NR 601 Case Study Physical Examination Task

Discussion Part Two (graded)

Physical examination:

Vital Signs:

Height: 5’8” Weight: 154 pounds BMI: 23.4 BP: 132/76 P: 76
regular R: 16

HEENT: Normocephalic, symmetric. PERRLA, EOMI, no cataracts noted; poor dentition.

NECK: Neck supple; non-palpable lymph nodes; no carotid bruits.
LUNGS: Respirations are unlabored, decreased breath sounds and crackles at the bases bilaterally. Prolonged expiratory phase throughout lung fields, inspiratory wheezes and a productive cough of cloudy white sputum.

HEART: RRR with regular without S3, S4, murmurs or rubs.

ABDOMEN: Round, firm abdomen; active bowel sounds; non-tender. NR 601 Case Study Physical Examination Task
NEUROLOGIC: Unsteady gait, swaying while standing during periods of agitation. Achilles reflexes are present bilaterally. Strength is equal but decreased in the upper and lower extremities bilaterally.

GENITOURINARY: Urinary incontinence with strong odor of urine. NO CVA tenderness.

MUSCULOSKELETAL: Mild kyphosis. Heberden’s nodes at the distal interphalangeal joints (DIP) of all fingers, and marked crepitus of the bilateral knees on flexion and extension. Pedal pulses palpable. No edema noted in lower extremities. NR 601 Case Study Physical Examination Task

PSYCH: Manic, restless, angry and hyperverbal

SKIN: Right forearm with 3 cm x 5 cm x 0 cm dry, scabbed abrasion. Left forearm with 4 cm x 5 cm x 0 cm dry, scabbed abrasion.

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. NR 601 Case Study Physical Examination Task

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? NR 601 Case Study Physical Examination Task

Description

We will be discussing ethical issues in your final assignment. Your paper is NOT in SOAP format. You will be discussing the issue and how you would address the issue as an advance practice nurse. Choose on of the scenarios below and provide detail on what information you would still need to know, and rationale on how you would handle the situation. NR 601 Case Study Physical Examination Task

Scenario #1: The parents of a 5-year-old boy have accompanied their son for his required physical examination before starting kindergarten. His parents are opposed to him receiving any vaccines.

Scenario #2: A 49-year-old woman with advanced stage cancer has been admitted to the emergency room with cardiac arrest. Her husband and one of her children accompanied the ambulance. NR 601 Case Study Physical Examination Task

Based on the scenarios provided:

Select one scenario, and reflect on the material presented throughout this course.
What necessary information would need to be obtained about the patient through health assessments and diagnostic tests?
Consider how you would respond as an advanced practice nurse. Review evidence-based practice guidelines and ethical considerations applicable to the scenarios you selected.