Posted: December 3rd, 2022

Case Title: A 67-year-old With Tachycardia and Coughing

Nursing
Title: 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.
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Assessing, Diagnosing, and Treating Cardiovascular and Pulmonary Disorders

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Assessing, Diagnosing, and Treating Cardiovascular and Pulmonary Disorders
Question 1: What findings would you expect to be reported or seen on her chest x-ray results, given the diagnosis of pneumonia?
The findings to expect on the x-ray results for the diagnosis of pneumonia include an area of lung inflammation. Inflammation occurs due to infection of the airspaces of the lungs. The results will show airspace opacity, interstitial opacities, and lobar consolidation. An x-ray result will show white spots called infiltrates that indicate the presence of an infection (Konomura et al., 2017).
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?
Ms. Jones is suffering from community-acquired pneumonia. The reason is that she came to the healthcare facility with the symptoms of the disease. Hospital-acquired pneumonia refers to an infection contracted by a patient 48-72 hours after being admitted to a healthcare facility (Konomura et al., 2017). Community-acquired pneumonia is acquired outside a hospital due to exposure to pathogens.
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.
The assessment tools to determine the severity of pneumonia include the pneumonia severity index or the PORT Score. Determining the severity of the disease is essential in determining the treatment options (Konomura et al., 2017). The severity will determine the treatment, including antibiotics, cough medicine, fever, or pain relievers.
The patient’s clinical factors demonstrate she is coughing, intermittent pain in her bilateral lower extremities, and pain on the left side of the back. The assessment of the tool shows the patient requires hospitalization for a few days. Hospitalization will allow assessment of the condition.
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?
Treatment of left lower lobe pneumonia involves curing the infection and prevent related complications. Treatment will take place after hospitalization since the patient is over 65 years. It will involve antibiotics to treat bacterial pneumonia (Uranga et al., 2016). A physician will select an appropriate antibiotic to treat the disease. Cough medicine is necessary to calm or eliminate the cough (Uranga et al., 2016). Fever and pain relievers are necessary to address the pain the patient is going through.
Question 5: Ms. Jones has a known history of COPD. What is the gold standard for measuring airflow limitation?
The gold standard of measuring airflow limitation for patients with a history of COPD is reduced FEV1/FVC ratio compared to the lower limit of normal for a specific measurement from a defined population (Shah et al., 2016). The measurement is essential since airflow limitation leads to difficulty in breathing and coughing. The standard gold measurement helps physicians to prescribe effective treatment.
Question 6: Ms. Jones mentions intermittent pain in her bilateral legs when walking and resting to stop the leg pain/cramps. Which choice below would be the best choice for a potential diagnosis for this? Explain your reasoning.
The best choice for a potential diagnosis is intermittent claudication. The condition causes pain, which subsides upon a short period of rest. It is one of the possible conditions since the patient has a history of COPD. It causes an itchy pain which occurs when an individual is walking (Shah et al., 2016). For instance, the patient states that she experiences the pain while walking, but the pain subsides upon stopping and resting briefly.
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?
The patient requires various tests to determine the condition causing the pain in her bilateral legs. One of the tests is the Ankle-brachial index (ABI), which compares the ankle’s blood pressure with that of the arm (Konomura et al., 2017). If the pressure in the ankle is lower, it means a patient can experience blocked arteries. The normal ABI index is between 1.0 and 1.4
Question 8: Name three (3) differentials for Ms. Jones’ initial presentation.
The patient’s initial presentation’s differential diagnosis includes pneumonia, chronic obstructive pulmonary disease, and asthma.
Question 9: What patient education would you give Ms. Jones and her daughter? What would be your follow-up instructions?
Patient education includes taking deep breaths and cough several times every hour to loosen up mucus and get it out of the lungs. The patient should wash hands after blowing the nose or using the washroom to avoid further infections (Metlay et al., 2019). Coughing or sneezing on a disposable material or elbow. The daughter should ensure the mother is breathing warm moist air to avoid a sticky mucus that can chock a patient.
Question 10: Would amoxicillin/clavulanate plus a macrolide have been an option to treat Ms. Jones’ Pneumonia? Explain why or why not.
Amoxicillin is one of the options available for the treatment of pneumonia. It is an effective bacteria that kills the bacteria, causing the disease. The patient should take Amoxicillin for a period of 5 days. Available literature shows that Amoxicillin can treat pneumonia successfully (Uranga et al., 2016). Macrolide is also an effective medication for community-acquired pneumonia. It is a class of antibiotics that kills germs.

References
Konomura, K., Nagai, H., & Akazawa, M. (2017). Economic burden of community-acquired pneumonia among elderly patients: a Japanese perspective. Pneumonia, 9(1), 19.
Metlay, J. P., Waterer, G. W., Long, A. C., Anzueto, A., Brozek, J., Crothers, K., … & Griffin, M. R. (2019). Diagnosis and treatment of adults with community-acquired pneumonia. An official clinical practice guideline of the American Thoracic Society and Infectious Diseases Society of America. American Journal of Respiratory and Critical Care Medicine, 200(7), 45-67.
Shah, S. S., Srivastava, R., Wu, S., Colvin, J. D., Williams, D. J., Rangel, S. J., … & Clohessy, C. (2016). Intravenous versus oral antibiotics for postdischarge treatment of complicated pneumonia. Pediatrics, 138(6).
Uranga, A., España, P. P., Bilbao, A., Quintana, J. M., Arriaga, I., Intxausti, M., … & Capelastegui, A. (2016). Duration of antibiotic treatment in community-acquired pneumonia: a multicenter randomized clinical trial. JAMA Internal Medicine, 176(9), 1257-1265.

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