NR507 Week 1 All Assignments May 2023 Latest

NR507

Week 1 Case Study

Assignment

Purpose

The purpose of this assignment is to apply hypersensitivity pathophysiological concepts to explain assessment findings of a patient with Allergic Rhinitis. Students will examine all aspects of the patient’s assessment including: Chief Complaint (CC), History of Present Illness (HPI), Past Medical History (PMH), Family History (FH), Social History (SH), Review of Systems (ROS), and Medications and then answer the questions that follow on the provided Comprehensive Case Study template.

Activity Learning Outcomes

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

1.Analyze the case to arrive at the type of hypersensitivity reaction that the patient is exhibiting. (CO1)

2.Explain the pathophysiology of the identified hypersensitivity reaction. (CO1)

3.Identify all subjective and objective information provided in the case. (CO3)

4.Explain, using pathophysiology, the rationale for each subjective and objective finding. (CO1, CO3)

5.Identify two types of medications that are strongly recommended for the treatment of allergic rhinitis according to the clinical practice guidelines on the management of allergic rhinitis. (CO2, CO5)

6.Explain the mechanism of action of the two medication classifications and include how the symptoms of allergic rhinitis are alleviated when taken. (CO2, CO5)

Due Date

Sunday by 11:59 PM MT of Week 1

Total Points Possible

This assignment is worth 100 points.

Preparing the Assignment

Content Criteria:

1.Read the case study listed below.

2.Refer to the rubric for grading requirements.

3.Utilizing the Week 1 Case Study TemplateLinks to an external site., provide your responses to the case study questions listed below.

4.You must use at least one scholarly reference to provide pathophysiology statements. For this class, use of the textbook for pathophysiology statements is acceptable. You may also use an appropriate evidence-based journal.

5.You must use the Clinical Practice Guideline (CPG) for the management of allergic rhinitis to answer the treatment recommendation questions. The guideline can be found at the following web address: https://journals.sagepub.com/doi/10.1177/0194599814561600Links to an external site..You may also use a medication administration reference such as Epocrates to provide medication names.

6.Proper APA format (in-text citations, reference page, spelling, English language, and grammar) must be used.

Case Study Scenario

A 35-year-old woman presents to the primary care office with a history of nasal congestion that has worsened over time and recurrent sinus infections. She considered herself healthy until about 12 months ago when she began experiencing rhinorrhea, sneezing, and nasal stuffiness that “seems to never go away”. She noticed that her rhinorrhea greatly improved when she attended her family reunion on a two-week Caribbean cruise but returned after being home a few days. She lives with her husband and 5- year-old child. They have two household pets: a dog that has lived with them for the last 4 years and a cat who joined the family 1 year ago. Upon exam, the NP observed eyelid redness and swelling, conjunctival swelling and erythema, allergic shiners (lower lid venous swelling), Allergic crease (lateral crease on the nose) and inflamed nares.

Case Study Questions

Pathophysiology & Clinical Findings of the Disease

1.Identify the correct hypersensitivity reaction.

2.Explain the pathophysiology associated with the chosen hypersensitivity reaction.

3.Identify at least three subjective findings from the case.

4.Identify at least three objective findings from the case.

Management of the Disease

*Utilize the required Clinical Practice Guideline (CPG) to support your treatment recommendations.

1.Identify two strongly recommended medication classes for the treatment of the condition and provide an example (drug name) for each.

2.Describe the mechanism of action for each of the medication classes identified above.

3.Identify two treatment options that are NOT recommended (I.e., recommended against).

 

 

 

NR507

Week 3 Case Study

Assignment

Purpose

The purpose of this assignment is to apply pulmonary pathophysiological concepts to explain assessment findings of a patient with respiratory disease. Students will examine all aspects of the patient’s assessment including: Chief Complaint (CC), History of Present Illness (HPI), Past Medical History (PMH), Family History (FH), Social History (SH), Review of Systems (ROS), and Medications and then answer the questions that follow on the provided Comprehensive Case Study template.

Activity Learning Outcomes

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

1.            Examine the case scenario and analyze the spirometry results to determine the most likely respiratory diagnosis. (CO1)

Explain the pathophysiology of the respiratory disease. (CO1)

Differentiate between subjective and objective findings which support the chosen diagnosis. (CO4)

Apply evidence-based practice guidelines to classify the severity of the respiratory disorder and employ an appropriate treatment plan. (CO1, CO5)

Due Date

Sunday by 11:59 PM MT of Week 3

Total Points Possible

This assignment is worth 100 points.

Preparing the Assignment

Requirements

Content Criteria:

1.Read the case study listed below.

2.Refer to the rubric for grading requirements.

3.Utilizing the Week 3 Case Study TemplateLinks to an external site., provide your responses to the case study questions listed below.

4.You must use at least one scholarly reference to provide pathophysiology statements. For this class, use of the textbook for pathophysiology statements is acceptable. You may also use an appropriate evidence-based journal.

5.You must use the current Clinical Practice Guideline (CPG) for the management and prevention of COPD (GOLD Criteria) to answer the classification of severity and treatment recommendation questions. The most current guideline may be found at the following web address: https://goldcopd.org/Links to an external site.. At the website, locate the current year’s CPG and download a personal copy for use. You may also use a medication administration reference such as Epocrates to provide medication names.

6.Proper APA format (in-text citations, reference page, spelling, English language, and grammar) must be used.

Case Study Scenario

Chief Complaint

A.C., is a 61-year old male with complaints of shortness of breath.

History of Present Illness

A.C. was seen in the emergency room 1 week ago for an acute onset of mid-sternal chest pain. The event was preceded with complaints of fatigue and increasing dyspnea for 3 months, for which he did not seek care. He was evaluated by cardiology and underwent a successful and uneventful angioplasty prior to discharge. Despite the intervention, the shortness of breath has not improved. Since starting cardiac rehabilitation, he feels that his breathlessness is worse. The cardiologist has requested that you, his primary care provider, evaluate him for further work-up. Prior to today, his last visit with your practice was 3 years ago when he was seen for acute bronchitis and smoking cessation counseling.

Past Medical History?

•Hypertension?

•Hyperlipidemia?

•Atherosclerotic coronary artery disease

•Smoker

Family History

•Father deceased of acute coronary syndrome at age 65

•Mother deceased of breast cancer at age 58.?

•One?sister, alive, who is a 5 year breast cancer survivor.

•One son and one daughter with no significant medical history.?

Social History

•35 pack-year smoking history; he has cut down to one cigarette at bedtime following his cardiac intervention.?

•Denies alcohol or recreational drug use?

Real estate agent??

Allergies

•No Known Drug Allergies?

Medications

•Rosuvastatin?20 mg?once daily by mouth?

•Carvedilol 25 mg twice daily by mouth

•Hydrochlorothiazide 12.5 mg once daily?by mouth

•Aspirin 81mg daily by mouth

Review of Systems

•Constitutional: Denies fever, chills or weight loss. + Fatigue.

•HEENT: Denies nasal congestion, rhinorrhea or sore throat.??

•Chest: + dyspnea with exertion. Denies productive cough or wheezing. + Dry, nonproductive cough in the AM.

•Heart: Denies chest pain, chest pressure or palpitations.

•Lymph: Denies lymph node swelling.

General Physical Exam??

•Constitutional: Alert and oriented male in no apparent distress.??

•Vital Signs:?BP-120/84, T-97.9 F, P-62, RR-22, SaO2: 93%?

•Wt. 180?lbs.,?Ht.?5’9″

HEENT?

•Eyes: Pupils equal, round and reactive to light and accommodation, normal conjunctiva.?

•Ears: Tympanic membranes intact.?

•Nose: Bilateral nasal turbinates without redness or swelling. Nares patent.?

•Mouth: Oropharynx clear. No mouth lesions. Dentures well-fitting.?Oral mucous membranes dry.?

Neck/Lymph Nodes?

•Neck supple without JVD.?

•No lymphadenopathy, masses or carotid bruits.?

Lungs?

•Bilateral breath sounds clear throughout lung fields. + Bilaterally wheezes noted with forced exhalation along with a prolonged expiratory phase. No intercostal retractions.

Heart?

•S1 and S2 regular rate and rhythm, no rubs or murmurs.?

Integumentary System?

•Skin cool, pale and dry. Nail beds pink without clubbing. ?

Chest?X-Ray?

•Lungs are hyper-inflated bilaterally with?a flattened?diaphragm. No effusions or?infiltrates.

Spirometry

Title       Predicted            Pre-bronchodilator         % Predicted        Post-bronchodilator       % Predicted        Change

FVC (L)  5.64        5.23        93           5.77        102         9%

FEV1 (L)                4.57        2.92        64           3.01        66           2%

FEV1/FVC (%)    81           56           69           52           64           -5%

TLC         5.5          6.9          125         6.9          125         0%

Case Study Questions

Pathophysiology & Clinical Findings of the Disease

1.Are the spirometry results consistent with obstructive or restrictive pulmonary disease? What is the most likely pulmonary diagnosis for this patient?

2.Explain the pathophysiology associated with the chosen pulmonary disease.

3.Identify at least three subjective findings from the case which support the chosen diagnosis.

4.Identify at least three objective findings from the case which support the chosen diagnosis.

Management of the Disease

*Utilize the required Clinical Practice Guideline (CPG) to support your treatment recommendations.

1.Classify the patient’s disease severity. Is this considered stable or unstable?

2.Identify two (2) “Evidence A” recommended medication classes for the treatment of this condition and provide an example (drug name) for each.

3.Describe the mechanism of action for each of the medication classes identified above.

4.Identify two (2) “Evidence A” recommended non-pharmacological treatment options for this patient.

 

 

NR507

Week 6 Case Study

Assignment

Purpose

The purpose of this assignment is to apply endocrine pathophysiological concepts to explain assessment findings of a patient with Diabetes. Students will examine all aspects of the patient’s assessment including: Chief Complaint (CC), History of Present Illness (HPI), Past Medical History (PMH), Family History (FH), Social History (SH), Review of Systems (ROS), and Medications and then answer the questions that follow on the provided Comprehensive Case Study template.

Activity Learning Outcomes

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

1.Examine the case scenario and analyze the exam and lab findings results to determine the patient’s type of diabetes. (CO1)

2.Explain the pathophysiology of the type of diabetes. (CO1)

3.Differentiate between subjective and objective findings which support the chosen diagnosis. (CO4)

4.Apply evidence-based practice guidelines to develop an appropriate treatment plan. (CO1, CO5)

Due Date

Sunday by 11:59 PM MT of Week 6

Total Points Possible

This assignment is worth 100 points.

Preparing the Assignment

Requirements

Content Criteria

1.Read the case study listed below.

2.Refer to the rubric for grading requirements.

3.Utilizing the Week 6 Case Study TemplateLinks to an external site., provide your responses to the case study questions listed below.

4.You must use at least one scholarly reference to provide pathophysiology statements. For this class, use of the textbook for pathophysiology statements is acceptable. You may also use an appropriate evidence-based journal.

5.You must use the current Clinical Practice Guideline (CPG) for the Standards of Medical Care in Diabetes -Abridged for Primary Care Providers provided by the American Diabetes Association to determine the patient’s type of diabetes and answer the treatment recommendation questions. The most current guideline can be found at the following web address: https://professional.diabetes.org/content-page/practice-guidelines-resourcesLinks to an external site. At the website, locate the current year’s CPG for use.

6.Proper APA format (in-text citations, reference page, spelling, English language, and grammar) must be used.

Case Study Scenario

Chief Complaint

J.T. is a 48-year old male who presents to the primary care clinic with fatigue, weight loss, and extreme thirst and increased appetite.

History of Present Illness

J.T. has been in his usual state of health until three weeks ago when he began experiencing symptoms of fatigue, weight loss, and extreme thirst. He reports that he would like to begin a walking program, but he feels too fatigued to walk at any point during the day. Now he is very concerned about gaining more weight since he is eating more. He reports insomnia due to having to get up and urinate greater than 4 times per night.

Past Medical History?

•Hypertension

•Hyperlipidemia

•Obesity

Family History

•Both parents deceased

•Brother: Type 2 diabetes?

Social History

•Denies?smoking

•Denies alcohol or recreational drug use

•Landscaper??

Allergies

•No Known Drug Allergies?

Medications

•Lisinopril 20 mg once daily by mouth

•Atorvastatin 20 mg once daily by mouth

•Aspirin 81 mg once daily by mouth

•Multivitamin once daily by mouth

Review of Systems

•Constitutional: – fever, – chills, – weight loss.

•Neurological: denies dizziness or disorientation

•HEENT: Denies nasal congestion, rhinorrhea or sore throat.??

•Chest: (-)Tachypnea. Denies cough.

•Heart: Denies chest pain, chest pressure or palpitations.

•Lymph: Denies lymph node swelling.

General Physical Exam??

•Constitutional: Alert and oriented male in no acute distress ??

•Vital Signs:?BP-136/80, T-98.6 F, P-78, RR-20

•Wt. 240?lbs.,?Ht.?5’8″, BMI 36.5

HEENT?

•Eyes: Pupils equal, round and reactive to light and accommodation, normal conjunctiva.?

•Ears: Tympanic membranes intact.?

•Nose: Bilateral nasal turbinates without redness or swelling. Nares patent.?

•Mouth: Oropharynx clear. No mouth lesions. Teeth present and intact; Oral mucous membranes and lips dry.?

Neck/Lymph Nodes?

•Neck supple without JVD.?

•No lymphadenopathy, masses or carotid bruits.?

Lungs?

•Bilateral breath sounds clear throughout lung fields. Breathing quality deep with fruity breath odor

Heart?

•S1 and S2 regular rate and rhythm; – tachycardia; no rubs or murmurs.?

Integumentary System?

•Skin warm, dry; Nail beds pink without clubbing. ?

Labs

Test       Patient’s Result Reference

Glucose (fasting)              132         60-120 mg/dL

BUN       20           7-24 mg/dL

Creatinine           0.8          0.7-1.4 mg/dL

Sodium 141         135-145 mEq/L

Sodium 141         135-145 mEq/L

Chloride               97           95-105 mEq/L

HCO3     24           22-28 mEq/L

A1C        7.2         

Urinalysis

Protein

Glucose

Ketones              

Negative

Positive

Negative             

Oral glucose tolerance test (OGTT)          220 mg/dL          

J.T. is diagnosed with diabetes. Review all information provided in the case to answer the following questions.

Case Study Questions

Pathophysiology & Clinical Findings of the Disease

1.Review the lab findings and decide if the diagnosis is Type 2 or Type 1 Diabetes Mellitus.

2.Explain the pathophysiology associated with your chosen diagnosis

3.Identify at least three subjective findings from the case which support the chosen diagnosis.

4.Identify at least three objective findings from the case which support the chosen diagnosis.

Management of the Disease

*Utilize the required Clinical Practice Guideline (CPG) to support your treatment recommendations.

1.Identify two (2) “Evidence A” recommended medication classes for the treatment of this condition and provide an example (drug name) for each.

2.Describe the mechanism of action for each of the medication classes identified above.

3.Identify two (2) “Evidence A” recommended non-pharmacological treatment options for this patient.

4.Utilizes the required Clinical Practice Guideline (CPG) to support the chosen treatment recommendations