NR 507 Behavioral Neurologic and Digestive Disorders Essay

Discussion Part Two

Your patient is a 77-year-old woman who has been more socially withdrawn lately and told her daughter she had not been feeling well. Her daughter has noticed a stepwise decline. While shopping for groceries with her daughter she became separated from daughter in the aisles. She became confused and angry when store employees and others tried to assist her. Her current medications are Hydrochlorothiazide, Lisinopril and Atorvastatin.

• What is your differential diagnosis based on the information you now have?

• What other questions would you like to ask her now? (Questions can be asked of patient first, and then of reliable historian separately.) NR 507 Behavioral Neurologic and Digestive Disorders Essay

• How would you treat this patient and discuss why you give each medication or therapy you give.

Discussion Part Two

This week’s graded topics relate to the following Course Outcomes (COs).

1 Analyze pathophysiologic mechanisms associated with selected disease states. (PO 1)

2 Differentiate the epidemiology, etiology, developmental considerations, pathogenesis, and clinical and laboratory manifestations of specific disease processes. (PO 1)

3 Examine the way in which homeostatic, adaptive, and compensatory physiological mechanisms can be supported and/or altered through specific therapeutic interventions. (PO 1, 7)

4 Distinguish risk factors associated with selected disease states. (PO 1)

5 Describe outcomes of disruptive or alterations in specific physiologic processes. (PO 1)

6 Distinguish risk factors associated with selected disease states. (PO 1) NR 507 Behavioral Neurologic and Digestive Disorders Essay

7 Explore age-specific and developmental alterations in physiologic and disease states. (PO 1, 4)

Tammy is a 33-year-old who presents for evaluation of a cough. She reports that about 3 weeks ago she developed a “really bad cold” with rhinorrhea. The cold seemed to go away but then she developed a profound, deep, mucus-producing cough. NR 507 Behavioral Neurologic and Digestive Disorders Essay

Now, there is no rhinorrhea or rhinitis—the primary problem is the cough. She develops these coughing fits that are prolonged, very deep, and productive of a lot of green sputum. She hasn’t had any fever but does have a scratchy throat. Tammy has tried over-the-counter cough medicines but has not had much relief. The cough keeps her awake at night and sometimes gets so bad that she gags and dry heaves.

Write a differential of at least five (5) possible diagnosis’s and explain how each may be a possible answer to the clinical presentation above.

Remember, to list the differential in the order of most likely to less likely. NR 507 Behavioral Neurologic and Digestive Disorders Essay

Based upon what you have at the top of the differential how would you treat this patient?

Suppose now, the patient has a fever of 100.4 and complains of foul smelling mucous and breath. Indeed, she complains of producing cups of mucous some days. She has some trouble breathing on moderate exertion but this is only a minor complaint to her. How does this change your differential and why? NR 507 Behavioral Neurologic and Digestive Disorders Essay

Description

Consider the example of Sue from the case study in Chapter 13 of your textbook:

Sue is a 68-year-old healthy woman with no significant medical history. She is in the office today with complaint of intractable nausea and vomiting for the past 5 weeks with an 11-pound weight loss. On review of systems she also has noted a dull, persistent headache, difficulty with concentration, and some blurred vision. She states these other problems are likely due to this gastrointestinal “bug” that will not go away. She denies similar symptoms in the past.

Her mother died from complications of diabetes at 42 years old. Her father died of a heart attack in is late fifties. One brother died in a car accident late in his teens and the other died of complications of diabetes in his late teens. She is a nurse, married with two adult children who are in good health. She drinks a a beer or glass of wine on most days, sometimes two. She has never used tobacco products of illegal drugs. NR 507 Behavioral Neurologic and Digestive Disorders Essay

Sue also has a notable family history of diabetes and heart attack. How would you, as an advanced practice nurse, assess, diagnose, and treat Sue? What specific considerations related to the older adult population would you need to consider? Keep these thoughts in mind as you examine this week’s case study.

Reference:

Kennedy-Malone, L., Martin-Plank, L., & Duffy, E. G. (2019). Advanced practice nursing in the care of older adults (2nd ed., p. 359). F. A. Davis.

To prepare:

Review the case study provided by your Instructor. NR 507 Behavioral Neurologic and Digestive Disorders Essay

Reflect on the patient’s symptoms and aspects of disorders that may be present.

Consider how you might assess, perform diagnostic tests, and recommend medications to treat patients presenting with the symptoms in the case.

Access the Focused SOAP Note Template in this week’s Resources.

The Assignment:

Complete the Focused SOAP Note Template provided for the patient in the case study. Be sure to address the following:

Subjective: What was the patient’s subjective complaint? What details did the patient provide regarding their history of present illness and personal and medical history? Include a list of prescription and over-the-counter drugs the patient is currently taking. Compare this list to the American Geriatrics Society Beers Criteria®, and consider alternative drugs if appropriate. Provide a review of systems. NR 507 Behavioral Neurologic and Digestive Disorders Essay

Objective: What observations did you note from the physical assessment? What were the lab, imaging, or functional assessments results?

Assessment: Provide a minimum of three differential diagnoses. List them from top priority to least priority. Compare the diagnostic criteria for each, and explain what rules each differential in or out. Explain you critical thinking process that led you to the primary diagnosis you selected. Include pertinent positives and pertinent negatives for the specific patient case. NR 507 Behavioral Neurologic and Digestive Disorders Essay

Plan: Provide a detailed treatment plan for the patient that addresses each diagnosis, as applicable. Include documentation of diagnostic studies that will be obtained, referrals to other health-care providers, therapeutic interventions, education, disposition of the patient, caregiver support, and any planned follow-up visits. NR 507 Behavioral Neurologic and Digestive Disorders Essay

Provide a discussion of health promotion and disease prevention for the patient, taking into consideration patient factors, past medical history (PMH), and other risk factors. Finally, include a reflection statement on the case that describes insights or lessons learned.

Provide at least three evidence-based peer-reviewed journal articles or evidenced-based guidelines, which relate to this case to support your diagnostics and differentials diagnoses. Be sure they are current (no more than 5 years old) and support the treatment plan in following current standards of care. Follow APA 7th edition formatting.

Case Study:

HPI: Mario is a 66-year-old Hispanic male who presents to the emergency room at his local hospital with acute aphasia, right facial droop, and right-sided weakness. The sudden onset of symptoms occurred at the post office where he works part time. One of his co-workers called 911. On the way to the hospital, the advanced squad team evaluated Mario’s neurologic deficits and glucose levels. The squad team then notified the receiving hospital of a possible stroke patient. NR 507 Behavioral Neurologic and Digestive Disorders Essay

Upon Mario’s arrival to the hospital, the ER nurse practitioner proceeds to gather the patient’s medical history from his wife, Lucinda, who accompanied him in the ambulance. She tells the nurse practitioner that Mario has a history of uncontrolled hypertension (and he was often non-compliant with his anti-hypertensive medications). His recent diagnosis of diabetes also was noted, as well as the oral hypoglycemic agents he was taking. NR 507 Behavioral Neurologic and Digestive Disorders Essay

The wife states both of Mario’s parents passed away from myocardial infarctions when they were in their late 60s.

Smoking history: Mario is a smoker, usually smoking about a pack and a half each day.

Exercise history: Mario’s leads a sedentary lifestyle that had contributed to his excess weight.

At 5’5” inches, Mario weighs 255 pounds. BMI of: ____

What other family history, social history, and vital signs will you obtain from the wife and the patient?

What diagnostic tests will you order for Mario to determine what type of stroke he is having? List at least four diagnostic tests you would order and explain the rationale of each test. NR 507 Behavioral Neurologic and Digestive Disorders Essay

The CT scan indicated a diagnosis of stroke. However, the lab tests and CT scan performed on Mario indicated there was no hemorrhage or early signs of ischemia. What education can you provide the family about the results of a CT scan for diagnosis of brain stroke? NR 507 Behavioral Neurologic and Digestive Disorders Essay

You tell Mario’s wife that it is crucial to recognize the signs of an impending stroke. Describe at least four symptoms and signs of stroke you will educate the patient and family to look for.

You also discuss the RISK factors for stroke with Mario’s family. Lucinda realizes that Mario meets the criteria for all of them. List at least four risk factors for having a stroke:

List at least three differential diagnoses for the symptoms listed above:

What referrals will you make for Mario after his stroke? List at least three. NR 507 Behavioral Neurologic and Digestive Disorders Essay