NR 603 Week 3 Hematological Conditions In Primary Care

NR 603 Week 3 Cardiovascular and Hematological Conditions in Primary Care

Week 3 Case Study Discussions – Cardiovascular
Part 1, Part 2 & Part 3 (Summary in SOAP Format)

Child with Fever and Respiratory or Skin Issues

Kayla brings Riley, now 17 months, in for complaint of fever and rash. The fever began “a couple of days ago” and is of normal levels in the morning then gets as high as 103 to 104 degrees in the afternoons. Riley has also had clear rhinorrhea and in the last 24 hours he has developed a red, diffuse rash to the torso and abdomen that does not itch and a dry cough in the last day. Mother reports he is drinking, but not as well as usual. He did have a good wet diaper this morning, but is not really eating much and is not playing. NR 603 Week 3 Hematological Conditions In Primary Care

Medications: Mother is giving OTC Robitussin cough and cold at 1 tsp last night and this morning. Liquid Tylenol ½ a tsp last night and this morning.
She is very concerned about the level of the fever and the fact that after 3 days he is not improving.
Discussion Questions Part One

We will begin by focusing on gathering history in an ill child.

What ‘red flags’ did you note in the historical data?
What data is most important to include in this particular case and which historical data that might be gathered on a well-child exam can be left out of this ill visit?
What are your differential diagnoses?
What parts of the physical exam will you focus on today to rule in or out your differentials?
Discussion Part Two (graded)

Physical Examination Riley:
V/S: Height: 81 cm (31.89 in), Weight: 13 kg (28.66 lbs), B/P: 94/60, T: 100.6, HR: 114 BMP/reg., Resp: 28, reg, non-labored, SpO2: 97%
17 months old, Height 51st percentile, Weight 87th percentile (CDC, 2016)
General: somewhat lethargic and cries some throughout exam. SKIN: Diffuse erythemamtous rash in fine popular patches across the torso and very erythematous to the cheeks. HEENT: Head normocephalic atraumiatic. Conjuctiva clear, non-icteric, but mildly injected PERRL. Unable to complete fundoscopic exam. Tympanic membranes intact with scant clear fluid posteriorly bill and mild injection. NR 603 Week 3 Hematological Conditions In Primary Care

EAC unremarkable. Pinna/tragus w/o tenderness. Nares patent, mucosa mildly injected with sl. edema to the inferior and medial turbinates bill, moderate clear rhinorrhea. Pharynx with mild slight erythema, tonsils 2/4 bill. Oral exam unremarkable. Neck supple w/mild anterior cervical lymphadenopathy bill. Thyroid small, firm, equal bill. CARDIOPULMONARY: Heart RRR w/o murmur. Lungs with mild expiratory wheeze in posterior bases. Respirations even and unlabored. Abdomen rounded normative bowel sounds throughout, soft, non-tender, no masses or organomegaly. NR 603 Week 3 Hematological Conditions In Primary Care

Lab: WBC 6.9, Lymph 50%, Neutrophils 40%, Monocytes 6%, Eosinophils 3%

Discussion Questions Part Two

After reviewing the physical exam.
What were your ‘red flags’ on physical exam?

Description

For this Assignment, you will work with a patient with a musculoskeletal condition that you examined during the last three weeks. You will complete your third Episodic/Focused Note Template Form for this course where you will gather patient information, relevant diagnostic and treatment information as well as reflect on health promotion and disease prevention in light of patient factors such as age, ethnic group, previous medical history (PMH), socio-economic, cultural background, etc. In this week’s Learning Resources, please review the Focused Note resources for guidance on writing Focused Notes. NR 603 Week 3 Hematological Conditions In Primary Care

Note: All Focused Notes must be signed, and each page must be initialed by your preceptor. When you submit your Focused Notes, you should include the complete Focused Note as a Word document and pdf/images of each page that is initialed and signed by your preceptor. You must submit your Focused Notes using SAFE ASSIGN.

Note: Electronic signatures are not accepted. If both files are not received by the due date, faculty will deduct points per the Walden Late Policies. NR 603 Week 3 Hematological Conditions In Primary Care

To prepare:

Use the Episodic/Focused Note Template found in the Learning Resources for this week to complete this assignment.
Select a patient that you examined during the last three weeks based on musculoskeletal conditions. With this patient in mind, address the following in a Focused Note: NR 603 Week 3 Hematological Conditions In Primary Care

Assignment:

Subjective: What details did the patient provide regarding her personal and medical history?
Objective: What observations did you make during the physical assessment? NR 603 Week 3 Hematological Conditions In Primary Care
Assessment: What were your differential diagnoses? Provide a minimum of three possible diagnoses. List them from highest priority to lowest priority. What was your primary diagnosis and why?
Plan: What was your plan for diagnostics and primary diagnosis? What was your plan for treatment and management, including alternative therapies? Include pharmacologic and nonpharmacologic treatments, alternative therapies, and follow-up parameters as well as a rationale for this treatment and management plan.
Reflection notes: What would you do differently in a similar patient evaluation? NR 603 Week 3 Hematological Conditions In Primary Care