Posted: February 28th, 2022

Assessing, Diagnosing, and Treating Cardiovascular and Pulmonary Disorders

Assessing, Diagnosing, and Treating Cardiovascular and Pulmonary Disorders
Number of sources: 4
Paper instructions:
Cardiovascular conditions are among the leading causes of hospitalization and death among older adults, even though many of the risk factors that contribute to such conditions are preventable or manageable. In your role as an advanced practice nurse, you must be able to apply sound critical thinking and diagnostic reasoning skills to correctly assess and diagnosis these conditions. You also play an important role in helping patients manage disorders by planning necessary treatments, assessments, and follow-up care.

To prepare:

Review the Week 5 Case Assignment document in the Learning Resources.
Reflect on the patient’s symptoms and aspects of disorders that may be present.
Consider how you might assess, perform diagnostic tests, and recommend medications to treat patients presenting with the symptoms in the case study.
The Assignment:

After reviewing the case and the accompanying case analysis questions, included in the document, answer the 10 questions directly in the Case Assignment document. When providing evidence to support your answers, be sure they evidenced-based, current (no more than 5 years old), and follow current standards of care. Follow APA 7th edition formatting. NRNP 6540 Week 5 Case Assignment
Case Title: A 67-year-old With Tachycardia and Coughing
Ms. Jones is a 67-year-old female who is brought to your office today by her daughter Susan. Ms. Jones lives with her daughter and is able to perform all activities of daily living (ADLs) independently. Her daughter reports that her mother’s heart rate has been quite elevated, and she has been coughing a lot over the last 2 days. Ms. Jones has a 30-pack per year history of smoking cigarettes but quit smoking 3 years ago. Other known history includes chronic obstructive pulmonary disease (COPD), hypertension, vitamin D deficiency, and hyperlipidemia. She also reports some complaints of intermittent pain/cramping in her bilateral lower extremities when walking, and has to stop walking at times for the pain to subside. She also reports some pain to the left side of her back, and some pain with aspiration.
Ms. Jones reports she has been coughing a lot lately, and notices some thick, brown-tinged sputum. She states she has COPD and has been using her albuterol inhaler more than usual. She says it helps her “get the cold up.” Her legs feel tired but denies any worsening shortness of breath. She admits that she has some weakness and fatigue but is still able to carry out her daily routine.
Vital Signs: 99.2, 126/78, 96, RR 22
Labs: Complete Metabolic Panel and CBC done and were within normal limits
CMP Component Value CBC Component Value
Glucose, Serum 86 mg/dL White blood cell count 5.0 x 10E3/uL
BUN 17 mg/dL RBC 4.71 x10E6/uL
Creatinine, Serum 0.63 mg/dL Hemoglobin 10.9 g/dL
EGFR 120 mL/min Hematocrit 36.4%
Sodium, Serum 141 mmol/L Mean Corpuscular Volume 79 fL
Potassium, Serum 4.0 mmol/L Mean Corpus HgB 28.9 pg
Chloride, Serum 100 mmol/L Mean Corpus HgB Conc 32.5 g/dL
Carbon Dioxide 26 mmol/L RBC Distribution Width 12.3%
Calcium 8.7 mg/dL Platelet Count 178 x 10E3/uL
Protein, Total, Serum 6.0 g/dL
Albumin 4.8 g/dL
Globulin 2.4 g/dL
Bilirubin 1.0 mg/dL
AST 17 IU/L
ALT 15 IU/L

Allergies: Penicillin
Current Medications:
• Atorvastatin 40mg p.o. daily
• Multivitamin 1 tablet daily
• Losartan 50mg p.o. daily
• ProAir HFA 90mcg 2 puffs q4–6 hrs. prn
• Caltrate 600mg+ D3 1 tablet daily
Diagnosis: Pneumonia

Directions: Answer the following 10 questions directly on this template.
Question 1: What findings would you expect to be reported or seen on her chest x-ray results, given the diagnosis of pneumonia?
Question 2: Define further what type of pneumonia Ms. Jones has, HAP (hospital-acquired pneumonia) or CAP (community-acquired pneumonia)? What’s the difference/criteria?
Question 3:
• 3A) What assessment tool should be used to determine the severity of pneumonia and treatment options?
• 3B) Based on Ms. Jones’ subjective and objective findings, apply that tool and elaborate on each clinical factor for this patient.
Question 4: Ms. Jones was diagnosed with left lower lobe pneumonia. What would your treatment be for her based on her diagnosis, case scenario, and evidence-based guidelines?
Question 5: Ms. Jones has a known history of COPD. What is the gold standard for measuring airflow limitation?
Question 6: Ms. Jones mentions intermittent pain in her bilateral legs when walking and having to rest to stop the leg pain/cramps. Which choice below would be the best choice for a potential diagnosis for this? Explain your reasoning.
a. DVT (Deep Vein Thrombosis)
b. Intermittent Claudication
c. Cellulitis
d. Electrolyte Imbalance
Question 7: Ms. Jones mentions intermittent pain in her bilateral legs when walking and having to rest to stop the leg pain. What test could be ordered to further evaluate this?
Question 8: Name three (3) differentials for Ms. Jones’ initial presentation.
Question 9: What patient education would you give Ms. Jones and her daughter? What would be your follow-up instructions?
Question 10: Would amoxicillin/clavulanate plus a macrolide have been an option to treat Ms. Jones’ Pneumonia? Explain why or why not.

_________________________

Question 1:

The following findings would be expected to be reported or seen on Ms. Jones’ chest x-ray results, given the diagnosis of pneumonia:

Infiltrates, which are areas of inflammation in the lungs
Consolidation, which is the filling of air spaces with fluid or cells
Pleural effusion, which is the buildup of fluid in the space between the lungs and the chest wall

Question 2:

Ms. Jones has community-acquired pneumonia (CAP). CAP is defined as pneumonia that is acquired in the community, not in a hospital or other healthcare setting. CAP is the most common type of pneumonia, accounting for about 80% of cases.

The main difference between CAP and hospital-acquired pneumonia (HAP) is the type of bacteria that causes the infection. CAP is most commonly caused by bacteria that are found in the environment, such as Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. HAP, on the other hand, is more likely to be caused by bacteria that are resistant to antibiotics, such as Pseudomonas aeruginosa and Acinetobacter baumannii.

Question 3:

3A) The Pneumonia Severity Index (PSI) is a tool that can be used to determine the severity of pneumonia and treatment options. The PSI is based on five clinical factors:

Age
Respiratory rate
Oxygen saturation
Leukocyte count
Comorbidities

3B) Based on Ms. Jones’ subjective and objective findings, she would be classified as a PSI score of 2, which indicates that she has moderate pneumonia. Treatment for moderate pneumonia typically includes antibiotics, such as azithromycin or levofloxacin, and supportive care, such as oxygen and fluids.

Question 4:

Ms. Jones was diagnosed with left lower lobe pneumonia. Based on her diagnosis, case scenario, and evidence-based guidelines, her treatment would include:

Antibiotics: Azithromycin or levofloxacin
Oxygen: If her oxygen saturation is less than 90%
Fluids: If she is dehydrated
Pain medication: If she is experiencing pain
Cough suppressant: If she is coughing up thick, brown sputum
Rest: She should avoid strenuous activity until she is feeling better.

Question 5:

The gold standard for measuring airflow limitation in patients with COPD is spirometry. Spirometry is a test that measures how much air a person can breathe in and out. A decrease in the forced expiratory volume in one second (FEV1) is a sign of airflow limitation.

Question 6:

The best choice for a potential diagnosis for Ms. Jones’ intermittent pain in her bilateral legs when walking and having to rest to stop the leg pain is intermittent claudication. Intermittent claudication is a condition that occurs when blood flow to the legs is reduced. This can cause pain in the legs, especially when walking.

Question 7:

A Doppler ultrasound of the legs can be ordered to further evaluate Ms. Jones’ intermittent pain in her bilateral legs. A Doppler ultrasound uses sound waves to measure blood flow in the legs. This test can help to diagnose intermittent claudication and other conditions that affect blood flow to the legs.

Question 8:

Three differentials for Ms. Jones’ initial presentation include:

Pneumonia
Heart failure
Chronic obstructive pulmonary disease (COPD) exacerbation

Question 9:

The following patient education would be given to Ms. Jones and her daughter:

Pneumonia is an infection of the lungs.
It is caused by bacteria, viruses, or fungi.
The symptoms of pneumonia include fever, cough, shortness of breath, and chest pain.
Treatment for pneumonia usually includes antibiotics.
It is important to complete the full course of antibiotics, even if you start to feel better.
Pneumonia can be a serious infection, but it is usually treatable.

Question 10:

Amoxicillin/clavulanate plus a macrolide would not have been an option to treat Ms. Jones’ pneumonia because she is allergic to penicillin. Penicillin is a type of antibiotic that is often used to treat pneumonia. However, it is not safe for people who are allergic to penicillin. In Ms. Jones’ case, she would have been treated with a different antibiotic, such as azithromycin or levofloxacin.

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