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NR 601 Week 2: COPD Case Study Part 2

NR 601 Week 2: COPD Case Study Part 2

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 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 Actual %Predicted Actual % 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/FV .75 .52 .52 0

 

Requirements/Questions:

  1. 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)
  2. Identify the corresponding ICD-10 code.
  3. 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
  4. Provide an active problem list for this patient based on the information given in the case.
  5. 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.

ORDER NR 601 Week 2: COPD Case Study Part 2

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 15 30%
  1. Student chooses one appropriate diagnosis for the patient; AND
  2. Diagnosis is supported with strong pertinent positive and negative subjective and objective data from parts 1 & 2; AND
  3. The ICD code for the diagnosis is correct; AND
  4. Treatment plan for primary diagnosis includes medication, additional testing, patient education, and referral; AND
  5. Prescription and OTC medications are written appropriately as a RX and all components are correct; AND
  6. Treatment decisions (medication, additional testing, referrals) are supported with appropriate EBP arguments; AND
  7. An accurate problem list is presented based on case information; AND
  8. Student discusses changes (or not) to the overall treatment plan for the patient for pertinent issues; AND
  9. 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:

  1. Demonstrate competence in the evaluation and management of common respiratory problems (WO 2.1)  (CO,2,3,4,5)
  2. 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)
  3. Interpret pulmonary function test results. (WO 2.3) (CO 2, 4)

Due Date: 

Student enters 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 11:59pm MT, regardless of the number of days late. NOTHING will be accepted after 11:59pm MT on Sunday (i.e. student 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
Aggravating factors 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 wakening 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

ORDER NR 601 Week 2: COPD Case Study Part 2 and Part 1

History
Medications Metoprolol succinate ER (Toprol-XL) 50mg daily for hypertension; Multivitamin daily
PMH Primary hypertension
PSH Cholecystectomy, appendectomy
Allergies 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 forced expiratory wheezes in bilateral bases. Respirations unlabored. Legs without edema.
Abdomen Soft, non-tender. No organomegaly

 

Requirements/Questions:

  1. 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.
  2. 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.
  3. Analyze the differential by using the pertinent findings from the history and physical to argue for or against a diagnosis.
  4. Rank the differential in order of most likely to least likely.
  5. Identify any additional tests and/or procedures that you feel is 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 Points % Description
Application of Course Knowledge 15 30% 1.      A brief AND concise summary of the history and physical (H&P) findings is presented without redundancy or irrelevant information; AND

2.      Three (3) appropriate diagnoses in the differential are presented which can explain the patient’s chief complaint; AND

3.      A brief statement of pathophysiology is included for each diagnosis; AND

4.      Each diagnosis in the differential is analyzed using pertinent positive and 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 from Evidence-Based Practice (EBP) 15 30% 1.      Discussion post is supported with appropriate, scholarly sources; AND

2.      Sources are published within the last 5 years (unless it is the most current CPG); AND

3.      Reference list is provided and in-text citations match; AND

4.      All testing decisions are fully supported with an appropriate EBP argument

(4 critical elements)

Interactive Dialogue 10 20% 1.      Student provides a substantive* response to at least one topic-related post of a peer; AND

2.      Evidence from appropriate scholarly sources are included; AND

3.      Reference list is provided and in-text citations match; AND

4.      Student responds to all direct faculty questions

(*) A substantive post adds new content or insights to the discussion thread and information from student’s original post is not reused in peer or faculty response

(4 critical elements)

Total CONTENT Points= 40 pts
DISCUSSION FORMAT
Category Points % Description
Organization 5 10% 1.      Case study response is presented in a logical format, AND

2.      Responses are in sequence with the numbered questions AND

3.      The case study response is understandable and easy to follow AND

4.      All responses are relevant to the case topic

(4 critical elements)

Grammar, Syntax, Spelling & Punctuation 5 10% Discussion post has minimal grammar, syntax, spelling, punctuation, or APA format errors*

 

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, 2020Jan 12 at 8:06am

Manage Discussion Entry

Summary

Patient is a 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-year 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.

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)).

ORDER NR 601 Week 2: COPD Case Study Part 2

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 abnormities (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 measure 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 (Bringham & West, 2015).

Chest x ray- A chest-xray will not diagnose asthma or COPD, but it will be used 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:

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=2.28012988.1211871446.1578704549-315720946.1563672617

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 in 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 Retrieval Paper: Part 3” (100 points total)

Task #1:

Conclusion: Summarize Key Points (Total 60 points)

Key findings are identified and discussed relating to the identified research question studied.  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 research question studied. Two sentences are written per topic and scholarly writing is predominately 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)

 

Does not complete.

(0 points)

Task  #2:

Reference Page and In-text Citations

(Total 40 points)

 

Correct Grammar and APA Format are graded heavily.

 

 

 

References are cited in APA format, alphabetized and complete.

(30 points)

 

 

 

Uses 3 properly formatted in-text citations to support thoughts.

 

(10 points)

Uses correct mechanics and APA format in writing professional papers (1-2 APA errors).

 (25 points)

 

 

 

Uses 2 properly formatted in-text citations 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 properly formatted in-text citations to support thoughts OR 3-4 APA errors r/t citations

(3 points)

Does not use correct mechanics and/or APA format (more than 5 APA and grammatical errors).

(0 points)

 

No use of in-text citations to support thoughts 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 your 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

Grammar

Spelling

Paragraphs of at least three well-written sentences

Organization and flow

Applicable each time sections are submitted
Content Criteria Timeline
Introduction:

Identification of clinical problem in a workplace setting

Research question stated correctly

Rationale for question

Title 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 systemic review and meta-analysis investigating the impact of health coaching on hospital readmissions and health-related quality of life among COPD patients. This systemic review and meta-analysis demonstrated that implementation of health coaching, a self-management intervention comprising 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)

 

References

Al-Jundi, A., & Sakka, S. (2017). Critical appraisal of clinical research. Journal of Clinical and Diagnostic Research: JCDR11(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 Disease12, 961–971. https://doi.org/10.2147/COPD.S124385

Cathala, X., & Moorley, C. (2018). How to appraise quantitative research. Evidence-Based Nursing21(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 Disease13, 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 the chronic obstructive pulmonary disease? A systematic review and meta-analysis. British Journal of Health Psychology24(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 Care63(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 Health47(1), 46. https://doi.org/10.1186/s41182-019-0165-6

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