NR 601 Week 2 COPD Case Study Part 2

This assignment is about a 62-year-old Caucasian male presenting to the clinic with complaints of persistent cough and a recent onset of breath shortness. Your work is to assess the patient to discover additional information, diagnose the patient then devise a management plan for the patient.

Week 2: COPD Case Study Part 2 (Initial post due Thursday, faculty and peer responses due Sunday)

Case Study – Part 2

You ordered a CXR and spirometry at the previous visit and he returns today to review the results. Physical exam and symptoms are unchanged since my last visit. Vital signs at this visit are: Temp-98.3, P-68, RR-20, BP 152/90, Height 68.9in., Weight 258 pounds, O2sat 94% on RA

CXR Result:

No acute inﬁltrates or consolidations are seen. Cardiac and mediastinal silhouettes are normal. No hilar enlargement is evident. Osseous thorax is intact.

Spirometry Results:


Pre-Bronchodilator				Post-Bronchodilator
	Predicted	Actu al	%Predicted	Actua l	% Predicted	% Change
FVC (L)	4.52	3.01	67	3.08	68	2
FEV1 (L)	3.40	1.58	46	1.60	47	1
FEV1/F V	.75	.52	—	.52	—	0

Requirements/Questions:

● What is your primary (one) diagnosis for this patient at this time? (support the decision for your diagnosis with pertinent positives and negatives from the case)

● Identify the corresponding ICD-10 code.

● Provide a treatment plan for this patient’s primary diagnosis which includes:

■ Medication*

■ Any additional testing necessary for this particular diagnosis*

■ Patient education

■ Referral

■ Follow up

● Provide an active problem list for this patient based on the information given in the case.

● Are there any changes that you would also make to this patient’s overall treatment plan at this time? Must provide an EBP argument for each treatment or testing decision.

Over-the-counter (OTC) and RXs must be written in full as if handing a prescription to the patient in the oﬃce.

Example:

Amoxicillin 500 mg capsule 1 tab po BID q 10 days

Disp #20 no reﬁlls

DISCUSSION CONTENT
Category	Points	%	Description

Application of Course Knowledge

30%

● Student chooses one appropriate diagnosis for the patient; AND● Diagnosis is supported with strong pertinent positive and negative subjective and objective data from parts 1 & 2; AND● The ICD code for the diagnosis is correct; AND● Treatment plan for primary diagnosis includes medication, additional testing, patient education, and referral; AND● Prescription and OTC medications are written appropriately as a RX and all components are correct; AND● Treatment decisions (medication, additional testing, referrals) are supported with appropriate EBP arguments; AND● An accurate problem list is presented based on case information; AND

● Student discusses changes (or not) to the overall treatment plan for thepatient for pertinent issues; AND ● An appropriate F/U plan is provided (9 critical elements)

Week 2: COPD Case Study Part 1 Example Purpose

Problem-based learning is a methodology designed to help students develop the reasoning process used in clinical practice through problem solving actual patient problems in the same manner as they occur in practice. The purpose of this activity is to develop students’ clinical reasoning skills using a case-based learning exercise.

Through participation in an online discussion forum, students identify learning issues in a self-directed manner which facilitates learning for the entire group.

Activity Learning Outcomes

Through this discussion, the student will demonstrate the ability to:

● Demonstrate competence in the evaluation and management of common respiratory problems (WO 2.1) (CO,2,3,4,5)

● Distinguish between obstructive and restrictive lung disease (CO 2, 4) Develop a management plan for the case study patient based on identiﬁed primary, secondary and differential diagnoses. (WO 2.2) (CO 2,4)

● Interpret pulmonary function test results. (WO 2.3) (CO 2, 4) Due Date:

Students enter the initial post to part one by 11:59 p.m. MT on Tuesday; responds substantively to at least one topic-related post of a peer including evidence from appropriate sources AND all direct faculty questions in parts one by Sunday, 11:59 p.m. MT.

A 10% late penalty will be imposed for discussions posted after the deadline on Tuesday 11:59 pm MT, regardless of the number of days late. NOTHING will be accepted after 11:59 pm MT on Sunday (i.e. students will receive an automatic 0).

Total Points Possible: 50

Case Study – Part 1

Date of visit: November 20,

A 62 year-old Caucasian male presents to the oﬃce with persistent cough and recent onset of shortness of breath. Upon further questioning you discover the following subjective information regarding the chief complaint.


History Of Present Illness
Onset	6 months
Location	Chest
Duration	Cough is intermittent but frequent, worse in the AM
Characteristics	Productive; whitish-yellow phlegm
Aggravatingfactors	Activity
Relieving factors	Rest
Treatments	Tried Robitussin DM without relief of symptoms
Severity	Unable to walk > 20ft without stopping to catch his breath. Last year at this time he routinely walked 1 mile per day without diﬃculty
Review of Systems (ROS)

Constitutional	Denies fever, chills, or weight loss
Ears	Denies otalgia and otorrhea
Nose	Denies rhinorrhea, nasal congestion, sneezing or post nasal drip.
Throat	Denies ST and redness
Neck	Denies lymph node tenderness or swelling
Chest	Describes a persistent productive cough upon waking for the last 6 months. Color of phlegm is usually white-yellowish. Shortness of breath with activity.
Cardiovascular	Denies chest pain and lower extremity edema


History NR 601 Week 2 COPD Case Study Part 2
Medications	Metoprolol succinate ER (Toprol-XL) 50mg daily for hypertension; Multivitamin daily
PMH	Primary hypertension
PSH	Cholecystectomy, appendectomy
Allergie s	Penicillin (hives)
Social	Married, 3 children Senior accountant at a risk management ﬁrm
Habits	Former smoker (20 pack-year), quit “cold turkey” when father died; Denies alcohol or illicit drug use.
FH	Father died of MI & CHF at age 59 years (diabetes, hypertension, smoker)Mother is alive (osteoporosis) Healthy siblings

Physical exam reveals the following:


Physical Exam
Constitutional	Adult male in NAD, alert and oriented, able to speak in full sentences
VS	Temp-98.1, P-66, RR-20, BP 156/94, Height 68.9in, Weight 258 pounds, O2sat 94% on RA
Head	Normocephalic
Ears	Tympanic membranes gray and intact with light reﬂex noted. Pinna and tragus nontender.
Nose	Nares patent. Nasal turbinates clear without redness or edema. Nasal drainage is clear.
Throat	Oropharynx moist, no lesions or exudate. Tonsils ¼ bilaterally. Teeth in good repair, no cavities noted.
Neck	Neck supple. No lymphadenopathy. Thyroid midline, small and ﬁrm without palpable masses. No JVD
Cardiopulmonary	Heart S1 and S2 with no murmurs, noted. Lungs clear to auscultation bilaterally with faint forcedexpiratory wheezes in bilateral bases. Respirations unlabored. Legs without edema.

Abdomen	Soft, non-tender. No organomegaly

Requirements/Questions:

● Brieﬂy and concisely summarize the history and physical (H&P) ﬁndings as if you were presenting it to your preceptor using the pertinent facts from the case. May use approved medical abbreviations. Avoid redundancy and irrelevant information.

● Provide a differential diagnosis (minimum of 3) which might explain the patient’s chief complaint along with a brief statement (2-3 sentences) of pathophysiology for each.

● Analyze the differential by using the pertinent ﬁndings from the history and physical to argue for or against a diagnosis.

● Rank the differential in order of most likely to least likely.

● Identify any additional tests and/or procedures that you feel are necessary or needed to help you narrow your differential. All testing decisions must be supported with an evidence-based practice (EBP) argument as to why it is necessary or pertinent in this case. If no testing is indicated or needed, you must also support this decision with EBP evidence.


DISCUSSION CONTENT
Category	Poin	%	Description
	ts
Application	15	30	1. A brief AND concise summary of
of Course	NR	%	the history and physical (H&P) ﬁndings is
Knowledge	601		presented without redundancy or
	Wee		irrelevant information; AND
	k 2		2. Three (3) appropriate diagnoses in
	COP		the differential are presented which can
	D		explain the patient’s chief complaint; AND
	Cas		3. A brief statement of
	e		pathophysiology is included for each
	Stud		diagnosis; AND
	y		4. Each diagnosis in the differential is
	Part		analyzed using pertinent positive and
	2		negative subjective and objective ﬁndings
			as support; AND
			5. The differential is ranked in order
			from most likely to least likely; AND

			6. Clinical reasoning skills are
			demonstrated by linking testing to
			diagnoses as applicable; AND
			7. Testing decisions are well
			supported with EBP arguments that are
			in-line with the clinical scenario and
			appropriate for the primary care setting
			(7 critical elements)
Support	15	30	1. Discussion post is supported with
from	NR	%	appropriate, scholarly sources; AND
Evidence-B	601		2. Sources are published within the
ased	Wee		last 5 years (unless it is the most current
Practice	k 2		CPG); AND
(EBP)	COP		3. Reference list is provided and
	D		in-text citations match; AND
	Cas		4. All testing decisions are fully
	e		supported with an appropriate EBP
	Stud		argument
	y		(4 critical elements)
	Part
	2

Interactive	10	20	1. Student provides a substantive*
Dialogue	NR	%	response to at least one topic-related post
	601		of a peer; AND
	Wee		2. Evidence from appropriate
	k 2		scholarly sources are included; AND
	COP		3. Reference list is provided and
	D		in-text citations match; AND
	Cas		4. Student responds to all direct
	e		faculty questions
	Stud		(*) A substantive post adds new content
	y		or insights to the discussion thread and
	Part		information from student’s original post is
	2		not reused in peer or faculty response
			(4 critical elements)
			Total CONTENT Points= 40 pts
DISCUSSION FORMAT
Category	Poin	%	Description
	ts

Organization	5	10	1. Case study response is presented
n NR 601		%	in a logical format, AND
Week 2			2. Responses are in sequence with
COPD Case			the numbered questions AND
Study Part			3. The case study response is
2			understandable and easy to follow AND
			4. All responses are relevant to the
			case topic
			(4 critical elements)
Grammar,	5	10	Discussion post has minimal grammar,
Syntax,		%	syntax, spelling, punctuation, or APA
Spelling &			format errors*
Punctuation
n
			Total FORMAT Points= 10 pts
			DISCUSSION TOTAL= 50 pts

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ReplyReply to Week 2: COPD Case Study Part 1 (Initial post due Tuesday, faculty and peer responses due Sunday)

Jan 12, 2020 Jan 12 at 8:06 am Manage Discussion Entry Summary

Patient is 62-yr. old male with a cc of frequent productive cough for the past 6 months that is worse in the morning. The cough is worse with activity and relieved by rest. He has been experiencing decreased activity tolerance. Last year he routinely walked a mile a day and now he can’t walk over 20 feet without having to stop due to being short of breath.

He has taken Robitussin DM without any relief in symptoms. He has a history of HTN for which he takes Toprol XL daily. He also takes a multivitamin daily. He is a former

smoker of 20 pack-years who denies alcohol or illicit drug use. His father died at age 59 of MI & CHF. His father had a history of diabetes, HTN, and smoking. His mother is alive with a history of osteoporosis. His siblings are healthy.

ROS– Patient denies any fever, chills, or weight loss. He has no nasal congestion or post-nasal drip. Patient has shortness of breath with activity. He reports having a persistent productive cough with with-yellowish phlegm. Patient denies any chest pain or edema in his lower extremities.The PE-Upon exam patient is afebrile with a BP of 156/94, HR 66, RR 20 and O2 sat 94% on room air. His BMI is 39.23. No has clear nasal drainage. S1 and S2 with no murmurs.

Lungs are clear bilaterally with faint forced expiratory wheezes in bilateral bases. Respirations unlabored. Legs without edema.

Differential Diagnosis ranked most likely to least likely:

#1 COPD

COPD is a persistent respiratory condition that is common and preventable. Cigarette smoking is the most signiﬁcant risk factor. COPD is characterized by chronic airﬂow limitation due to inﬂammation. Structural changes and destruction of the lung parenchyma take place leading to loss of alveolar attachments to the small airways and a reduction in lung elastic recoil. These changes decrease the ability of the airways to remain open during expiration (GOLD, 2020).

Analysis:

Pertinent positives- chronic cough (6 months), progressive decrease in activity tolerance due to shortness of breath wheezing, history of smoking and was exposed to smoke as a child since his father smoked Pertinent negatives-afebrile, nasal turbinates without redness or edema, Oropharynx moist, no lesions or exudate, denies sore throat, no family history of COPD

#2 Asthma

Asthma is a chronic inﬂammatory disorder of the airways. The inﬂammation is associated with bronchial hyperresponsive, constriction of the airways, and variable airﬂow obstruction that is reversible. This causes wheezing, shortness of breath, chest tightness, and coughing. Contributing factors include exposure to allergens,environmental pollution, tobacco smoke, and obesity (GINA, 2019)).

Analysis:

Pertinent positives- wheezing, on beta blocker, obesity, previous smoker and exposed to smoke as a child since father smoked, cough worse in morning, activity intolerance due to shortness of breath Pertinent negatives-respirations unlabored, no occupational exposure (senior accountant), no known environmental allergies, no family history of asthma

#3 Heart Failure

Heart failure (HF) is a complex syndrome that results from any structural or functional impairment of ventricular ﬁlling or ejection of blood. Risk factors include HTN, elevated cholesterol, obesity, diet, and physical inactivity. Symptoms of HF include dyspnea,fatigue, ﬂuid retention, and exercise intolerance. These clinical symptoms result from disorders of the pericardium, myocardium, endocardium, heart valves, or from certain metabolic abnormalities (Yancy et al., 2013).

Analysis:

Pertinent positives- shortness of breath, progressive activity intolerance, persistent productive cough, wheezing, HTN (155/94) Risk factors present: male, 62 yrs. old, history of HTN and smoking- Father has history CHF

Pertinent negatives- no edema in extremities, no JVD, heart rate 66 (no tachycardia)

Additional test or procedures:

Pulse oximetry- a simple non-invasive way to assess the patient’s arterial oxygen saturation. (GOLD, 2020). A decreased oxygen saturation may be present with COPD,Asthma, or HF. It is important to evaluate to determine if supplemental oxygen is needed.

Spirometry- Airﬂow limitation can be measured with spirometry. It is the most widely available and reproducible test of lung function (GOLD, 2020). This is a simple lung function test that can be used to diagnose asthma or COPD. An improvement of 12% and 200lm in the FEV1/FVC ratio after a bronchodilator indicates reversible airway obstruction. This would be helpful to differentiate asthma from COPD (Brigham & West, 2015).

Chest x ray- A chest-x ray will not diagnose asthma or COPD, but it will be used to exclude the presence of some other pulmonary or cardiac diseases (GOLD, 2020). It can show heart enlargement and ﬂuid in the lungs which would help diagnose HF.

CBC- A CBC will check for anemia, (which occurs in advanced COPD with hypoxemia), infection, or eosinophilia which would indicate an allergic or asthmatic component

(GOLD, 2020).

BNP-A lower BNP can exclude the presence of HF and a higher result has a reasonably high predictive value to diagnose HF (Yancy et al., 2013).

Reference: NR 601 Week 2 COPD Case Study Part 2

Bringham, E. West, N., (2015). Diagnosis of asthma: Diagnostic testing. International Forum of Allergy & Rhinology, 5 (1). 527-530. doi: 10.1022/air.21597

Global Initiative for Asthma. Management and prevention for adults and children over 5 years old. (2019). Retrieved from https://ginasthma.org/gina-reports/

Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management, and prevention of COPD, Global Initiative for Chronic Obstructive Lung

Disease (GOLD). (2020). Retrieved from

https://goldcopd.org/wp-content/uploads/2019/12/GOLD-2020-FINAL-ver1.2-03Dec19_ WMV.pdf

Yancy, C. W., Jessup, M., Butler, J., Drazner, M., Geraci, S., Januzzi, J., Kasper, E., Masoudi, F., McMurray, J., Peterson, P., Sam, F., Tang, W., Wilkoff, B. (2013). 2013

ACCF/AHA guideline for the management of heart failure. A report of the American

College of Cardiology Foundation/ American Heart Association task force on practice guidelines. Retrieved from

http://www.onlinejacc.org/content/accj/62/16/e147.full.pdf?_ga=2.28012988.1211871 446.1578704549-315720946.1563672617

Module 5 Assignment – Information Retrieval Paper, Part 3 COPD

Submit by 2359 Saturday at the close of Module 5 (Last week of the course)

Name

Date:

Overview: “Information Retrieval Paper: Part 3”

This week, you will complete Part 3 of the Information Retrieval Paper, which you

worked on Module 3 and 4. You are using the template provided, do not create a new word document.

So far, you have developed a research question, identiﬁed the PICO components of your research question, included your rationale for selecting your research question, created a title page for your paper in APA format, located three peer-reviewed articles, summarized each article in APA format, and critically analyzed the articles.

In this module, you will summarize and synthesize the key points of the peer-reviewed, evidence-based articles and develop a reference page in APA format.

Be sure to review the previous assignments that relate to the Information Retrieval Paper. Incorporate your Coach’s suggestions and corrections so you won’t make the same mistakes again in this last section of the Information Retrieval Paper.

Performance Objectives:

■ Synthesize the key points of peer-reviewed, evidence-based articles.

■ Develop a reference page in APA format.

■ Use correct grammar, punctuation, and American Psychological Association (APA) format in writing professional papers.

Rubric

Use this rubric to guide your work “Information Retrieval Paper, Part 3.”

Task

Accomplished

Proﬁcient

Needs Improvement

Missing Information

Week 5 Application: “Information RetrievalPaper: Part 3” (100 points total)Task #1: Conclusion: Summarize Key Points (Total 60points)

Key ﬁndings are identiﬁed and discussed relating to the identiﬁedresearch questionstudied. Well written with at least 3 sentences per topic. Scholarly writing is fully observed. (60 points)

Key ﬁndings are identiﬁed and minimally linked to the identiﬁed researchquestion studied. Two sentences are written per topic and scholarly writing ispredominantly observed. (40 points)

Key ﬁndings are not fully identiﬁed or discussed as related to the peer research question. One sentence per topic is noted and scholarly writing is not observed. (20 points)

Please Do not modify it. (0 points)

Task #2: Reference Page and In-textCitations (Total 40 points) Correct Grammar and APA Format are graded heavily.

References are cited in APAformat, alphabetized and complete. (30 points) Uses 3 properly formattedin-text citations to supportthoughts. (10 points)

Uses correct mechanics and APA format in writingprofessional papers (1-2 APA errors).(25 points) Uses 2 properly formatted in-textcitations to support thoughts OR 1-2 APA errors r/t citations(7 points)

3-4 APA and/or grammatical errors noted. (15 points) Uses 1 properlyformatted in-text citations to supportthoughts OR 3-4 APA errors r/t citations(3 points)

Does not use correct mechanics and/or APAformat (more than 5 APA andgrammatical errors).(0 points) NR 601 Week 2 COPD Case Study Part 2 No use of in-text citations to supportthoughts OR >5 APA

errors r/t citations (0 points)

Week 5 Application

Information Retrieval Paper: Part 3

In this week’s assignment, you will complete your Information Retrieval Paper. Review the outline for the entire assignment before you begin.

APA Format Elements	Timeline
Title Page in APA format	Completion Timeline
APA format Citations in the body of the paper Headings	Applicable each time sections are submitted
Writing style GrammarSpelling Paragraphs of at least three well-written sentencesOrganization and ﬂow	Applicable each time sections are submitted

Content Criteria	Timeline
Introduction: Identiﬁcation of clinical problem in a workplace settingResearch question stated correctly Rationale for questionTitle page	Completed Module 3
Summary of 3 peer-reviewed articles Overview: Where did you search? How did you decide on the 3 articles?3 article summaries	Completed Module 3
Critical Analysis Completeness of analysis	Completed Module 4
Conclusion Synthesis of key points for the 3 articles	To be completed Module 5 (now)

Reference Page Alphabetized Sources cited in APA format References complete	To be completed Module 5 (now)

Task #1 – Conclusion: Summarize Key Points

In this part of the Information Retrieval Paper, you will synthesize the main points from the three peer-reviewed, evidence-based articles.

Directions:

In this section write a paragraph or two to synthesize the key points of the articles. Consider this section a conclusion of your ﬁndings.

For full credit, each of the 3 articles needs a minimum of 3 sentences. Each article topic requires an in-text citation (3 total).

Synthesis Points from Articles (Type Below)

The ﬁrst article was a retrospective study exploring the Impact of a COPD comprehensive case management program on hospital length of stay and readmission rates. COPD accounts for the majority of chronic disease hospitalizations that are associated with substantial economic and social burdens in the form of impaired quality of life and increased healthcare utilization costs. COPD comprehensive case management program is a vital intervention that can be executed to counter the consequences of COPD hospitalizations.

The COPD comprehensive case management program encompassing patient education, follow-ups, and home visits signiﬁcantly reduces the length of hospital stay as well as readmission rates among COPD patients (Alshabanat et al., 2017).

Consequently, nurse leaders should implement the program to improve the overall quality of care for COPD patients.

The second article was a systematic review and meta-analysis investigating the impact of health coaching on hospital readmissions and health-related quality of life among COPD patients. This systematic review and meta-analysis demonstrated that implementation of health coaching, a self-management intervention consisting of goal setting, motivational interviewing, and COPD-related health education, exceptionally reduces hospital readmissions and improves the health-related quality of life among COPD patients (Long et al., 2019).

Nurse leaders should establish the most effective health coaching components and delivery modality to accrue its beneﬁts among COPD patients. The ﬁnal article looked into the role of respiratory care education in reducing readmissions in COPD patients. This research conducted at Houston Methodist Hospital exhibited that respiratory care education in COPD patients remarkably reduces hospital readmissions (RajtakMuller & Berger, 2018).

However, offering respiratory education to COPD patients should be a multidisciplinary approach with nurses as active and critical participants. Subsequently, nurse leaders should consider a multidisciplinary task force including respiratory therapists in the identiﬁcation, development, and implementation of a care plan that educates the patients as well as their families on COPD as a disease process.

Task #2 – Reference Page

In this part of the Information Retrieval Paper, you will create the reference page for the entire paper in APA format.

Directions:

■ Develop the reference page for your Information Retrieval Paper. Make sure that references are:

– cited in APA format.

– alphabetized.

■ Complete the reference page in the space below.

– Must have 3 peer-reviewed, evidence-based articles

Reference Page (Type Below)

NR 601 Week 2 COPD Case Study Part 2 References

● Al-Jundi, A., & Sakka, S. (2017). Critical appraisal of clinical research. Journal of Clinical and Diagnostic Research: JCDR, 11(5), JE01–JE05.

https://doi.org/10.7860/JCDR/2017/26047.9942

● Alshabanat, A., Otterstatter, M. C., Sin, D. D., Road, J., Rempel, C., Burns, J., van Eeden, S. F., & FitzGerald, J. M. (2017). Impact of a COPD comprehensive case management program on hospital length of stay and readmission rates.

International Journal of Chronic Obstructive Pulmonary Disease, 12, 961–971. https://doi.org/10.2147/COPD.S124385

● Cathala, X., & Moorley, C. (2018). How to appraise quantitative research.

Evidence-Based Nursing, 21(4), 99–101. https://doi.org/10.1136/eb-2018-102996

● Collinsworth, A. W., Brown, R. M., James, C. S., Stanford, R. H., Alemayehu, D., & Priest, E. L. (2018). The impact of patient education and shared decision-making on hospital readmissions for COPD. International Journal of Chronic Obstructive Pulmonary Disease, 13, 1325–1332. https://doi.org/10.2147/COPD.S154414

● Long, H., Howells, K., Peters, S., & Blakemore, A. (2019). Does health coaching improve health-related quality of life and reduce hospital admissions in people with chronic obstructive pulmonary disease? A systematic review and meta-analysis. British Journal of Health Psychology, 24(3), 515–546. https://doi.org/10.1111/bjhp.12366

● RajtakMuller, L., & Berger, M. (2018). Respiratory care education: A vital role for Respiratory Therapists in reducing readmissions in COPD patient population. Respiratory Care, 63(Suppl 10).http://rc.rcjournal.com/content/63/Suppl_10/3007422

● Tawﬁk, G. M., Dila, K. A. S., Mohamed, M. Y. F., Tam, D. N. H., Kien, N. D., Ahmed, A. M., & Huy, N. T. (2019). A step-by-step guide for conducting a systematic review and meta-analysis with simulation data. Tropical Medicine and Health, 47(1), 46. https://doi.org/10.1186/s41182-019-0165-6

Submit this Assignment Document into Canvas for grading.

NR 601 Week 2 COPD Case Study Part 2