Case Study Discussions Physical Examination (Part-1) NEW
Discussion Part One (graded)
You are seeing S.F., a 74-year-old. Hispanic male in the office this morning for difficulty breathing.
Background:
S.F. presents with increased dyspnea on exertion that has become progressively worse over the last 3 days. You observe that he is using pursed lip breathing as he explains his chief complaint. He reports that he has been coughing up a moderate amount of thick, green sputum for approximately one week that was accompanied by a fever of 100.6 and chills. He took Ibuprofen 400 mg every 4 hours and increased his fluid intake for the last week. Two days ago he noticed that the sputum is now yellow rather than green and that he has not experienced any more fever. Overall, he feels like he is getting better. However, the dyspnea on exertion developed three days ago without relief despite the use of his Spiriva HandiHaler. He reports that he lost his rescue inhaler and has not had it to use in over 2 months.
PMH:
COPD
Hypertension
Osteoarthritis
Current medications:
Asprin-81 daily
Cyclobenzaprine 10 mg prn
Meloxicam 15 mg daily
Metoprolol 25 mg daily
Spiriva HandiHaler daily as directed
Tramadol 50 mg daily prn
Surgeries:
Appendectomy as a child (date unknown)
2004-Left cataract extraction with intraocular lens placement
2008-Right cataract extraction with intraocular lens placement
Allergies: NKA
Vaccination History:
Influenza vaccine- October 2013
Pneumovax-2010
His last TD-can’t remember
Has not a TDAP/TD in 20 years
Screening History:
Last Colonoscopy was 2012-normal
Last dilated retinal and glaucoma exam was 2013
Social history:
Retired roofer-stopped working in 2004 due to arthritis and pain in his rotator cuff. Is married and lives with spouse. They have 4 grown children who live within a 10 mile radius of them. Currently smokes-is down to ½ pack cigarettes daily. Has smoked for 45 years total. Family history:
Father is deceased and had a history of hypertension and diabetes; Mother is deceased and had a history of CAD/MI; Sister-history of colon cancer.
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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NR 601 Week 6 Case Study Discussions Health Promotion, Health Protection, Disease Prevention, and Treatment Considerations in Long-Term Care (Part-1) NEW
Discussion Part One (graded)
Ms. S. is a 62-year-old black female who has returned to the clinic to discuss her concerns that her lifestyle modifications to lose weight have not worked. At the last visit 3 months ago, she was advised to change her eating habits and increase activity to promote weight loss. She reports walking at least 30 minutes a day but has lost very little weight. ……….. indicates that the walking only made her extremely thirsty and hungry and attributes her increased thirst and hunger to increased exercise and her increased urination due to drinking more water since “it’s been hot lately” and exercise makes me thirsty”…… has returned to the clinic to discuss if there is anything else that can be done to lose weight and to determine why she is so tired, thirsty and hungry all the time. She also thinks she may have an overactive bladder since she has to urinate frequently during the day, which has influenced her not to go on outings with her friends.
Discussion Questions Part One
Conduct a ROS on this patient.
Indicate which symptoms are most concerning to you.
List your differential diagnoses.
What types of screenings would be appropriate to use based on the chief complaint?
What primary diagnosis are you choosing at this point?
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NR 601 Week 6 Case Study Discussions Health Promotion, Health Protection, Disease Prevention, and Treatment Considerations in Long-Term Care (Part-2) NEW
Discussion Part Two (graded)
Physical Exam:
Discussion Part Two (graded)
Vital signs: blood pressure 145/90, heart rate 100, respirations 20 height 5’1”; weight 210 pounds
Labwork:
CBC: normal
UA: 2+ glucose; 1+ protein; negative for ketones
CMP: BUN/Creat. elevated; Glucose is 300 mg/dL
Hemoglobin A1c: 12%
Thyroid panel: normal
LFTs: normal
Cholesterol: total cholesterol (206), LDL elevated; HDL is low EKG: normal
General: obese female in not acute distress HEENT: unremarkable
CV: S1 and S2 RRR without murmurs or rubs
Lungs: Clear to auscultation
Abdomen– soft, round, nontender with positive bowel sounds present; no organomegaly; no abdominal bruits
Discussion Questions Part Two
For the primary diagnosis, what non-pharmacological and pharmacological strategies would be appropriate?
Include the following: lab work and screenings to be completed. Describe patient education strategies.
Describe follow-up and any referrals that may be necessary.
Discussion Part One (graded)
C.G. is a 69-year-old male with a history of right head and neck cancer that you have been following for one year. The carcinoma was initially localized to the head and neck-specifically at the left lingual tonsil region and went on to complete a total of 6 weeks of radiation and chemotherapy. Recently, the last PET scan indicated some metabolic activity in the left lymph node area along with other regions of abnormal metabolic activity in the body-particularly the liver and the lungs indicating metastasis. C.G. indicates that he is tired of the effects of chemotherapy and radiation and does not want to pursue any more treatment for cancer.
Background:
Right head and neck cancer with metastasis to liver and lungs; patient is refusing further treatment.
PMH:
Hypertension
Hyperlipidemia
Stomatitis
Anemia
Neutropenia
Current medications:
Carvedilol 12.5 mg po 1 daily
Furosemide 40 mg po daily
Surgeries:
2012: right radical neck dissection
Allergies:
None
Vaccination History:
Influenza vaccine last received 1 year ago
Received pneumovax at age 65
Received Tdap 5 years ago
Has not had the herpes zoster vaccine
Social history and Risk Factors:
Former smoker-stopped smoking at the time his cancer was diagnosed-2 years ago
Negative for alcohol intake or drug use
Patient does not have an advanced directive or living will. He is refusing further treatment for his cancer and his wife and children are in disagreement with him. The patient wants to know what his options are for the remainder of his life.
Family history:
Negative
Discussion Part One:
Provide differential diagnoses (DD) with rationale.
Further ROS questions needed to develop DD.
Identify the legal/ethical issues involved with the patient and describe your approach to addressing end-of-life care for this patient.
Discussion Part Two (graded)
Physical examination:
Vital Signs: Height: 6’0 Weight: 140 pounds; BMI: 19.0 BP: 156/84 P: 84 regular R: 20
HEENT: normocephalic, symmetric PERRLA, EOMI; poor dentition NECK: left neck supple; non-palpable lymph nodes; no carotid bruits. Limited ROM
LUNGS: rhonchi in anterior chest bilaterally.
HEART: S1 and S2 audible; regular rate and rhythm
ABDOMEN: active bowel sounds all 4 quadrants; Normal contour; RUQ tenderness; liver palpable
NEUROLOGIC: negative
GENITOURINARY: negative
MUSCULOSKELETAL: negative
PSYCH: PHQ-9 is 15
SKIN: oral mucosa irritated-stomatitis
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.
for assignment help and quiz, visit
http://www.dreamassignment.com/
PSY 330 Week 5 DQ 2 Sociobiology
View the interview with E.O. Wilson (http://www.charlierose.com/view/interview/4989), a pioneer in the field of sociobiology. In the video, Dr. Wilson makes some very strong statements regarding the biological nature of human behavior. Many of these statements are in direct opposition to other models and theories that you have been exposed to throughout this course. You will be divided by last names for this discussion. Your initial post should formulate an argument either to support or refute E.O. Wilson’s claims from the interview.
Last names beginning with letters A-M: Provide a reasoned argument that supports the statements that E.O. Wilson makes regarding the biological nature of human behavior in the interview video clip. Your initial post should be a minimum of 250 words and utilize at least one peer-reviewed source that was published within the last five years, cited according to APA guidelines as outlined in the Ashford Writing Center.
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PSY 330 ASH
PSY 330 Week 1 DQ 1 Methods PSY 330 Week 1 DQ 2 Psychoanalytic Theory PSY 330 Week 2 Assignment Nature Versus Nurture PSY 330 Week 2 DQ 1 Neurobiology PSY 330 Week 2 DQ 2 Heritability PSY 330 Week 3 Assignment Final Project Outline PSY 330 Week 3 DQ 1 Behaviorism PSY 330 Week 3 DQ 2 Psychodynamic Theory PSY 330 Week 4 DQ 1 Cognitive Theory PSY 330 Week 4 DQ 2 Interpersonal Style PSY 330 Week 5 Assignment Final Project PSY 330 Week 5 DQ 1 Triadic Theory PSY 330 Week 5 DQ 2 Sociobiology
PSY 330 Week 1 DQ 1 Methods
Which of the methods and statistics presented in Chapter 2 of your course text do you think are the most effective for the study of personality? Why? Identify and discuss at least one experimental method and one statistical approach. Explain their specific uses as outlined in your course text.
PSY 330 Week 1 DQ 2 Psychoanalytic Theory
Select one of the following options for this discussion. Indicate in your post which option you are responding to.
Option A: Psychoanalytic theory presents explanations for abnormal behavior as well as a variety of methods for treatment of that behavior. Select one of the methods or techniques used in psychoanalysis and discuss the strengths and weaknesses of this approach as it applies to the treatment of psychological disorders. Your initial post should be a minimum of 250 words. It must include at least 1 peer-reviewed source that was published within the last five years, cited according to APA guidelines as outlined in the Ashford Writing Center.
Guided Response: Review several of your classmates’ posts. Respond substantively to two of your peers who identified different methods and techniques than what you chose. In your response, compare the strengths and weaknesses of their selection to yours. Do you think one of the selected methods or techniques is superior? Why?
Option B: Select one of the following early theorists that were instrumental in developing the psychoanalytic theoretical approach. Examine and describe the theorist’s contribution(s) to psychoanalytic theory. Your initial post should be a minimum of 250 words. It must include at least 1 peer-reviewed source that was published within the last five years, cited according to APA guidelines as outlined in the Ashford Writing Center. a. Sigmund Freud b. Carl Jung c. Alfred Adler d. Wilhelm Reich e. Karen Horney f. Anna Freud g. Melanie Klein h. Helen Deutsch
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53/100 days of productivity: I don't have a lot of things to post. I revise all days long and that is not really photogenic. But today my mother bring me flower, so I needed to take a picture I will also wear new glasses because my view changed due to working a lot. So take care of your eyes !