Posted: April 20th, 2022

Week Seven Signature Assignment

WEEK SEVEN Four

Week Seven Signature Assignment
FNP 595: Main Healthcare of Power Shoppers/Households Throughout the Lifespan

Week Seven Signature Assignment

This paper discusses a case of a 64-year-old Asian male who presents to the clinic resulting from wheezing and a non-healing wound on his left foot. His subjective and goal data is important for a historical past of Hypertension, Diabetes Mellitus Sort 2, Hypothyroidism, and Anemia. This paper will current a SOAP word concerning this case, evidence-based literature, dialogue, and suggestions associated to the EBP literature.

SOAP Word
ID: B.V. is a 64-year-old Asian Indian male who presents to the clinic together with his son. He seems to be a dependable historian and the son interpreted for his father.

CC: Wheezing and non-healing wound on the left foot.

HPI: B.V. is a 64-year-old Asian Indian male who offered to the clinic resulting from wheezing and a non-healing wound on his left plantar foot. This affected person not too long ago moved to the US from India a month in the past and desires to ascertain his PCP on this clinic. The affected person seen a wound that has not healed for greater than 1 month. The affected person states that the wound has no drainage, and his son has been doing house dressings at house. Additionally, the affected person seen that he began having steady wheezing for greater than Three weeks. The affected person is a power smoker x 20 years x 1 PPD. He admits to having a cough with minimal sputum (greenish). Hoarseness, dysphagia, SOB is current and he vomited Three days in the past. He seems like there’s a “lump in his throat”. He has a previous medical historical past of HTN, DM, 2, hypothyroidism, and Anemia. He denies taking any drugs for his wheezing. Dyspnea is worsened by exercise. He denies chest ache, palpitations, and dizziness. The son states that the affected person has been non-compliant together with his drugs

Previous Medical/Surgical Historical past:

HTN, DM 2, Hypothyroidism, Anemia.

Hospitalization: unable to recall Allergic reactions: NKDA

Medicines: Medicines from India

Vildagliptin 50 mg day by day Levothyroxine 50 mcg day by day

Telmisartan 40 mg day by day Bisoprolol 50 mg day by day

Lantus 20 models SC day by day Delpran-L ½ tab at evening (dosage unable to recall)

Vaccinations: Tdap- UTD, 2018 Flu- not updated, refused vaccination; COVID vaccine- acquired 2 doses, different vaccinations- unknown if acquired

Social Historical past:

The affected person states that he has been actively smoking for 20 years x 1PPD. He stopped smoking every week in the past. He drinks alcohol often and denies using avenue medicine. He states that he consumes 2 cups of tea per day. He’s a retired instructor and isn’t sexually energetic. He at the moment lives together with his 2 kids in a residential house. He not too long ago moved to the US and is utilizing his journey insurance coverage for healthcare protection. His kids are supportive and supply for his wants.

Non secular Choice: Sikhism

Household Historical past:

Father- deceased at 55 y.o. resulting from respiratory failure, Mom- deceased at 80 y.o., no identified previous medical historical past.

Siblings- 1 brother- has DM 2, Youngsters- 1 lady, 1 boy- wholesome, no identified medical situation

ROS:

Basic: Denies fever, chills, or urge for food modifications. Admits to feeling fatigued.

Pores and skin: States that he has a non-healing wound on his left plantar foot that has been there for 1 month.

Head/Neck: He denies any headache or neck ache.

ENT: Denies blurry imaginative and prescient or rhinorrhea. Admits to having dysphagia and voice hoarseness x weeks.

Respiratory: States that he has a cough with minimal greenish sputum and dyspnea that’s worsened by exertion.

C/V: denies chest ache or palpitations. Endocrine: Has a historical past of hypothyroidism and DM 2.

GI: Denies stomach ache, diarrhea, constipation, nausea, or vomiting. States that he was 2-Three episodes of vomiting Three days in the past. Neuro: Denies seizures, tingling on decrease extremities, numbness.

Psychiatric: Denies melancholy, anxiousness, or insomnia

Vitals Indicators:

Temperature: 98.1 (pores and skin) BP: 125/76 (left arm, sitting), HR: 94, O2 saturation 99% on RA

RR:20 ; Weight: 144 lbs.; Peak: 5ft, Eight inches, BMI: 22

Bodily Examination:

Basic Look: Affected person is alert and oriented x Three. He seems fatigued.

Pores and skin: Wound famous on the left plantar foot, dime-sized and with scant clear discharge. No bleeding or purulent discharge was famous.

ENT: No discharges on ear canals. Moist and pink oral mucosa with out lesions. Posterior pharynx moist, pink with none exudate.

GI: Regular bowel sounds. No tenderness, lots, or lumps had been famous upon palpation.

Respiratory: Rhonchi and wheezing had been famous bilaterally all through upon auscultation.

Cardiovascular: No gallops, friction rubs, or murmurs famous. RRR, S1 and S2 had been famous. No edema on extremities was famous.

Musculoskeletal: Capable of carry out ROM with out problem.

Neurologic: No syncope, confusion, or dizziness famous. The affected person is alert and oriented.

A:

COPD

Rationale: Smoking is probably the most vital reason for COPD. People who’ve COPD normally current of their fifth or sixth decade of life manifesting extreme sputum manufacturing, cough, and dyspnea (Papadakis et al., 2021).

DM 2

Rationale: This affected person is non-compliant and possibly have uncontrolled DM. He has a longtime prognosis of DM 2. Diabetes mellitus is a syndrome of metabolic dysfunction and hyperglycemia resulting from insulin secretion deficiency and or insulin resistance (Papadakis et al., 2021)

Diabetic wound left foot

Rationale: The impaired metabolic mechanism in DM 2 results in poor wound therapeutic. The mechanisms of DM are resulting from decreased cell and progress issue response decreased blood movement within the peripheral areas, and impaired native angiogenesis (Syafril, 2018).

Diagnostics:

Random blood sugar, HbA1C, and TSH right this moment

Lung Operate Take a look at/Spirometry- not ordered throughout this encounter

Administration

Pharmacologic/Therapeutic:

1. Combivent Respimat 1 puff QID

2. Augmentin 875 mg 1 tab q 12 x 10 days

Three. Qvar 80 mcg/puff 2 puffs BID x 7 days

Four. Lantus 20 models SC day by day

5. Bactroban ointment to wound BID.

Schooling:

1. Imparted smoking cessation data. Smoking will increase the chance of creating coronary heart ailments and worsening diabetic foot ulcers.

2. Blood sugar must be monitored frequently at house. Glycemic management objectives are as follows: Fasting blood sugar- 80-120 mg/dL and Glucose at bedtime- 100-140 mg/dL

Three. If the blood sugar drops under 59, comply with the 15:15 rule- eat 15 grams of Carbohydrates and wait 15 minutes earlier than taking both of the next: Three glucose tablets, ½ cup orange juice, ½ cup apple juice, 1/Three cup grape juice, or 6 ouncesof standard coke (Money et al., 2021).

Four. Carry out moderate-intensity workouts (jogging, biking, strolling) 20-45 minutes/day Three to 4x per week.

5. Chorus from exercising if the fasting blood sugar is > 250 or random BS is > 300 mg/dL as this may increasingly trigger diabetic ketoacidosis.

6. Frequently examine ft for cuts or lesions. Carry out day by day dressing on the affected foot and maintain clear. Every day/PRN dressing—irrigate/clear with NS, pat dry, apply Bactroban ointment, and canopy with 4×4.

7. Keep wholesome physique weight and devour meals which have a low glycemic index. Keep away from starchy meals and greens.

Eight. Cut back publicity to environmental irritants/pollution.

9. Carry out deep respiratory or pursed-lip respiratory when wanting breath.

Comply with-up:

1. Dilated eye examination, fasting lipid profile and particular foot examination must be carried out yearly.

2. HbA1c must be monitored each Three months to examine the affected person’s blood glucose management.

Three. Maintain BP lower than 140/80 mmHg.

Four. Maintain shingles, flu, pneumonia, and different vaccines updated.

5. Urine must be checked for the presence of protein/different issues.

(Money et al., 2021).

Referrals:

Comply with up in 1-2 weeks or earlier if signs worsen.

Podiatrist referral for administration of the diabetic wound.

Associated Literature
COPD is likely one of the most typical problems of smoking cigarettes and long-term publicity to irritants (Money et al., 2021). The criterion that defines obstruction of airflow that’s utilized in diagnosing COPD in most tips is an FEV1/FVC ratio of <70% (Miravitlles et al., 2016). The remedy objectives in a examine achieved by Miravitlles et al. (2016) are targeted on reducing signs, slowing down then pure illness development, enhancing life high quality, enhancing bodily exercise, stopping adversarial sequelae and problems, and enhancing life expectancy. As well as, this examine recommends a short-acting muscarinic agent (SAMA) or short-acting β2-agonist (SABA) for gentle illness and a LABA or LAMA for extra symptomatic sufferers. The mixture of ICS and bronchodilator is really helpful in sufferers with FEV1<50% or <60%, those that are at excessive danger for exacerbations and hose with a earlier historical past of two or extra exacerbations up to now yr, and those that have asthma-COPD overlap syndrome (Miravitlles et al., 2016). One other examine that was achieved by (Fazleen & Wilkinson, 2020) mentions using spirometry because the gold commonplace for COPD prognosis. As well as, in addition they point out potential early diagnostic modalities within the type of diffusion capability for carbon monoxide (DLCO), pressured expiratory movement at 25-75% of FVC, whole lung quantity, and imaging. The second examine additionally mentions that potential interventions for early COPD embrace smoking cessation, inhaled bronchodilator and steroid remedy, phosphodiesterase-Four inhibitors, macrolides, N-acetylcysteine, and vaccinations (flu, RSV, and different viral infections).

The record of suggestions for diabetic foot administration by Pérez-Panero et al., (2019) contains the next: screening inspection of the leg and ft; use of therapeutic footwear, stress offloading, debridement, dressings, antibiotic remedy, adjuvant remedies (G-CSF), administration of neuropathic ache and a multi-disciplinary method. In a examine by (Chawla et al., 2020) that concerned the prognosis of DM amongst Indian sufferers, the panel suggests an A1c of larger than or equal to six.5% for the prognosis of DM amongst Indian sufferers. As well as, screening and early detection embrace using a danger Assessment questionnaire and glycemic measure amongst high-risk people. Medical vitamin remedy on this examine recommends a food regimen with the next breakdown: 50-60% carbohydrates with low glycemic load, 30% fats-avoid saturated fatty acids, 15% proteins-limit purple meat and the remainder embrace leafy greens, nuts, complete grains, and unsaturated fat (Chawla et al., 2020). Metformin is the drug of selection together with way of life modification. Twin remedy is required if glucose targets aren’t achieved. A sulfonylurea, or thiazolidinediones, or SGLT2 inhibitor or DPP-Four inhibitor or AGI could also be added.

Dialogue
Based mostly on the information gained, the creator believes that many of the diagnostic and administration orders are applicable for this affected person. Some additions, nevertheless, might enhance the administration of this affected person. For the affected person’s COPD, to ascertain a correct prognosis, lung operate assessments resembling spirometry must be included. The usage of QVAR and Combivent Respimat is suitable for this affected person. Qvar accommodates a corticosteroid that helps with the inflammatory responses related to the affected person’s signs. The Combivent Respimat helps chill out the graceful muscle tissues of the airways. Some applicable interventions that may very well be added embrace a referral to a podiatrist and an ophthalmologist. Relying on the results of the A1c, this affected person must be referred to a diabetes specialist. People who find themselves of Asian Indian descent could also be uncovered to extreme consumption of sugary sweets which have vital cultural relevance. As well as, this affected person only recently moved from India and will have a tough time in search of western equivalents or beforehand consumed Indian meals. On this case, a dietary seek the advice of with a registered dietician must be achieved. Medical proof demonstrates that individuals with Diabetes who’re on medical vitamin remedy accomplish a 1-2% discount in A1c, akin to the outcomes of antidiabetic remedy, resulting in a discount in prices and enchancment within the high quality of life (Viswanathan et al., 2019).

References

Money, J. C., Glass, C. A., & Mullen, J. (2021). Household Apply Pointers (fifth ed.). Springer Publishing Firm, LLC.

Papadakis, M., McPhee, S., & Rabow, M. (2021). Present medical prognosis and remedy. McGraw Hill

Pérez-Panero, A. J., Ruiz-Muñoz, M., Cuesta-Vargas, A. I., & Gónzalez-Sánchez, M. (2019). Prevention, Assessment, prognosis and administration of diabetic foot based mostly on medical observe tips: A scientific overview. Drugs, 98(35), e16877.

Syafril, S. (2018, March). Pathophysiology diabetic foot ulcer. In IOP Convention Collection: Earth and Environmental Science (Vol. 125, No. 1, p. 012161). IOP Publishing.

Viswanathan, V., Krishnan, D., Kalra, S., Chawla, R., Tiwaskar, M., Saboo, B., Baruah, M., Chowdhury, S., Makkar, B. M., & Jaggi, S. (2019). Insights on Medical Diet Remedy for Sort 2 Diabetes Mellitus: An Indian Perspective. Advances in remedy, 36(Three), 520–547. https://doi.org/10.1007/s12325-019-0872-Eight

SEVENTH WEEK Four

Signature Assignment for Week Seven

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