NUR 504 506

Throat, Respiratory & Cardiovascular Disorders For this Discussion, you will take on the role of a clinician who is building a health history for one of the following cases. Your instructor will assign you your case number. Case 2


Case 1 Case 2 Case 3

Chief Compl aint (CC)

A 65-year-old male with chronic obstructive pulmonary disease (COPD) presents to the clinic with a cough he has had for the past 2 weeks.

A 25-year-old Hispanic female, computer programmer presents to your clinic complaining of a 12- day history of a runny nose

A 75-year-old female reports experiencing pain in her chest while walking up steps today.

Subje ctive

denies chest pain, denies night sweats, admits to having a fever but does not know the temp.

States that her symptoms began about 12 days ago. She suffers from allergies; she gets a runny nose during the spring-time, pollen season. However, in the winter, her allergies are not a problem.

Could not sleep previous night. Feels like an ache or a burning sensation at the center of sternum. Denies any arm pain, pain was at a scale of 8 in the AM now it is at a 2. Suffers from History of hypertension, denies heart disease, denies leg swelling up, denies pain feeling worse when taking deep breath.

Objective Data

VS

(BP) 115/75, (P) 89, (RR) 16, (T) 100.4°F (38°C), O2 sat 98% on room air.

(BP) 115/75, (P) 89, (RR) 16, (T) 100.4°F (38°C), O2 sat 98% on room air

BP 129/70, (HR) 72 and regular, (RR) 16 unlabored, temperature 98.8°F, oral pulse oximetry is 99%

Gener al

patient appears tired; skin color pale, patient is diaphoretic and sweaty, height 5′3″; weight 175 lbs

No signs of acute distress. Patient appears mildly fatigued. She is breathing through her mouth. Breathing easily. Voice has a nasal quality to it.

obese female, alert, in no acute distress.

HEEN T

EYES: no injection, no increase in lacrimation or purulent drainage; EARS: normal TM: Normal NOSE: Bilateral erythema and edema of turbinates with significant yellow drainage on the right. Obstructed air passages

Ear canals: normal; EYES: normal; NOSE: Bilateral erythema and edema of turbinates with significant yellow drainage on the right. Nares: Obstructed air passages

Atraumatic, normocephalic, PERRLA, EOMI, sclera with mild icterus, nares patent, nasopharynx clear, poor dentition – multiple carries.

Respir atory

lung crackles in LLL, no wheezes or rhonchi noted; does not clear with coughing; dullness to percussion over the LLL; shallow respirations and is 30, accessory muscles use not present

CTA AP&L CTA AP&L


 Once you received your case number, answer the following questions:

1. What other subjective data would you obtain? 2. What other objective findings would you look for? 3. What diagnostic exams do you want to order? 4. Name 3 differential diagnoses based on this patient

presenting symptoms? 5. Give rationales for your each differential diagnosis.

Submission Instructions:

• Your instructor will assign you your case number and you will post on the case number you have been assigned.

• You will reply to the other two case studies (One of each). • Your initial post should be at least 500 words, formatted and

cited in current APA style with support from at least 2 academic sources. Your initial post is worth 8 points.

• You should respond to at least two of your peers by extending, refuting/correcting, or adding additional nuance to their posts. Your reply posts are worth 2 points (1 point per response.) 

• All replies must be constructive and use literature where possible

Neck/ Throat

no neck swelling or tenderness with palpation; neck is supple; no JVD; thyroid is not enlarged; trachea midline

Posterior pharynx: mildly injected, scant postnasal drainage (PND), no exudate, tonsils 1+, no cobblestoning

carotids are 2+ without bruits; thyroid is not palpable; no lymphadenopathy

Heart Regular rate and rhythm, no murmur, S3, or S4

Regular rate and rhythm, no murmur, S3, or S4

S1 and S2 normal without murmur, gallop, or rub

Throat, Respiratory & Cardiovascular Disorders For this Discussion, you will take on the role of a clinician who is building a health history for one of the following cases. Your instructor will assign you your case number. Case 2


Case 1 Case 2 Case 3

Chief Compl aint (CC)

A 65-year-old male with chronic obstructive pulmonary disease (COPD) presents to the clinic with a cough he has had for the past 2 weeks.

A 25-year-old Hispanic female, computer programmer presents to your clinic complaining of a 12- day history of a runny nose

A 75-year-old female reports experiencing pain in her chest while walking up steps today.

Subje ctive

denies chest pain, denies night sweats, admits to having a fever but does not know the temp.

States that her symptoms began about 12 days ago. She suffers from allergies; she gets a runny nose during the spring-time, pollen season. However, in the winter, her allergies are not a problem.

Could not sleep previous night. Feels like an ache or a burning sensation at the center of sternum. Denies any arm pain, pain was at a scale of 8 in the AM now it is at a 2. Suffers from History of hypertension, denies heart disease, denies leg swelling up, denies pain feeling worse when taking deep breath.

Objective Data

VS

(BP) 115/75, (P) 89, (RR) 16, (T) 100.4°F (38°C), O2 sat 98% on room air.

(BP) 115/75, (P) 89, (RR) 16, (T) 100.4°F (38°C), O2 sat 98% on room air

BP 129/70, (HR) 72 and regular, (RR) 16 unlabored, temperature 98.8°F, oral pulse oximetry is 99%

Gener al

patient appears tired; skin color pale, patient is diaphoretic and sweaty, height 5′3″; weight 175 lbs

No signs of acute distress. Patient appears mildly fatigued. She is breathing through her mouth. Breathing easily. Voice has a nasal quality to it.

obese female, alert, in no acute distress.

HEEN T

EYES: no injection, no increase in lacrimation or purulent drainage; EARS: normal TM: Normal NOSE: Bilateral erythema and edema of turbinates with significant yellow drainage on the right. Obstructed air passages

Ear canals: normal; EYES: normal; NOSE: Bilateral erythema and edema of turbinates with significant yellow drainage on the right. Nares: Obstructed air passages

Atraumatic, normocephalic, PERRLA, EOMI, sclera with mild icterus, nares patent, nasopharynx clear, poor dentition – multiple carries.

Respir atory

lung crackles in LLL, no wheezes or rhonchi noted; does not clear with coughing; dullness to percussion over the LLL; shallow respirations and is 30, accessory muscles use not present

CTA AP&L CTA AP&L


 Once you received your case number, answer the following questions:

1. What other subjective data would you obtain? 2. What other objective findings would you look for? 3. What diagnostic exams do you want to order? 4. Name 3 differential diagnoses based on this patient

presenting symptoms? 5. Give rationales for your each differential diagnosis.

Submission Instructions:

• Your instructor will assign you your case number and you will post on the case number you have been assigned.

• You will reply to the other two case studies (One of each). • Your initial post should be at least 500 words, formatted and

cited in current APA style with support from at least 2 academic sources. Your initial post is worth 8 points.

• You should respond to at least two of your peers by extending, refuting/correcting, or adding additional nuance to their posts. Your reply posts are worth 2 points (1 point per response.) 

• All replies must be constructive and use literature where possible

Neck/ Throat

no neck swelling or tenderness with palpation; neck is supple; no JVD; thyroid is not enlarged; trachea midline

Posterior pharynx: mildly injected, scant postnasal drainage (PND), no exudate, tonsils 1+, no cobblestoning

carotids are 2+ without bruits; thyroid is not palpable; no lymphadenopathy

Heart Regular rate and rhythm, no murmur, S3, or S4

Regular rate and rhythm, no murmur, S3, or S4

S1 and S2 normal without murmur, gallop, or rub