NR 601 Case Study Discussions Health Promotion Week 6
NR 601 Week 6 Case Study Discussions Health Promotion Week 6
Discussion Part Two (graded)
Physical Exam:
Discussion Part Two (graded)
Vital signs: blood pressure 145/90, heart rate 100, respirations 20
height 5’1”; weight 210 pounds
Labwork:
CBC: normal
UA: 2+ glucose; 1+ protein; negative for ketones
CMP: BUN/Creat. elevated; Glucose is 300 mg/dL
Hemoglobin A1c: 12%
Thyroid panel: normal
LFTs: normal
Cholesterol: total cholesterol (206), LDL elevated; HDL is low
EKG: normal
General: obese female in not acute distress
HEENT: unremarkable NR 601 Case Study Health Promotion Week 6
CV: S1 and S2 RRR without murmurs or rubs
Lungs: Clear to auscultation
Abdomen– soft, round, nontender with positive bowel sounds present; no organomegaly; no abdominal bruits
Discussion Questions Part Two
For the primary diagnosis, what non-pharmacological and pharmacological strategies would be appropriate?
Include the following: lab work and screenings to be completed. NR 601 Case Study Health Promotion Week 6
Describe patient education strategies.
Describe follow-up and any referrals that may be necessary.
Discussion Part One (graded)
C.G. is a 69-year-old male with a history of right head and neck cancer that you have been following for one year. The carcinoma was initially localized to the head and neck-specifically at the left lingual tonsil region and went on to complete a total of 6 weeks of radiation and chemotherapy. NR 601 Case Study Health Promotion Week 6
Recently, the last PET scan indicated some metabolic activity in the left lymph node area along with other regions of abnormal metabolic activity in the body-particularly the liver and the lungs indicating metastasis. C.G. indicates that he is tired of the effects of chemotherapy and radiation and does not want to pursue any more treatment for cancer. NR 601 Case Study Health Promotion Week 6
Background:
Right head and neck cancer with metastasis to liver and lungs; patient is refusing further treatment.
PMH:
Hypertension
Hyperlipidemia
Stomatitis
Anemia
Neutropenia
Current medications:
Carvedilol 12.5 mg po 1 daily
Furosemide 40 mg po daily
Surgeries:
2012: right radical neck dissection
Allergies:
None
Influenza vaccine last received 1 year ago
Received pneumovax at age 65
Received Tdap 5 years ago
Has not had the herpes zoster vaccine
Social history and Risk Factors:
Former smoker-stopped smoking at the time his cancer was diagnosed-2 years ago
Negative for alcohol intake or drug use
Patient does not have an advanced directive or living will. He is refusing further treatment for his cancer and his wife and children are in disagreement with him. The patient wants to know what his options are for the remainder of his life. NR 601 Case Study Health Promotion Week 6
Family history:
Negative
Discussion Part One:
Provide differential diagnoses (DD) with rationale.
Further ROS questions needed to develop DD.
Identify the legal/ethical issues involved with the patient and describe your approach to addressing end-of-life care for this patient. NR 601 Case Study Health Promotion Week 6
Discussion Part Two (graded)
Physical examination:
Vital Signs: Height: 6’0 Weight: 140 pounds; BMI: 19.0 BP: 156/84 P: 84 regular R: 20 NR 601 Case Study Health Promotion Week 6
HEENT: normocephalic, symmetric PERRLA, EOMI; poor dentition
NECK: left neck supple; non-palpable lymph nodes; no carotid bruits. Limited ROM
LUNGS: rhonchi in anterior chest bilaterally.
HEART: S1 and S2 audible; regular rate and rhythm
ABDOMEN: active bowel sounds all 4 quadrants; Normal contour; RUQ tenderness; liver palpable
NEUROLOGIC: negative
GENITOURINARY: negative
MUSCULOSKELETAL: negative
PSYCH: PHQ-9 is 15
SKIN: oral mucosa irritated-stomatitis
Discussion Part Two:
Summarize the history and results of the physical exam. Discuss the differential diagnosis and rationale for choosing the primary diagnosis. Include one evidence-based journal article that supports your rationale and include a complete treatment plan that includes medications, possible referrals, patient education, ICD 10 Codes, and plan for follow up. NR 601 Case Study Health Promotion Week 6