NR 601 Study Physical Examination Discussions
NR 601 Study Physical Examination Discussions
Discussion Part One (graded)
C.W. is a tall, thin 78-year-old African American male brought into the office by his son who states that the patient is restless, angry, and has been unable to sleep for the last week. The son indicates that he is very concerned about his father because he lives alone. Also, he is concerned about the “strange” symptoms that his father has presented with recently. NR 601 Study Physical Examination Discussions
C.W. presents as restless, hyperverbal, obnoxious and angry. He expresses himself by periodic yelling. He is unkempt and smells strongly of urine, alcohol and body odor. ………… has an unsteady gait and sways while standing. As you converse with the son, you determine that C.W. was medically separated from military service due to mental health issues after 2 years of active duty that ended in 1947.
He has been married and divorced three times over the years. He typically seeks no acute or preventative medical care. ___ was treated by a psychiatrist previously, but he did not like taking the prescribed medications so he stopped taking them and did not keep any further psychiatric appointments. NR 601 Study Physical Examination Discussions
Patient denies any previous diagnoses. However, when asked why he saw a psychiatrist in the past, he tells you that the psychiatrist diagnosed paranoid schizophrenia, but that he does not have any psychiatric diagnoses or problems. He states: “It was just a way for him to make money off me coming in and seeing him and paying the drug companies for me to take all those meds!” NR 601 Study Physical Examination Discussions
Denies prescription medications, over the counter medication, herbal therapies or vitamins.
Flu vaccine: never given
Pneumovax: never given
Tetanus: never given
Herpes zoster: never given
Last Colonoscopy was 2012-normal
Last dilated retinal and glaucoma exam was 2013
Social history and Risk Factors:
Patient admits to smoking cigarettes and cigars. …… estimates that he smokes about 1 pack of cigarettes daily for the last 40 years, and 2 cigars each week for the last 30 years.
He states that he drinks a 24 ounce bottle of beer 4-6 times a week. … denies drinking wine or hard liquor. …….. does admit to smoking marijuana on occasion but does not use other recreational drugs. NR 601 Study Physical Examination Discussions
Patient denies falling. You notice some scrapes on his forearms, and when asked, he tells you that he fell yesterday: “I got pretty drunk out fishin’ with friends and fell off my bike trying to ride home”. He does not use any assistive devices for ambulation or balance.
Productive cough with white sputum. Denies hemoptysis.
He answers “No” to the PHQ-2 screening questions.
Reports no significant family history
Discussion Part One:
Provide differential diagnoses (DD) with rationale.
Further ROS questions needed to develop DD.
Based on the patient data provided, choose geriatric assessment tools that would be appropriate to use in conducting a thorough geriatric assessment. Provide a rationale on why you are choosing these particular tools. NR 601 Study Physical Examination Discussions
Write a 1200-1500 word APA formatted essay with three sources of support, addressing all of the following topics:
- Compile a list of at least 10 herbal medications you have seen patients taking in your practice. Discuss the rationale for taking each medication, possible benefits and consequences of taking it, and drugs that it may interact with. This question can be completed as a grid or an essay. NR 601 Study Physical Examination Discussions
- Compile a list of at least 10 vitamins and minerals, including the rationale for taking each medication and benefits and consequences of taking it. Also list any potential complications and drug interactions. This question can be completed as a grid or an essay.
- Choose one type of complementary or alternative (CAM) therapy and discuss its benefits in preventing and treating disease. Discuss how the use of this CAM therapy can reduce the need for medications. Research this therapy on ProQuest or another scholarly database. What does the research demonstrate regarding its efficacy?
- Choose one nutritional supplement you see commonly prescribed or recommended by medical professionals in your practice. Discuss the reasons why this supplement is recommended and its method of action. What concerns should you have regarding a patient taking this supplement? Could the patient overdose and if so what are the consequences and treatment? NR 601 Study Physical Examination Discussions
the notes below will be of assistance