• Ask Questions for your peer regarding their post.
• Insight on a solution to an identified peer challenge.
• Resources that may be helpful related to your peers’ post.

Work 1

Cardiovascular exams can be very involved, as there are many parts to the exam. Being knowledgeable and proficient in assessing the cardiovascular system is imperative to providing quality care for your patient. As a bedside nurse, basic cardiovascular and peripheral vascular assessments have become a routine part of my shift. However, I did not realize how much more in depth these assessments could become. For instance, murmurs can be indicative of many pathologies that can be concerning for your patient. It is important to be able to differentiate between different murmurs, which is not something that I have done in the past. I can indicate if a patient has a murmur but not the type or what specific significance it has. This type of assessment will be challenging to me. Getting a good understanding of the anatomy and physiology of the heart as well as practice will help to assist in being proficient in assessing murmurs (Bickley, 2016).
       There are many age related changes related to the cardiovascular system. Over time, the structure and function of the heart changes. Typical changes in the heart include a loss of muscle cells, decreased the strength of contractions (Hubert, 2016). There is also a decline in the function of the heart valves due to thickening of the valve, which can cause them to be less effective. It is important to understand different age-related changes, as these can impact the function of the heart and the overall health of the patient. With an aging population, it is very important to be able to perform assessments on people across the lifespan, including older adults. Thankfully, there are plenty of resources available, including the Cleveland Clinic (2021) and information provided on how to identify heart murmurs and different treatment options. With more knowledge and practice, I hope to have the ability identify heart murmurs more efficiently. 

Work 2

 This week one of the assessment focus areas is the cardiovascular system. The majority of patients I have encountered had unremarkable history in this area systems, so coming across abnormalities was not common. Because of this I anticipate difficulties in recognizing heart murmurs. In addition to my inexperience, some suspicious sounds come with their barriers to being recognized correctly. Some murmurs may be difficult to identify because their pitch is on the lower end of threshold of human hearing, they can only be heard only in a small area, or they may be obscured extra, irrelevant sounds such as abdominal noise (Silverman, 1990).

In order to help me perform and interpret a correct cardiovascular assessment, I will also need to know what is normal for each age group. For example, S3, or a gallop, can be benign in children and may be found in pregnant women without cause for alarm, but the same is not always true for older adults (Bickley et al., 2017; Strait & Lakatta, 2012). A resource I found to help me with this assessment is a library of heart sounds. The Department of Medicine at the University of Washington has published a site that contains example of heart sounds and murmurs. Users are able to click on the description of the sound and hear a sample of it. This resource can be found here:  

Women’s Health Case Study

General Guidelines for Comprehensive Case Study

You will complete the Aquifer case, Internal Medicine 14: 18-year-old female for pre-college physical, focusing on the “Revisit three months later” for this assignment.

After completing the Aquifer case, you will present the case and supporting evidence in a PowerPoint presentation with the following components:

• Slide 1: Title, Student Name, Course, Date
• Slide 2: Summary or synopsis of Judy Pham’s case
• Slide 3: HPI
• Slide 4: Medical History
• Slide 5: Family History
• Slide 6: Social History
• Slide 7: ROS
• Slide 8: Examination
• Slide 9: Labs (In-house)
• Slide 10: Primary Diagnosis and 3 Differential Diagnoses – ranked in priority

Primary Diagnosis should be supported by data in the patient’s history, exam, and lab results.

• Slide 11: Management Plan: medication (dose, route, frequency), non-medication treatment, tests ordered, education, follow-up/referral.
• Slide 12-16: An evaluation of 5 evidence-based articles applicable to Ms. Pham’s case: evaluate 1 article per slide.

1. Include title, author, and year of article
2. Brief summary/purpose of the study
3. How did the study support Ms. Pham’s case?

Course texts will not count as a scholarly source. If using data from websites you must go back to the literature source for the information; no secondary sources are allowed, e.g. Medscape, UptoDate, etc. 

• Slide 17: Reference List