Posted: April 20th, 2022

Week Seven Signature Assignment

Week Seven Signature Assignment

FNP 595: Main Healthcare of Persistent 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 attributable to 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 Kind 2, Hypothyroidism, and Anemia. This paper will current a SOAP observe relating to this case, evidence-based literature, dialogue, and proposals associated to the EBP literature.
SOAP Word
ID: B.V. is a 64-year-old Asian Indian male who presents to the clinic along 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 attributable to 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 observed 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 residence dressings at residence. Additionally, the affected person observed that he began having steady wheezing for greater than Three weeks. The affected person is a continual 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 looks 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 medicines 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 along with his medicines
Previous Medical/Surgical Historical past:
HTN, DM 2, Hypothyroidism, Anemia.
Hospitalization: unable to recall Allergy symptoms: NKDA
Drugs: Drugs from India
Vildagliptin 50 mg each day Levothyroxine 50 mcg each day
Telmisartan 40 mg each day Bisoprolol 50 mg each day
Lantus 20 models SC each day Delpran-L ½ tab at night time (dosage unable to recall)
Vaccinations: Tdap- UTD, 2018 Flu- not updated, refused vaccination; COVID vaccine- obtained 2 doses, different vaccinations- unknown if obtained
Social Historical past:
The affected person states that he has been actively smoking for 20 years x 1PPD. He stopped smoking per week in the past. He drinks alcohol often and denies using road medication. He states that he consumes 2 cups of tea per day. He’s a retired trainer and isn’t sexually lively. He presently lives along with his 2 kids in a residential residence. 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. attributable to respiratory failure, Mom- deceased at 80 y.o., no identified previous medical historical past.
Siblings- 1 brother- has DM 2, Youngsters- 1 woman, 1 boy- wholesome, no identified medical situation
ROS:
Common: Denies fever, chills, or urge for food adjustments. 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 belly 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, nervousness, 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:
Common 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 have been famous upon palpation.
Respiratory: Rhonchi and wheezing have been famous bilaterally all through upon auscultation.
Cardiovascular: No gallops, friction rubs, or murmurs famous. RRR, S1 and S2 have been famous. No edema on extremities was famous.
Musculoskeletal: Capable of carry out ROM with out issue.
Neurologic: No syncope, confusion, or dizziness famous. The affected person is alert and oriented.
A:
COPD
Rationale: Smoking is essentially the most important reason for COPD. People who’ve COPD often 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 perhaps have uncontrolled DM. He has a longtime analysis of DM 2. Diabetes mellitus is a syndrome of metabolic dysfunction and hyperglycemia attributable to 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 attributable to decreased cell and development issue response decreased blood circulate within the peripheral areas, and impaired native angiogenesis (Syafril, 2018).
Diagnostics:
Random blood sugar, HbA1C, and TSH in the present day
Lung Operate Check/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 each day
5. Bactroban ointment to wound BID.
Training:
1. Imparted smoking cessation data. Smoking will increase the chance of creating coronary heart ailments and worsening diabetic foot ulcers.
2. Blood sugar needs to be monitored frequently at residence. Glycemic management targets are as follows: Fasting blood sugar- 80-120 mg/dL and Glucose at bedtime- 100-140 mg/dL
Three. If the blood sugar drops beneath 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 ozof standard coke (Money et al., 2021).
Four. Carry out moderate-intensity workout routines (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 occasionally trigger diabetic ketoacidosis.
6. Frequently test toes for cuts or lesions. Carry out each day dressing on the affected foot and hold clear. Each day/PRN dressing—irrigate/clear with NS, pat dry, apply Bactroban ointment, and canopy with 4×4.
7. Preserve wholesome physique weight and eat meals which have a low glycemic index. Keep away from starchy meals and greens.
Eight. Scale back publicity to environmental irritants/pollution.
9. Carry out deep respiration or pursed-lip respiration when in need of breath.

Observe-up:
1. Dilated eye examination, fasting lipid profile and particular foot examination needs to be carried out yearly.
2. HbA1c needs to be monitored each Three months to test 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 needs to be checked for the presence of protein/different issues.

(Money et al., 2021).
Referrals:
Observe up in 1-2 weeks or earlier if signs worsen.
Podiatrist referral for administration of the diabetic wound.

Associated Literature
COPD is among the commonest issues 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 therapy targets in a research carried out by Miravitlles et al. (2016) are centered on lowering signs, slowing down then pure illness development, enhancing life high quality, enhancing bodily exercise, stopping hostile sequelae and issues, and enhancing life expectancy. As well as, this research 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 beneficial in sufferers with FEV1<50% or <60%, those that are at excessive threat for exacerbations and hose with a earlier historical past of two or extra exacerbations up to now 12 months, and people who have asthma-COPD overlap syndrome (Miravitlles et al., 2016). One other research that was carried out by (Fazleen & Wilkinson, 2020) mentions using spirometry because the gold commonplace for COPD analysis. As well as, in addition they point out potential early diagnostic modalities within the type of diffusion capability for carbon monoxide (DLCO), compelled expiratory circulate at 25-75% of FVC, complete lung quantity, and imaging. The second research 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 toes; 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 research by (Chawla et al., 2020) that concerned the analysis of DM amongst Indian sufferers, the panel suggests an A1c of better than or equal to six.5% for the analysis of DM amongst Indian sufferers. As well as, screening and early detection embrace using a threat Assessment questionnaire and glycemic measure amongst high-risk people. Medical diet remedy on this research recommends a weight loss program with the next breakdown: 50-60% carbohydrates with low glycemic load, 30% fats-avoid saturated fatty acids, 15% proteins-limit crimson meat and the remainder embrace leafy greens, nuts, entire 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 are usually not achieved. A sulfonylurea, or thiazolidinediones, or SGLT2 inhibitor or DPP-Four inhibitor or AGI could also be added.

Dialogue
Based mostly on the data gained, the writer believes that many of the diagnostic and administration orders are acceptable for this affected person. Some additions, nonetheless, might enhance the administration of this affected person. For the affected person’s COPD, to ascertain a correct analysis, lung operate exams equivalent to spirometry needs to be integrated. The usage of QVAR and Combivent Respimat is suitable for this affected person. Qvar comprises a corticosteroid that helps with the inflammatory responses related to the affected person’s signs. The Combivent Respimat helps calm down the sleek muscle tissue of the airways. Some acceptable 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 needs to 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 important cultural relevance. As well as, this affected person only recently moved from India and will have a tough time searching for western equivalents or beforehand consumed Indian meals. On this case, a dietary seek the advice of with a registered dietician needs to be carried out. Scientific proof demonstrates that folks with Diabetes who’re on medical diet remedy accomplish a 1-2% discount in A1c, similar 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 Follow Pointers (fifth ed.). Springer Publishing Firm, LLC.
Papadakis, M., McPhee, S., & Rabow, M. (2021). Present medical analysis and therapy. McGraw Hill
Pérez-Panero, A. J., Ruiz-Muñoz, M., Cuesta-Vargas, A. I., & Gónzalez-Sánchez, M. (2019). Prevention, Assessment, analysis and administration of diabetic foot based mostly on scientific follow tips: A scientific Assessment. 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 Kind 2 Diabetes Mellitus: An Indian Perspective. Advances in remedy, 36(Three), 520–547. https://doi.org/10.1007/s12325-019-0872-Eight

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Signature Assignment for Week Seven

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

This paper discusses a case of a 64-year-old Asian male who presents to the clinic attributable to 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 Kind 2, Hypothyroidism, and Anemia. This paper will current a SOAP observe relating to this case, evidence-based literature, dialogue, and proposals associated to the EBP literature.
SOAP Word ID: B.V. is a 64-year-old Asian Indian male who presents to the clinic along 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

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