NURS 696 Discussion

Instructions: Pick one case scenario to discuss in your initial post (initial post must be 300-500 words and at least 1 reference-peer review journal within the last 5 year). For your peer responses, please reply to the case scenario you did not choose for the initial post. You are expected to respond to two different peers

Case Scenario 1: A 59-year-old male with PMH of COPD, DM, HTN, CKD stage III, and HLD who presents due to worsening SOB x 5 days despite regular use of his home inhaler. The patient reported other symptoms, including non-productive cough, wheezing, and chest discomfort. He states this is his 4th ED visit within the last 2 months due to worsening SOB and wheezing.

Answer the following questions:

Subjective:

a. What pertinent questions will you ask to describe the patient’s chief complaints?

b. What are the risk factors and co-morbidities?

Objective:

Based on the patient’s HPI, how do you classify his symptoms? Complete the 2018 GOLD Report Classification of the Severity of COPD table below. 2018 GOLD Report – Classification of the Severity of COPDGOLD 1GOLD 2GOLD 3GOLD 4Symptoms and Risk ComponentsGROUP AGROUP BGROUP CGROUP DExacerbation of COPDClassificationTreatmentMILDMODERATESEVERE

1. What tests or procedures (Lab or Diagnostic) would you perform or order for this patient?

What other diagnostic tools would you use to help you diagnose the patient?

• Diagnosis:
• What are the top 3 differential diagnoses you would consider for this patient, and what is your rationale?

1. What is the patient final diagnosis?

Plan:

• What is the gold standard treatment for this patient’s final diagnosis?

What is your disposition? Admit or discharge? Why?

Case Scenario 2: A 78-year-old female patient with PMH of HTN, HLD, Iron Deficiency Anemia, COPD, and OSA who presents due to productive cough x 2 weeks. The patient reports a productive cough with greenish sputum, wheezing, subjective fever, and chills. Vital signs: HR 120, RR 30, BP 100/59, O2 sats 90% on room air, Temp 101.3 F

Answer the following questions:

Subjective:

What pertinent questions will you ask to describe the patient’s chief complaints?

What are the risk factors and co-morbidities for this patient?

Objective:

Complete the table below to differentiate the classification of pneumonia based on the patient clinical presentation. Typical PneumoniaAtypical PneumoniaSigns and SymptomsChest X-ray

What tests or procedures (Lab or Diagnostic) would you perform or order for this patient?

What other diagnostic tools would you use to help you diagnose the patient?

Diagnosis:

What are the top 3 differential diagnoses you would consider for this patient, and what is your rationale?

You obtain labs, and the results are as follows:
Na= 136
WBC = 18,000
K = 3.7
Platelet = 98,000
BUN = 25
Creatinine = 1.3

Chest x-ray: Right lower lobe consolidation

How do you classify this patient based on the Infectious Diseases Society of America (IDSA) Severe Pneumonia Criteria? Severe or non-severe? What are the criteria? Complete the IDSA Severe Pneumonia Criteria table below. IDSA Severe Pneumonia CriteriaMinor CriteriaMajor Criteria

Plan:

What is the gold standard treatment for this patient?

What is your disposition? Admit or discharge? Why?