Skip to main content

Amanda Smith (69 year old, black female) is a retired postal worker.

By
minimum of 1 to 1 and 1/2 full content pages, plus title, and reference page APA Style, double spaced, times new romans, font 12, and and 3 references with intext citations. References within 3 years (2016-2018). 

Location: XYZ Family Practice

You are an NP student in this practice. Your next patient is the following:
“I had to come in today because I have been coughing for a long time”
Amanda Smith (69 year old, black female) is a retired postal worker. During the visit, she is coughing continually. She states the cough started 5 days ago intermittently but 2 days ago it became constant. Her chart indicates that she has been a patient of the practice for 5 years, gets care regularly and her HTN has been controlled for 4 years.

Social History
Married – 2 adult children A & W
Non-Smoker now. Smoke 1 pack a day for 15 years. Quit x5 years ago
No alcohol or drug use
Baptist, attends church regularly and is a member of the choir

Family History
Mother – Deceased at age 27 from traumatic accident
Father – Deceased age 78 related to renal failure secondary to diabetes type II
Siblings – one brother age 61 A & W
Medical/Surgical/Health Maintenance Hx
Measles, mumps and chicken pox as a child.
Tetanus/Diptheria/Pertussis – Last dose 2 years ago
Influenza – Last dose 9 months ago
Pneumococcal vaccine at age 65
Zostivax at age 60
Chronic diagnoses – HTN x 5 years
Takes HCTZ 25 mg daily

ROS
General
Usual weight has been maintained
Fever for 5 days up to 101

Skin
Dry skin, uses emollient frequently

HEENT
Wears reading glasses
Dentition fair. Partial upper denture
Neck
No swelling or stiffness

Chest
Substernal pain on cough
Respiratory
Began coughing 4 days ago. Started mild, intermittent and non-productive. Two days ago became constant and productive of frothy sputum. Keeps her awake at night. No relief with OTC cough syrup. She states she is short of breath today.

CV
No CP at rest or when not coughing

PV
Some swelling of feet and ankles at end of day, relieved by elevating feet

GI
Decreased appetite for one week
No change in bowel habits

GU
No frequency, hesitancy, nocturia or change in bladder habits

Genitalia
No changes

MS
Stiffness in hands and legs on awakening. Relieved with activity

Psych
No depression, anxiety, or memory change

Neurologic
No numbness, weakness, headache, change in mentation, or paralysis

Hematologic
No past anemia

Endocrine
No change in weight, thirst, heat/cold intolerance.
Your physical exam reveals:
Temp 101.4, Resp 30 labored, no retractions, BP 135/92, HR 110, Pulse Ox 90 Wt 130 lbs
General appearance – Alert in all spheres, in mild respiratory distress, able to answer questions with short sentences, tripod breathing

HEENT –
Eyes ,ear, nose, head wnl
Mouth -mucosa dry
Pharynx – tonsils present not enlarged, normal pink color
Lymph – no enlargement
Skin – Dry and scaly legs and arms. Tenting of skin noted
Heart- regular rhythm at 110 bpm, no murmurs or extra sounds
Lungs – normal breath sound without crackles, bronchophony or egophony
Abdomen – no mass, tenderness, rigidity
Extremities – Hands – no swelling, Feet/legs - +1 edema feet to ankle level
Pedal pulses – wnl
Differential diagnoses:
  • CAP
  • Acute bronchitis
  • Congestive heart failure
  • Influenza
Plan - transfer to acute care setting for further work-up 

Assignment Details:
The “Elevator Consult” 
In this activity, you will practice giving a synopsis of your patient to your preceptor. In practice, you may often give this type of report if you are sending a patient for a consultation and your phone the specialist to discuss the patient. This report should be concise and clear. The receiver should, within one minute (slightly less for simple cases, slightly more for complex cases) have a picture of the patient in his/her head. You will report on ONLY items pertaining to the acute problem in this case. Do not include extraneous material or material not directly impacting the decision-making regarding this problem. Remember, this is a FOCUSED visit and assessment to evaluate a focused concern. The history and physical exam applies techniques relevant to the specific complaint for the patient at that visit. Your report should be similarly focused, providing only information that relates specifically to the presenting problem. 
Please review the grading rubric under Course Resources in the Grading Rubric section.

Comments

Post a Comment

Popular posts from this blog

Starting with this provided code, add the following functionality

By
1.Starting with this provided code, add the following functionality: Replace hardcoded strings “Zero”, “One”, “Two”, “Three” in the ArrayList based on user typed input (use Scanner or JOptionPane classes). The user will be prompted for the String to be stored in the ArrayList and then hit enter. The user will be able to continue to add items to the ArrayList until they just hit enter without typing anything. Once the user does this (hits enter without typing anything), the program will display all of the elements of the ArrayList, both the index and String values, in a table. It will do this via a single loop making use of an iterator method. 2. Starting with this provided code, add the following functionality: Use a Try/Catch block so that the exception is caught and the program exits a bit more gracefully. Save this file as TryCatch.java. (Be sure to rename the Public Class accordingly.) Starting with the provided code again (without the Try/Catch block), fix the code so that
2 comments
Read more

Josie Eskander

By
  Question 1: Task 1: Report Assume you are Josie Eskander. You are writing in response to techno trading P/L’s advertisement of a new laptop at 20% below normal price. You want information on brand name, availability of service and repairs, delivery times and methods of payment. Write the letter using the seven basic parts of the letter. In the opening paragraph present a clear and courteous request. Secondly write a response from techno trading giving details and proposing the sale. Provide draft of both emails in the space below. Question 2: Task 2: Report In pairs, nominate a good and a bad letter writer. Discuss the key differences. Write a good/bad letter from techno training to Alex Antonov accepting/declining his proposal to invest in the business Question 3: Task 3: Report Write a letter from techno trading p/l to a new client ‘new realities p/l’ urging them to buy techno new virtual reality software. Make a strong argument for the product. Question 4: Task 4: Report Write a l
Post a Comment
Read more

THE AMERICAN REVOLUTION AND THE EARLY REPUBLIC

By
Assignment Overview The American Revolution and Independence As we saw in the Module Overview, there were numerous factors that ultimately led to revolution and independence. In this second Case assignment, you’ll be researching and writing about some of those factors. Case Assignment Write a 3 to 4-page essay identifying at least FOUR factors which led to colonial independence. In your paper, explain which events triggered discord between the colonies and the Mother Country. Be sure to do some research on your own and use other resources to analyze the thought-processes which sparked independent thinking. The best way to approach and organize the paper would be to create a title for each event and then discuss your findings. For example; for the first one you could write, “Event 1, The Seven Years War”. This would be followed by your narrative on how this war led to independence. The rest of the paper would follow this pattern. Assignment Expectations Use concepts from the background
Post a Comment
Read more