If our studies depend on plagiarism which in fact is dishonesty or cheating, we will definitely carry it into our profession. As you said, we will be prone to falsifying important patient data that could easily jeopardize patient care. The concept of evidence-based practice will suffer because we will be using ideas that are not ours and surely with no clue on how they should work. It is therefore very important that we show respect for other author’s work by giving them the credit they deserve.

APA format 3 peer review article references Due 10/12/18 at 5pm

 

Patient Information:

Mr. H, Age 58, Male, White

S.

CC:  Chest Pain “Shortness of breath with severe pain on deep inhalation” (according to Dains, Baumann, & Scheibel, (2016) before a complete HPI is taken this patient must be a quickly assessed as this complaint can have rapid, life-threatening consequences).

HPI: Reports a constant chest pain for two days ago, taking a full breath makes it worst (inhalation), pain is sharp and severe with a current PIS of 8. Subject feel like his heart is racing. Nothing makes the chest pain better. The patient also has exhibited signs and symptoms of a cough, “spit up blood,” right leg swollen and red. He recalls being stationary for an eight-hour period while on a plane, in the economy section middle row, recently from vacationing in Europe, without bathroom overall usually has a sedentary lifestyle mostly due to working 9 am -5 pm as a customer service representative at a call center. After work he sits in front of the television and watches various programs for about four hours while eating dinner, drinking a can of beer or two and smoking a cigarette before bed. It started two days ago when the patient was running to clock in at work, to avoid being late.

Location: right chest pain

Onset: 2 days ago

Character: Sharp and constant

Associated signs and symptoms: a cough, elevated heart rate, and most recently expectoration of blood.

Timing: running to avoid being late for work

Exacerbating/ relieving factors: activity makes it worst. Nothing relieves the pain.

Severity: 8/10 pain scale

Current Medications: Hydrochlorothiazide 25 mg daily for six months, and Norvasc 5 mg twice daily from one month ago for hypertension, Lipitor 80 mg daily for high cholesterol; However, has not been compliant. The patient also stated that he was taking thiamin 100 mg, folic acid 250 mcg and vitamin D 5000 daily as supplements. Currently, he only takes ginseng to boost sexual performance.    

Allergies: Patient is allergic to latex and mold both cause SOB chest tightening

PMHx: diagnose with hypertension and high cholesterol 10 years ago, left hip replacement 2 years ago. Immunization is up to date.  

Soc Hx: Patient works at a call center as a customer service representative for the past thirty years. Married has no children.  They live in their two-bedroom mortgage-free house.  He currently smokes and has just reduced to 3 cigarettes per day after over forty years of smoking two packs per day. On the weekends he usually goes to the casino with his two college friends to gamble and have a good time. He has no special diet and will eat “anything from anywhere.” Drinks 2 six packs beer per week, and a bottle of vodka on weekends.

Fam Hx: His father died of lung cancer 15 years ago.  

ROS:

GENERAL:  No weight loss, fever, chills, weakness or fatigue. 

Head: Symmetrical, no swollen lymph nodes, no signs of sinus infection

Eyes:  Does wear glasses due to myopia, no blurred vision, double vision or yellow sclerae.

Ear: No hearing loss.

Nose: Cough present, no congestion, runny nose.

Throat: No sore throat or difficulty swallowing.

SKIN:  No rash or itching. Some redness and swelling to right leg.

CARDIOVASCULAR:  Right side chest pain, chest pressure, and chest discomfort. Racing heart palpitations.

RESPIRATORY:  shortness of breath, chest tightening, increased pain when inhaling, labored breathing.

GASTROINTESTINAL:  No anorexia, nausea, vomiting or diarrhea. No abdominal pain or blood.

GENITOURINARY:  Some frequency in urination, wakes twice at night to urinate.

NEUROLOGICAL: headaches and numbness and tingling of fingers. MUSCULOSKELETAL:  No muscle, back pain, joint pain or stiffness.

HEMATOLOGIC:  No anemia, bleeding or bruising.

LYMPHATICS:  No enlarged nodes. No known history of splenectomy.

PSYCHIATRIC:  Endorse feeling anxious

ENDOCRINOLOGIC:  reports cold sweat

ALLERGIES:  latex and mold

O.

General: steady gait. Flushed face with a facial grimace. Appears anxious

Vital signs:

Temperature: 97.9 oral

Respiratory rate: 32, labored

Heart rate: 112, tachycardic

BP right arm: 148/88

Oxygen saturation: 90% on room air

Weight: 210 lbs., stable

Height: 5’8”

Skin: Cool, diaphoretic

Thorax and lungs: Thorax symmetrical; diminished breath sounds right middle and lower lobes; no rales, rhonchi, or wheezes; breath sounds vesicular with no adventitious sounds to the left lung

Cardiovascular: Heart rate is irregular with good S1, S2; no S3 or S4; no murmur or jugular vein distention.

Abdomen: Protuberant with normoactive bowel sounds auscultated x4 quadrants

Peripheral vascular: Right calf with 2+ edema, erythema; warmth and tenderness

on palpation noted; left lower extremity without edema or erythema; 2+ dorsalis pedis pulses bilaterally

Neurologic: Anxious; awake, alert, and oriented to person, place, and time

Diagnostic results: EKG shows Atrial fibrillation. He is waiting to do an angiography, chest x-ray and a ventilation/perfusion scan (V/Q) to examine blood flow in the lungs. Labs for collection are complete blood count, complete metabolic panel, lipid panel, troponin, creatinine kinase, creatine phosphokinase.  D-dimer test to check for DVT and pulmonary embolism are needed, and a cardiac MRI to fully view the heart. (Dains, et al., loc 3494. 2016)

A.

The provider states that the patient may have a pulmonary embolism. While this may be accurate, it is good to rule out other illnesses before giving a definitive diagnosis without proper analysis as misdiagnosis can cause a delay in treatment leading to great consequences. There are other possible differential diagnoses such as GERD, anxiety, and angina; however, listed below are three sudden, life-threatening differential diagnoses listed below.

Differential Diagnoses:

            Right side Congestive Heart Failure where according to Ball, Dains, Flynn, Solomon, & Stewart, (2015) the heart is unable to properly pump the blood to the body causing backflow to the lung and congestion in the heart. Hussein, A., & Staufenbiel, R. (2014) noted in their study of 59 cows with heart failures, that with right-sided heart failure the blood venous blood returning to heart is disrupted hence patient ends up with edema to the legs, shortness of breath, increased urination, rapid heartbeat which the patient is currently exhibiting and needs to be further investigated so proper treatment can be done.

            Myocardial Infarction occurs due to the heart thickening thus causing decrease blood flow (Ball, et al. p.323. 2016). In Bahall, Seemungal, & Legall, (2018) controlled case study which focused on first time myocardial infarction in the same hospital in Trinidad and their risk factors. The writers look at the risk factors which includes diabetes mellitus, hypertension, hypercholesterolemia, smoking, alcohol consumption, obesity, and sedentary lifestyle, most of which is applicable Mr. H. the writers also reported with myocardial infraction no seen all over the globe therefore region, ethnicity and culture has no bearings on who may fall, victim, especially when they identify with one or more of the listed risk factors.

             Pericarditis is when there is an inflamed pericardium due to infection. (Ball, et al. p.322. 2016). Per Dybowska, Kazanecka, Kuca, Burakowski, Czajka, Grzegorczyk, … Tomkowski, (2015) pericarditis is life-threatening and has a high death rate; urgent care is needed to prevent fatalities. While the patient does not have a fever the presentation of pericarditis symptom of chest pain, shortness of breath and chest pressure which the patient presents with should be completely ruled out as soon as possible.  

References

Bahall, M., Seemungal, T., & Legall, G. (2018). Risk factors for first-time acute myocardial infarction patients in Trinidad. BMC Public Health, 18(1), 161. https://doi-org.ezp.waldenulibrary.org/10.1186/s12889-018-5080-y

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2015). Seidel’s guide to physical examination (8th ed.). St. Louis, MO: Elsevier Mosby.

Dains, J. E., Baumann, L. C., & Scheibel, P. (2016). Advanced health assessment and clinical diagnosis in primary care (5th ed.). St. Louis, MO: Elsevier Mosby.

Dybowska, M., Kazanecka, B., Kuca, P., Burakowski, J., Czajka, C., Grzegorczyk, F., … Tomkowski, W. (2015). Intrapericardial fibrinolysis in purulent pericarditis–case report. International Journal of Emergency Medicine, (1), 1. https://doi-org.ezp.waldenulibrary.org/10.1186/s12245-015-0087-y

Hussein, A., & Staufenbiel, R. (2014). Clinical presentation and ultrasonographic findings in buffaloes with congestive heart failure. Turkish Journal of Veterinary & Animal Sciences, 38(5), 534–545. https://doi-org.ezp.waldenulibrary.org/10.3906/vet-1404-111

 

Assignment 1: “Captain of the Ship” Project – Bipolar Disorders

Bipolar disorders are severe disorders of mood that include both depressive episodes and expansive, grandiose, or manic episodes. During these times, the person may engage in activities with little awareness of the consequences because of accompanying psychosis. A diagnosis of bipolar disorder includes periods of mania or hypomania and periods of depression where the mood is down, hopeless, and suicidal. The neurovegetative symptoms of bipolar depression can be incapacitating. It is also important to differentiate the psychosis of bipolar disorder from schizophrenia.

In this Assignment, you will become the “captain of the ship” as you provide treatment recommendations and identify medical management, community support resources, and follow-up plans for a client with a bipolar disorder.

Students will:

• Recommend psychopharmacologic treatments based on therapeutic end points for clients with bipolar disorders
• Recommend psychotherapy based on therapeutic end points for clients with bipolar disorders
• Identify medical management needs for clients with bipolar disorders
• Identify community support resources for clients with bipolar disorders
• Recommend follow-up plans for clients with bipolar disorders

To prepare for this Assignment:

• Select an adult or older adult client with a bipolar disorder that you have seen in your practicum.

In 3-4 pages, write a treatment plan for your client. In which you do the following:

• Describe the HPI and clinical impression for the client.
• Recommend psychopharmacologic treatments and describe specific and therapeutic end points for your psychopharmacologic agent. (This should relate to HPI and clinical impression.).
• Recommend psychotherapy choices (individual, family, and group) and specific therapeutic endpoints for your choices.
• Identify medical management needs, including primary care needs, specific to this client.
• Identify community support resources (housing, socioeconomic needs, etc.) and community agencies that are available to assist the client.
• Recommend a plan for follow-up intensity and frequency and collaboration with other providers.

Analyze the key benefits and/or consequences of practicing in a multicultural city such as Miami, FL. Select one (1) scholarly practice-based article that addresses application of theTheory of Culture Care Diversity and Universality in advanced nursing clinical practice, and after reading the article, create a diagram to document the ways in which the article identifies all components of the theory and its application to clinical and/or advanced nursing practice. 

Read the article “Sentence Variety,”      https://www.englishclub.com/writing/sentence-variety.htm 

and then write a response that discusses the importance of using sentence variety when writing.As part of your response, address the following:Find and post an example of a simple sentence: Explain why a simple sentence was most effective in this case, or explain why it might need to be changed to a different sentence type.Look at the sentences before and after. Are they both simple sentences as well? If so, does sentence variety need to be addressed here? Why or why not?Find and post an example of a complex sentence in your rough draft: Explain why a complex sentence was most effective in this case, or explain why it might need to be changed to a different sentence type.Look at the sentences before and after. Are they both complex sentences as well? If so, does sentence variety need to be addressed here? Why or why not?Find and post an example of a compound sentence in your rough draft: Explain why a compound sentence was most effective in this case, or explain why it might need to be changed to a different sentence type.Look at the sentences before and after. Are they both compound sentences as well? If so, does sentence variety need to be addressed here? Why or why not?Check all three sentences to see if they are correctly punctuated, and if not, address what changes need to be made and why.