NSG530 Module 4 Discussion latest

Mrs. K is a 60-year-old white female who presented to the ER with complaints of her heart “beating out of my chest.” She is complaining that she is having increased episodes of shortness of breath over the last month and in fact, has to sleep on 4 pillows. She also notes that the typical swelling she’s had in her ankles for years has started to get worse over the past two months, making it especially difficult to get her shoes on toward the end of the day.

In the past week, she’s been experiencing fatigue and decreased urine output. Her past history is positive for an acute anterior wall myocardial infarction and coronary artery bypass surgery. She was a 2 pack a day smoker, but quit 8 years ago.

On physical examination, auscultation of the heart revealed a rumbling S3 gallop and inspiratory crackles. She has +3 edema of the lower extremities.

Discuss the pathophysiology of an S3 heart sound and include causes for an S3 gallop?

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NSG530 Module 5 Discussion

Brian is a 7-year-old boy who presents to the primary care office with his mother. His mom has noticed that Brian has been coughing frequently and seems to have shortness of breath at times. She reports that Brian had a “cold” with a low grade fever and runny nose about 2 weeks ago and the symptoms seem to appear after the cold.

On physical examination, Brian appears in moderate respiratory distress, with suprasternal and intercostal retractions. His vital signs include a temperature of 100 A°F, a respiratory rate of 32 breaths per minute, heart rate of 120 beats per minute, and pulse oximetry of 95% on room air.

Lung exam is notable for diffuse symmetrical expiratory wheezes. His nasal mucosa is erythematous with boggy turbinates and clear mucus. The remainder of the exam is unremarkable.

Based on this case, discuss the differences in the pathophysiology for asthma vs pneumonia. Include your thoughts as to the diagnosis for this case.

NSG530 Module 6 Discussion

Mike is a 23-year-old white male admitted for severe depression. He has a history of bipolar disorder and is currently taking valproate (Depakote) 500 mg XR daily. His psychiatrist ordered LFT’s to follow the valproate therapy. LFT’s were abnormal: ALT 1178 u/L, AST 746 u/L. the patient was asymptomatic. He denies fever, abdominal pain, nausea, vomiting or jaundice.

He denies using other medication or alcohol but admits using illicit IV drugs starting about 8 weeks ago and continuing to present. He never had a blood transfusion. Aside from Depakote he is presently taking clonazepam 1 mg prn and fluoxetine (Prozac) 40 mg qd.

Other blood work: Direct bili 1 mg/dL, alkphos 188 u/L, anti-HCV negative on hospital day 1, positive on day 3. HCV-RNA PCR positive. Hep A, B, and D markers negative.

Patient diagnosis: Acute Hepatitis C.

List some clinical manifestations typically seen in Hepatitis C and major treatment strategies.

NSG530 Module 7 Discussion

A nurse practitioner (NP) is talking with a 70-year-old patient who asks if she could discuss a problem that she is embarrassed to talk about with her physician. She states she has been having increasing problems with incontinence. Every time she coughs or sneezes, she notices a loss of urine. She has not had any fever or chills or pain with urination. She asks the NP if this is just a sign of getting older?

1. Discuss the etiology associated with incontinence in the aging adult.

NSG530 Module 8 Discussion

Ann is a 32-year-old married female who presents to her nurse practitioner reporting lower abdominal pain, cramping, slight fever, and dysuria of 3 days duration.

History includes:

LMP 2 weeks ago (regular)
Reports oral contraceptive use
Reports pain in lower abdomen with cramping and pain on urination for 3 days
Denies any GI problems, reports regular bowel movements.
Denies vaginal discharge
Ann is married and in a monogamous relationship. Has one child age 2
Reports no use of condoms/sexual intercourse 2-3 times per week
Denies any history of STDs

Physical Exam reveals:

Temp 100.6, P 80 BP 100/62 Wt. 125 Ht. 5’3’’
HEENT WNL
No CVA tenderness
Pain in lower quadrants with light palpation. Positive inguinal lymphadenopathy
External genitalia without lesions or discharge
Pelvic exam reveals minimal cervical mucopus
Bimanual exam reveals uterine and adnexal tenderness and cervical motion pain. Uterus anterior, midline, smooth, not enlarged

Based on the above case the diagnosis is PID, What is an appropriate CDC-recommended therapeutic regimen for this patient?

NSG530 Module 4 Discussion latest