Discussion:Assessing Peripheral Vascular System

Discussion:Assessing Peripheral Vascular System

Discussion:Assessing Peripheral Vascular System

ORDER NOW FOR AN ORIGINAL PAPER ASSIGNMENT: Discussion:Assessing Peripheral Vascular System

I need 1 reply comment to each post with a credible sources, citation and years above 2013 in APA format.

Post 1

CHIEF COMPLAINT: Shortness of Breath and cough

Subjective: Pt presents with complaints of shortness of breath and productive cough. Pt relates he is coughing up thick green sputum with occasional bloody sputum. Pt relates that he has increased shortness of breath with walking. Patient relates that he is also short of breath at rest. Pt also relates that he has had some chills and sweats and felt like he may have a fever. He states that he has taken Tylenol for those symptoms.

Objective: Temperature 100.9, Respiratory rate 20, Heart rate 82, Blood pressure right arm 128/70, Oxygen saturation 89% on room air, Weight 210 pounds, EKG shows normal sinus rhythm, Chest radiograph

Assessment: Skin is warm and moist. Thorax is symmetrical with diminished breath sounds with rales and expiratory wheezes throughout, negative for rhonchi. Wet productive cough noted during exam. Heart is regular sinus rhythm with rate of 82. Good S1, S2; negative S3 or S4 and negative for murmur. Abdomen protuberant with normoactive bowel sounds auscultated in all four quadrants. No pedal edema noted. 2+ dorsalis pedis pulses bilaterally. Neurologic: Patient is awake, alert and oriented to person, place and time. Chest radiograph shows infiltrate in the right middle lobe.

Priority diagnosis includes 1. Pneumonia 2. Myocardial Infarction 3. Pulmonary embolism 4. Congestive Heart Failure 5. Asthma

1. Pneumonia: The patient presents with productive cough and shortness of breath with exertion. Patient has elevated temperature and low oxygen saturations along with diminished breath sounds, rales and expiratory wheezes which are all consistent symptoms with community acquired pneumonia. (Lynn, 2017). Chest radiograph shows right middle lobe infiltrate which is also consistent with pneumonia. (Kaysin and Viera, 2016).

2. Myocardial Infarction: The patient presents with shortness of breath and low oxygen saturations. Pt states that his shortness of breath is worse with exertion but is present at rest also. Dyspnea is a frequent associated symptom with MI. (Lawesson, Thylen, Ericsson, Swahn, Isaksson and Angerud, 2018). The patient did have an EKG completed that revealed a normal sinus rhythm at a rate of 80 with no obvious signs of ectopy. Evaluation of troponin level would assist in ruling out MI as a diagnosis for this patient. (Berliner, Schneider, Welte and Bauersachs, 2016).

3. Pulmonary Embolism: Dyspnea is the primary symptom for patients with PE. (Garcia-Sanz, Pena-Alvarez, Lopez-Landeiro, Bermo-Dominguez, Fonturbel and Gonzalex-Barcala, 2014). Onset of dyspnea with PE is typically sudden and further history for this patient related to onset of symptoms. Evaluation of any extremity pain and swelling, D-dimer or chest angiography would also assist in determining if this was a more likely diagnosis. (Berliner, Schneider, Welte and Bauersachs, 2016).

4. Congestive Heart Failure: Dyspnea is also a common symptom with congestive heart failure. Fatigue, diminished exercise tolerance and fluid retention are also common symptoms of CHF. (Berliner, Schneider, Welte and Bauersachs, 2016). The patient has rales noted upon auscultation which could be consistent with congestive heart failure however coupled with the remainder of the exam including productive cough with thick green sputum and fever, CHF would not be the primary diagnosis. Further evaluation of extremities of abdomen and extremities for signs of fluid retention would be indicated as well as labs such as BNP.

5. Asthma: The patient has expiratory wheezes and shortness of breath which are both consistent with asthma; however the patient also has fever and productive cough which are not consistent asthma symptoms. (Huether and McCance, 2017).

Plan: Not indicated

References

Arcangelo, V. P., Peterson, A. M., Wilbur, V. & Reinhold, J. A. (Eds.). (2017). Pharmacotherapeutics for advanced practice: A practical approach (4th ed.). Ambler, PA: Lippincott Williams & Wilkins.

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2015). Seidel’s guide to physical examination (8th ed.). St. Louis, MO: Elsevier Mosby.

Berliner, D., Schneider, N., Welte, T., & Bauersachs, J. (2016). The Differential Diagnosis of Dyspnea. Deutsches Aerzteblatt International, 113(49), 834. doi:10.3238/arztebl.2016.0834

Debasis, D., & David C., H. (2009). Chest X-ray manifestations of pneumonia. Surgery Oxford, (10), 453. doi:10.1016/j.mpsur.2009.08.006

Dains, J. E., Baumann, L. C., & Scheibel, P. (2016). Advanced health assessment and clinical diagnosis in primary care (5th ed.). St. Louis, MO: Elsevier Mosby.

García-Sanz, M., Pena-Álvarez, C., López-Landeiro, P., Bermo-Domínguez, A., Fontúrbel, T., & González-Barcala, F. (2014). Original article: Symptoms, location and prognosis of pulmonary embolism. Revista Portuguesa De Pneumologia, 20194-199. doi:10.1016/j.rppneu.2013.09.006

Post 2

S:

Chief Complaint: “I am having chest pain at this time”

History of Present Illness: Pleasant, Caucasian male experiencing an acute onset of sharp, constant chest pain when taking a deep breath. Denies any alleviating factors. Yesterday his wife noticed his RT leg was edematous with erythema, denies any injury. Recently he returned from a vacation with an 8-hour plane ride. The patient was not asked if his pain radiated or if he had nausea or dizziness.

Past Medical History: Denies taking any medications. Allergies, surgeries, past medical conditions “not provided.” History of cancer or deep vein thrombosis not provided.

Social History: Married

Review of symptoms:

General: Feels short of breath when taking a deep breath, also having sharp lower RT rib pain.

Cardiovascular: Experiencing tachycardia. Peripheral edema started yesterday in RT lower leg.

Pulmonary: Reports having sharp pain when taking a deep breath with no relief measures noted. Complains of dyspnea with productive hemoptysis cough this morning.

Gastrointestinal: “not provided.”

O:

VS: BP 148/88 RT arm; P 112 and irregular; R 32 and labored; T 97.9 orally; Pulse Ox 90% on RA; His current weight is stable at 210 pounds.

General: Well-nourished, a well developed Caucasian male who is alert and cooperative. He is a good historian and answers questions appropriately. Patient sitting upright at the side of the cot appears anxious with labored breathing. Guarding noted in the anterior, distal RT rib area.

Cardiovascular: Skin is pallor, cool and diaphoretic. Heart rate is tachycardic. S1 and S2 irregular with no S3, S4, or murmur auscultated. RT calf with erythema, 2+ edema, warmth, and tender with palpation. LT leg with no edema, tenderness, or erythema noted. Bilateral 2+ dorsalis pedis pulse. Telemetry showing a sinus arrhythmia.

Gastrointestinal: Protuberant abdomen with active bowels x 4 quadrants.

Pulmonary: LT Lung clear to auscultation, RT middle and lower lobes with diminished breath sounds. No rales, rhonchi, or wheezing auscultated. Respirations labored. Respiratory excursion symmetrical.

Diagnostic results: CXR, ECG, venous doppler studies and ultrasound for DVT, V/Q scan, CT of the chest, labs- sputum culture, cardiac enzymes. Telemetry.

A:

Differential Diagnosis:

1.) Pulmonary Embolism

2.) Pneumonia

3.) Lung Cancer

4.) Myocardial Infarction

5.) Cardiac Arrythmia

P: “not required”

Evidence and Justification of Differential Diagnosis and Diagnostic Tests

Gruettner J. et al. (2015) report the Wells risk score assesses the history of a previous

DVT or PE in a patient. Assessment of tachycardia, recent surgeries or immobilization,

observation of DVT signs, an alternative diagnosis less likely than pulmonary embolism,

hemoptysis, and cancer are gathered. Each area is assigned a score and the calculated total score

interprets the probability of having a pulmonary embolism. The patient calculated score

indicated a pulmonary embolism even though the history of cancer was unknown.

The diagnostic test of a CT angiography was found to be successful in the diagnosis of a

pulmonary embolism with Gruettner J. et al. (2015) research. The D-dimer, ABG, EKG, and

computed tomography showed little value in the diagnosis (Gruettner J. et al., 2015).

Dains, J. E., Baumann, L. C., & Scheibel, P. (2016) indicate pneumonia causes the

Discussion:Assessing Peripheral Vascular System

Discussion:Assessing Peripheral Vascular System

Discussion:Assessing Peripheral Vascular System

You must proofread your paper. But do not strictly rely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort on your part and you can expect your grade to suffer accordingly. Papers with numerous misspelled words and grammatical mistakes will be penalized. Read over your paper – in silence and then aloud – before handing it in and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes.

Use a standard 10 to 12 point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. It is better to let your essay run over the recommended number of pages than to try to compress it into fewer pages.

Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor.

The paper must be neatly formatted, double-spaced with a one-inch margin on the top, bottom, and sides of each page. When submitting hard copy, be sure to use white paper and print out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument.

ADDITIONAL INSTRUCTIONS FOR THE CLASS

Discussion Questions (DQ)

Initial responses to the DQ should address all components of the questions asked, include a minimum of one scholarly source, and be at least 250 words.
Successful responses are substantive (i.e., add something new to the discussion, engage others in the discussion, well-developed idea) and include at least one scholarly source.
One or two sentence responses, simple statements of agreement or “good post,” and responses that are off-topic will not count as substantive. Substantive responses should be at least 150 words.
I encourage you to incorporate the readings from the week (as applicable) into your responses.
Weekly Participation

Your initial responses to the mandatory DQ do not count toward participation and are graded separately.
In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days, for a total of three replies.
Participation posts do not require a scholarly source/citation (unless you cite someone else’s work).
Part of your weekly participation includes viewing the weekly announcement and attesting to watching it in the comments. These announcements are made to ensure you understand everything that is due during the week.
APA Format and Writing Quality

Familiarize yourself with APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for APA paper templates, citation examples, tips, etc. Points will be deducted for poor use of APA format or absence of APA format (if required).
Cite all sources of information! When in doubt, cite the source. Paraphrasing also requires a citation.
I highly recommend using the APA Publication Manual, 6th edition.
Use of Direct Quotes

I discourage overutilization of direct quotes in DQs and assignments at the Masters’ level and deduct points accordingly.
As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content.
It is best to paraphrase content and cite your source.
LopesWrite Policy

For assignments that need to be submitted to LopesWrite, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me.
Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes.
Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own?
Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for tips on improving your paper and SI score.
Late Policy

The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies.
Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances.
If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect.
I do not accept assignments that are two or more weeks late unless we have worked out an extension.
As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.
Communication

Communication is so very important. There are multiple ways to communicate with me:
Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class.
Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.