Posted: January 31st, 2022

NURS6531 Advanced Practice Care of Adults Across the Life SpanWeek 2 Forum Diagnosing Integumentary Disorders

NURS6531 Advanced Practice Care of Adults Across the Life SpanWeek 2 Forum Diagnosing Integumentary Disorders

When getting into examination rooms, superior apply nurses usually instantly start assessing sufferers by searching for exterior abnormalities corresponding to pores and skin irritations or cloudy eyes. By making these easy observations, they’ll decide how you can proceed with their affected person Assessments. Throughout the affected person analysis, superior apply nurses will use preliminary observations to information them in buying the crucial medical historical past, performing further assessments, and ordering the acceptable diagnostics. The knowledge obtained throughout this analysis course of will Help in the improvement of a differential analysis. As soon as a analysis is made, the superior apply nurse can think about potential remedy choices and work with the affected person to develop a plan of care. For this Forum, think about the following three case research of sufferers presenting with integumentary issues.

Case Examine 1

A 46-year-old male presents to the workplace complaining of a pruritic pores and skin rash that has been current for a number of weeks. He initially famous the rash on his ft, but it surely then unfold to between the fingers, his wrist, and waist. He notes that it doesn’t appear to be on his face or trunk. He not too long ago got here house from a visit to Florida the place he had stayed in a number of lodges. He takes occasional ibuprofen for knee ache, however denies taking different medicines or having different well being issues. He has no identified drug allergic reactions. The bodily examination reveals a male with a number of tiny vesicles and scales in between the fingers, on the ft and ankles, round the affected person’s wrist and round the belt line.

Image of a hand that’s lined in a pruritic pores and skin rash between the fingers, which covers the wrist. The rash doesn’t uniformly cowl the hand and is scaly in some areas.

Case Examine 2

Okay.B., a 52 12 months previous Irish American affected person who current immediately complaining of “a mole” on the pores and skin that’s altering colours. He stated he has had this ‘mole’ for nearly two years. Okay.B. is a building employee presently residing in Hawaii. As a teen he labored outdoors and visited the tanning mattress a number of occasions a month. He’s a fearful that this “mole” doesn’t seem like the others on his physique.

In your examination, you notice, the lesion as spherical, darkish coloured in look, and scaly. You additionally notice the mole has an irregular border and about zero.2cm in dimension.

Depicted on the pores and skin are 4 moles. In the middle is a big mole that’s darkish coloured in look, with an uneven coloured tone, seems scaly, and has an irregular border. The opposite three moles depicted seem regular in look.

Case Examine three

J.V. 50 12 months previous affected person with historical past of eczema is right here immediately complaining of lesions on the proper facet of her face and neck. She thinks it’s a flare up of her eczema and is asking for a refill of her ointment, TAC zero.1%.

She complains of some ‘itching’ and a bit of ‘tingling and ache’ to the lesions. She’s a pharmaceutical employee and thinks that the ‘ache’ possibly as a consequence of contaminate publicity. Denies some other associating signs. Under is a photograph of the lesions.

Affected person presents with lesions on the proper facet of her face and neck. The lesions are pink in look and fluctuate in dimension. They seem scaly and don’t uniformly cowl the total area of her face or neck.

To organize:

Assessment Half 5 of the Buttaro et al. textual content and the case research supplied

You’ll both choose or be assigned one of the three case research supplied.

Mirror on the supplied affected person info together with historical past and bodily exams.

Take into consideration a differential analysis. Think about the function the affected person historical past and bodily examination performed in your analysis.

Mirror on potential remedy choices based mostly in your analysis.

Be aware: For this Forum, you might be required to finish your preliminary submit earlier than it is possible for you to to view and reply to your colleagues’ postings. Start by clicking on the “Submit to Forum Question Assignment” hyperlink after which choose “Create Thread” to finish your preliminary submit. Bear in mind, when you click on on Submit, you can not delete or edit your individual posts, and you can not submit anonymously. Please test your submit fastidiously earlier than clicking on Submit!

By Day three

Submit a proof of the main analysis, in addition to three differential diagnoses, for the affected person in the case examine that you just chosen or had been assigned. Describe the function the affected person historical past and bodily examination performed in the analysis. Then, recommend potential remedy choices based mostly in your affected person analysis.

NURS6531 Advanced Practice Care of Adults Across the Life Span Week three Forum

Diagnosing HEENT Disorders

In medical settings, superior apply nurses might provoke a bodily examination of a affected person by analyzing the parts of the HEENT system. Assessing main diagnoses and differential diagnoses as they concern the HEENT system are vital in informing your apply in offering optimum care.

For this Forum, think about the following three case research of sufferers presenting with head, eyes, ears, nostril, and throat issues.

Case Examine 1

An 86-year-old widowed feminine is delivered to the workplace by her daughter-in-law. The affected person complains of fixed tearing and an itchy, burning sensation in each eyes. The affected person states this isn’t a brand new downside, but it surely has worsened in the previous week and is affecting her imaginative and prescient. The affected person complains that her eyes are dry. She thinks the downside should be brought on by one of her medicines. Her affected person medical historical past is constructive for hypertension, atrial fibrillation, and coronary heart failure. She has an allergy to erythromycin that causes rash and elevated liver enzymes. Medicines presently prescribed embrace Furosemide 40 milligrams po twice a day, diltiazem 240 milligrams po every day, lisinopril 20 milligrams po every day, and warfarin three milligrams po every day. The bodily examination reveals a frail older feminine with some facial dryness and slight scaling. Her visible acuity is 20/60 OU, 20/40 OD, 20/60 OS. The eyelids are erythematous and edematous with yellow crusting round the lashes. Sclera are injected, conjunctiva are pale, and pupils are equal and reactive to mild and lodging.

Case Examine 2

A middle-aged male presents to the workplace complaining of a two-day historical past of a left earache. The onset was gradual, however has steadily been rising. It has been continually aching since final night time, and his listening to appears diminished to him. At present he thinks the left facet of his face might even be swollen. He denies higher respiratory an infection, identified fever, or chills. His affected person medical historical past is constructive for Sort 2 diabetes mellitus, hypertension, and hyperlipidemia. The affected person has a identified allergy to Amoxicillin that leads to pruritus. Medicines presently prescribed embrace Metformin 1,000 milligrams po twice a day, lisinopril 20 milligrams po every day, Aspirin 81 milligrams po every day, and simvastatin 40 milligrams po every day. The bodily examination reveals a center aged male at a weight of 160 kilos, top of 5’eight”, temperature of 98.eight levels Fahrenheit, coronary heart charge of 88, respiratory charge of 18, and blood strain of 138/76. Additional examination reveals the following:

Face: Faint asymmetry with left periauricular space barely edematous

Eyes: sclera clear, conj wnl

L ear: + tenderness L pinna, + edema, erythema, exudates left exterior auditory canal, TM not seen

R ear: no tenderness, R exterior auditory canal clear with out edema, erythema, exudates

+ tenderness L preauricular node, in any other case no lymphadenopathy

Cardiac: S1 S2 common. No S3 S4 or murmur.

Lungs: CTA w/o rales, wheezes, or rhonchi.

Case Examine three

A middle-aged feminine presents to the workplace complaining of strep throat. She states she instantly developed a sore throat yesterday afternoon, and it has gotten worse since then. Throughout the night time she felt like she was chilled and feverish. She denies identified current contact with anybody else who had strep throat, however states she has had strep earlier than and it looks like she has strep now. She takes no medicines, however is allergic to penicillin. The bodily examination reveals a slender feminine mendacity on the examination desk. She has a temperature of 101 levels Fahrenheit, coronary heart charge of 112, respiratory charge of 22, and blood strain of 96/64. The pinnacle, eyes, ears, nostril, and throat analysis is constructive for bilateral tonsillar swelling with out exudates. Her neck is supple with bilateral, tender, enlarged anterior cervical nodes.

To organize:

Assessment the case research supplied on this week’s Assets.

You’ll both choose or be assigned one of the three case research supplied.

Mirror on the supplied affected person info together with historical past and bodily exams.

Take into consideration a differential analysis. Think about the function the affected person historical past and bodily examination performed in your analysis.

Mirror on potential remedy choices based mostly in your analysis.

NURS6531 Advanced Practice Care of Adults Across the Life Span Week 5 Forum

Analyzing Chest X-Rays

Chest x-rays are a useful diagnostic software as they can Help determine widespread respiratory issues corresponding to pneumonia, pleural effusion, and tumors, in addition to cardiovascular issues corresponding to an enlarged coronary heart and coronary heart failure. As a complicated apply nurse, it is necessary that you’ll be able to differentiate a traditional x-ray from an irregular x-ray so as to determine these issues. The flexibility to articulate the outcomes of a chest x-ray with the doctor, radiologist, and affected person is an important ability when facilitating care in a medical setting. On this Forum, you apply your interprofessional collaboration abilities as you interpret chest x-rays and change suggestions together with your colleagues.

Think about the three affected person case research and x-rays

Be aware: By Day 1 of this week, your Teacher will assign you to submit on one of these affected person case research and x-rays:

Case Examine 1

35-year-old Asian male presents to your clinic complaining of productive cough for 2 weeks. Said he has had delicate intermittent fever with myalgia, malaise and occasional nausea.

SH: works as a legislation clerk

PE: NP famous low grade fever (99 levels), with very delicate wheezing and scattered rhonchi.

An x-ray movie is offered which reveals a cloudy lung that seems barely distended.

Case Examine 2

It is a 44-year-old Caucasian male being seen at your clinics with complaints of complaints of cough for four days and worsening. Said he has had excessive grade fever. States he feels weak and has been in mattress most of the final two days. Complains of exertional dyspnea, adopted by dyspnea at relaxation, non-productive cough and pleuritic chest ache

MEDS: Zovirax, Diflucan, magic mouth wash, Zofran, mycostatin, filgrastin

PMH: HTN, Hep C, HIV/AIDS, thrush

SH: Previous IV Drug abuse; lives in a gaggle house;

PE: VS: Ht: 5’7, Wt: 150#, BMI 23,

Anorexic male, febrile, tachypneic, tachycardic, with rales and rhonchi. You notice decreased in breath sounds, dullness, and egophony

An x-ray movie is offered which reveals petechial markings on the lungs and that are cloudy in look.

Case Examine three

A 50 12 months previous Caucasian feminine presents to the clinic with complaints of cough for nearly 2 weeks. Optimistic productive inexperienced sputum with related chills, sweating, and fever as much as 101.5. She manages a daycare and states that many of the kids have had higher respiratory signs in the final two weeks. PMH: DM recognized 7 years in the past, managed on medicines.

MEDS: Glyburide 10mg qd

PE: She appears to be like ailing with steady coughing and chills.

BP 100/80, T: 102, HR: 110; O2Sat 97% on RA.

Lungs: +Crackles, elevated fremitus

Labs: CBC 17,000 cells/mm3 , blood sugar is 120

An x-ray movie is offered which reveals cloudiness on the lungs and which additionally reveals some scarring on the lungs.

To organize:

Assessment Half 10 of the Buttaro et al. textual content on this week’s Assets, in addition to the supplied x-rays.

Mirror on what you see in the x-ray assigned to you by the Course Teacher.

Think about whether or not the affected person in your assigned x-ray has an enlarged coronary heart, enlarged blood vessels, fluid in the lungs, and/or pneumonia in the lungs.

NURS6531 Advanced Practice Care of Adults Across the Life Span Week 7 Forum

Urinary Frequency

Urinary frequency is a genitourinary dysfunction that presents issues for adults throughout the lifespan. It may be the outcome of varied systemic issues corresponding to diabetes, urinary tract infections, enlarged prostates, kidney infections, or prostate most cancers. Many of these issues have very severe implications requiring thorough affected person Assessments. When evaluating sufferers, it’s important to fastidiously assess the affected person’s private, medical, and household historical past previous to recommending sure bodily exams and diagnostic testing, as typically the advantages of these exams don’t outweigh the dangers. On this Forum, you look at a case examine of a affected person presenting with urinary frequency. Based mostly on the supplied affected person info, how would you diagnose and deal with the affected person?

Case Examine 1

A 52-year-old African American male presents to an pressing care middle complaining of urinary frequency and nocturia. The signs have been current for a number of months and have elevated in frequency over the previous week. He has been unable to sleep as a result of of the have to urinate at the very least hourly all day and night time. He doesn’t have a main care supplier and has not seen a physician in additional than 10 years. His father died when he was a baby in an car accident, and his mom is 79 years previous and has hypertension. The affected person has no siblings. His social historical past consists of the following: banker by career, divorced father of two grown kids, non-smoker, and infrequently consumes alcohol on weekends solely.

Case Examine 2

It is a 40 12 months previous Hindu married male complaining of sudden excessive grade fever for the final 2 days. He’s complaining of proper flank ache with some burning on urination. PMH: diabetes, HTN. Present meds: metformin 500mg bid, Lisinopril 10mg QD

Case Examine three

A 52 12 months previous lady offered to the clinic for ongoing fatigue and weight reduction throughout the final 6 weeks. She thinks she’s loss at the very least “10 kilos”. For the previous week and a half she’s famous some progressing ‘muscle cramping’ tetany, in addition to ‘tingling’ sensation round her mouth and decrease extremities. She’s additionally famous some intermittent colicky stomach ache. In your examination, you famous a constructive Chvostek’s signal. PMH: 20 12 months historical past of Crohn’s illness. She additionally tells you that she is a working towards vegan.

To organize:

Assessment Half 13 and 17 of the Buttaro et al. textual content on this week’s Assets.

You’ll both choose or be assigned to a affected person case examine for this Forum.

Assessment the affected person case examine and replicate on the info supplied about the affected person.

Take into consideration the private, medical, and household historical past it is advisable receive from the affected person in the case examine. Mirror on what questions you would possibly ask throughout an analysis.

Think about varieties of bodily exams and diagnostics that is likely to be acceptable for analysis of the affected person in the examine.

Mirror on a doable analysis for the affected person.

Assessment the Marroquin article on this week’s Assets. If you happen to suspect prostate most cancers, think about whether or not or not you’d suggest a biopsy.

Take into consideration potential remedy choices for the affected person.

NURS6531 Advanced Practice Care of Adults Across the Life Span Week 9 Forum

Diagnosing Neurological Disorders

As a complicated apply nurse, you’ll possible observe sufferers who expertise neurological issues. Difficult to the analysis of neurological issues is the realization that many manifestations of illness will not be overt bodily.

For this Forum, think about the following three case research of sufferers presenting with neurological issues.

Case Examine 1

80-year-old male Caucasian male delivered to the clinic by his spouse involved about his “reminiscence issues”. Per the spouse, she has seen his reminiscence declining however has by no means interfered together with his every day actions till now. He’s unable to recollect his appointments and closely depends on written notes for reminder. Simply final week, he obtained misplaced driving and was not discovered by his household till eight hours later. He’s unable to make use of his mobile phone or recall his house tackle or cellphone quantity. He has turn out to be a “hermit” per his spouse. He has withdrawn from taking part with church actions and has turn out to be much less attentive.

PMH: HTN, managed

Prostate most cancers 20 years in the past

Dyslipidemia

SH: no alcohol or tobacco use; wants help with medicines

PE: VS secure, bodily examination unremarkable

Case Examine 2

A 30-year-old Asian feminine presents to the clinic with complications. Historical past of complications since her teen years. Complications have turn out to be extra debilitating not too long ago. Describes the ache as sharp, worsens with mild and accompanied by nausea and at occasions vomiting. Charges the ache as 7/10. Usually takes 2 tabs of OTC Motrin with ‘some Help’. “Sleeping it off in a darkened room’ helps alleviate the headache. VS WNL, bodily examination unremarkable.

Case Examine three

A 50-year-old African American male presents with complaints of dizziness left arm weak spot and fatigue. PMH: poorly managed diabetes, hypertension, hyperlipidemia

PE: Upon examination, you famous a really delicate dysarthria, he understands and follows instructions very nicely. Gentle weak spot on the left facet of the face is famous, and left sided homonymous hemianopsia however no ptosis or nystagmus or uvula deviation.

To Put together:

You’ll both choose or be assigned one of the three case research supplied.

Mirror on the supplied affected person info together with historical past and bodily exams.

Take into consideration a differential analysis. Think about the function the affected person historical past and bodily examination performed in your analysis.

Mirror on potential remedy choices based mostly in your analysis.

NURS6531 Advanced Practice Care of Adults Across the Life Span Week 10 Forum

Analyzing Endocrine, Metabolic, and Hematologic Disorders

In the United States, 25.6 million adults age 20 years or older have diabetes (American Diabetes Affiliation, 2011). If not correctly handled and managed, these thousands and thousands of diabetic sufferers are in danger for a number of alterations together with coronary heart illness, stroke, kidney failure, neuropathy, and blindness. Correct remedy and administration is the key for diabetic sufferers, and as the superior apply nurse offering take care of these sufferers, it’s your duty to facilitate this course of. Affected person training is essential, as is working with sufferers to determine a daily sample for every day actions corresponding to consuming and taking medicines. When creating care plans for sufferers, you have to preserve the projected outcomes of remedy in thoughts, in addition to affected person preferences and different elements that may affect adherence to remedy and administration plans. On this Forum, you draw out of your Practicum Expertise and think about elements that affect the training and remedy of sufferers with diabetes.

For this Forum, think about the following three case research of sufferers presenting with endocrine, metabolic, and hematological issues.

Case Examine 1

An 82-year-old feminine presents to the workplace complaining of fatigue, dizziness, weak spot, and rising dyspnea on exertion. She has a previous medical historical past of atrial fibrillation, hypertension, and hyperlipidemia. Medicines embrace warfarin 2 milligrams po every day, lisinopril 10 milligrams po every day, and simvastatin 10 milligrams po every day. There are not any identified drug allergic reactions. The bodily examination reveals a 5’2” older feminine. Her weight is 128 kilos, blood strain is 144/80, coronary heart charge is 98, temperature is 98 levels Fahrenheit, and O2 saturation is 98%. Additional examination reveals the following:

Eyes: + pallor conjunctiva

Cardiac: irregular rhythm. No S3 S4 or M. NO JVD

Lungs: CTA w/o rales, wheezes, or rhonchi

Stomach: tender, BS +, + epigastric tenderness. No organomegaly, rebound, or guarding

Rectal: no stool in rectal vault

Case Examine 2

A 78-year-old feminine presents to the emergency room after a fall three days in the past. She not too long ago had a proper above-the-knee amputation and was leaning over to choose one thing up when she fell. She didn’t wish to come to the hospital, however she is having problem managing at house as a result of of the ache in her left leg the place she fell. Her affected person medical historical past reveals RAKA, peripheral vascular illness, Sort 2 diabetes, and stage three persistent kidney illness. Present medicines embrace quinapril 20 milligrams PO every day, Lantus 30 models at bedtime, and Humalog to scale earlier than meals. There are not any identified drug allergic reactions. The bodily examination is unfavourable and x-rays reveal no acute accidents. Laboratory research reveal a traditional white blood cell depend: Hgb of eight and HCT 24. The MCV is regular.

Case Examine three

V.G. is a 47 12 months previous African American male with kind 2 diabetes recognized two years in the past. He’s for a comply with up and complaining of elevated tingling to the decrease extremities. PMH: weight problems, dyslipidemia, HTN. He give up smoking smoking two years in the past. Denies any alcohol use. SH: lives with alone in a backed housing. He’s a veteran and depends on meals stamps and welfare. Works sometimes. MEDS: he misplaced his medicines and hasn’t taken any in a couple of week. His chart signifies his is on Lisinopril 20mg, Januvia 50mg QD, Lipitor 40mg QD, PE: 5’9, BP: 160/100 RBG: 415.

To organize:

Assessment Half 17 and 21 of the Buttaro et al. textual content on this week’s Assets.

You’ll both choose or be assigned to a affected person case examine for this Forum.

Assessment the affected person case examine and replicate on the info supplied about the affected person.

Take into consideration the private, medical, and household historical past it is advisable receive from the affected person in the case examine. Mirror on what questions you would possibly ask throughout an analysis.

Think about varieties of bodily exams and diagnostics that is likely to be acceptable for analysis of the affected person in the examine.

Mirror on a doable analysis for the affected person.

Take into consideration potential remedy choices for the affected person.

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