NRNP 6540 WEEK 5 ASSIGNMENT: ASSESSING, DIAGNOSING, AND TREATING CARDIOVASCULAR AND PULMONARY DISORDERS

NRNP 6540 WEEK 5 ASSIGNMENT: ASSESSING, DIAGNOSING, AND TREATING CARDIOVASCULAR AND PULMONARY DISORDERS

NRNP 6540 WEEK 5 ASSIGNMENT: ASSESSING, DIAGNOSING, AND TREATING CARDIOVASCULAR AND PULMONARY DISORDERS

Case Title: A 67-year-old With Tachycardia and Coughing

Ms. Baker is a 68-year-old female who is brought to your office today by her daughter Susan. Ms. Baker lives with her daughter and is able to perform all activities of daily living (ADLs) independently. Her daughter reports that her mother’s heart rate has been quite elevated, and she has been coughing a lot over the last 2 days. Ms. Baker has a 30-pack per year history of smoking cigarettes but quit smoking 3 years ago. Other known history includes chronic obstructive pulmonary disease (COPD), hypertension, vitamin D deficiency, and hyperlipidemia. She also reports some complaints of intermittent pain/cramping in her bilateral lower extremities when walking and has to stop walking at times for the pain to subside. She also reports some pain to the left side of her back, and some pain with aspiration.

Ms. Baker reports she has been coughing a lot lately, and notices some thick, brown-tinged sputum. She states she has COPD and has been using her albuterol inhaler more than usual. She says it helps her “get the cold up.” Her legs feel tired but denies any worsening shortness of breath. She admits that she has some weakness and fatigue but is still able to carry out her daily routine.

Vital Signs: 99.2, 126/78, 90, RR 22

Labs: Complete Metabolic Panel and CBC done and were within normal limits

CMP Component

Value

CBC Component

Value

Glucose, Serum

86 mg/dL

White blood cell count

5.0 x 10E3/uL

BUN

17 mg/dL

RBC

4.71 x10E6/uL

Creatinine, Serum

0.63 mg/dL

Hemoglobin

10.9 g/dL

EGFR

120 mL/min

Hematocrit

36.4%

Sodium, Serum

141 mmol/L

Mean Corpuscular Volume

79 fL

Potassium, Serum

4.0 mmol/L

Mean Corpus HgB

28.9 pg

Chloride, Serum

100 mmol/L

Mean Corpus HgB Conc

32.5 g/dL

Carbon Dioxide
26 mmol/L
RBC Distribution Width

12.3%

Calcium

8.7 mg/dL

Platelet Count

178 x 10E3/uL

Protein, Total, Serum

6.0 g/dL

Albumin

4.8 g/dL

Globulin

2.4 g/dL

Bilirubin

1.0 mg/dL

AST

17 IU/L

ALT
15 IU/L

 

Case Title: A 67-year-old With Tachycardia and Coughing

Ms. Baker is a 68-year-old female who is brought to your office today by her daughter Susan. Ms. Baker lives with her daughter and is able to perform all activities of daily living (ADLs) independently. Her daughter reports that her mother’s heart rate has been quite elevated, and she has been coughing a lot over the last 2 days. Ms. Baker has a 30-pack per year history of smoking cigarettes but quit smoking 3 years ago. Other known history includes chronic obstructive pulmonary disease (COPD), hypertension, vitamin D deficiency, and hyperlipidemia. She also reports some complaints of intermittent pain/cramping in her bilateral lower extremities when walking and has to stop walking at times for the pain to subside. She also reports some pain to the left side of her back, and some pain with aspiration.

Ms. Baker reports she has been coughing a lot lately, and notices some thick, brown-tinged sputum. She states she has COPD and has been using her albuterol inhaler more than usual. She says it helps her “get the cold up.” Her legs feel tired but denies any worsening shortness of breath. She admits that she has some weakness and fatigue but is still able to carry out her daily routine.

Vital Signs: 99.2, 126/78, 90, RR 22

Labs: Complete Metabolic Panel and CBC done and were within normal limits

CMP Component	Value	CBC Component	Value
Glucose, Serum	86 mg/dL	White blood cell count	5.0 x 10E3/uL
BUN	17 mg/dL	RBC	4.71 x10E6/uL
Creatinine, Serum	0.63 mg/dL	Hemoglobin	10.9 g/dL
EGFR	120 mL/min	Hematocrit	36.4%
Sodium, Serum	141 mmol/L	Mean Corpuscular Volume	79 fL
Potassium, Serum	4.0 mmol/L	Mean Corpus HgB	28.9 pg
Chloride, Serum	100 mmol/L	Mean Corpus HgB Conc	32.5 g/dL
Carbon Dioxide	26 mmol/L	RBC Distribution Width	12.3%
Calcium	8.7 mg/dL	Platelet Count	178 x 10E3/uL
Protein, Total, Serum	6.0 g/dL
Albumin	4.8 g/dL
Globulin	2.4 g/dL
Bilirubin	1.0 mg/dL
AST	17 IU/L
ALT	15 IU/L

 

Allergies: Penicillin

Current Medications:

• Atorvastatin 40mg p.o. daily
• Multivitamin 1 tablet p.o. daily
• Losartan 50mg p.o. daily
• ProAir HFA 90mcg 2 puffs q4–6 hrs. prn
• Caltrate 600mg+ D3 1 tablet p.o. daily

Diagnosis: Pneumonia

Question 1: What findings would you expect to be reported or seen on her chest x-ray results, given the diagnosis of pneumonia?

Question 2: Define further what type of pneumonia Ms. Baker has, HAP (hospital-acquired pneumonia) or CAP (community-acquired pneumonia)? What’s the difference/criteria?

Question 3:

• A) What assessment tool should be used to determine the severity of pneumonia and treatment options?
• B) Based on Ms. Baker’s subjective and objective findings, apply that tool and elaborate on each clinical factor for this patient.

Question 4: Ms. Baker was diagnosed with left lower lobe pneumonia. What would your treatment be for her based on her diagnosis, case scenario, and evidence-based guidelines?

Question 5: Ms. Baker has a known history of COPD. What is the gold standard for measuring airflow limitation?

Question 6: Ms. Baker mentions intermittent pain in her bilateral legs when walking and having to rest to stop the leg pain/cramps. Which choice below would be the best choice for a potential diagnosis for this? Explain your reasoning.

1. DVT (Deep Vein Thrombosis)
2. Intermittent Claudication
3. Cellulitis
4. Electrolyte Imbalance

Question 7: Ms. Baker mentions intermittent pain in her bilateral legs when walking and having to rest to stop the leg pain. What test could be ordered to further evaluate this?

Question 8: Name three (3) differentials for Ms. Baker’s initial presentation.

Question 9: What patient education would you give Ms. Baker and her daughter? What would be your follow-up instructions?

Question 10: Would amoxicillin/clavulanate plus a macrolide have been an option to treat Ms. Baker’ Pneumonia?

Cardiovascular conditions are among the leading causes of hospitalization and death among older adults, even though many of the risk factors that contribute to such conditions are preventable or manageable. In your role as an advanced practice nurse, you must be able to apply sound critical thinking and diagnostic reasoning skills to correctly assess and diagnosis these conditions. You also play an important role in helping patients manage disorders by planning necessary treatments, assessments, and follow-up care.

RESOURCES

Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.

WEEKLY RESOURCES

To prepare:

• Review the Week 5 Case Assignment document in the Learning Resources.
• Reflect on the patient’s symptoms and aspects of disorders that may be present.
• Consider how you might assess, perform diagnostic tests, and recommend medications to treat patients presenting with the symptoms in the case study.

The Assignment:

After reviewing the case and the accompanying case analysis questions, included in the document, answer the 10 questions directly in the Case Assignment document. When providing evidence to support your answers, be sure they evidenced-based, current (no more than 5 years old), and follow current standards of care. Follow APA 7th edition formatting.

• Kennedy-Malone, L., & Groenke-Duffy, E. (2023). Cardiovascular disorders. In Advanced practice nursing in the care of older adults (3rd ed., pp. 186-218). F.A. Davis.
• Kennedy-Malone, L., & Groenke-Duffy, E. (2023). Peripheral vascular disorders. In Advanced practice nursing in the care of older adults (3rd ed., pp. 258-267). F.A. Davis.

• Document: Week 5 Case Assignment (Word Document)

llergies: Penicillin

Current Medications:Atorvastatin 40mg p.o. daily

Multivitamin 1 tablet p.o. daily

Losartan 50mg p.o. daily

ProAir HFA 90mcg 2 puffs q4–6 hrs. prn

Caltrate 600mg+ D3 1 tablet p.o. daily

Diagnosis: Pneumonia

Question 1: What findings would you expect to be reported or seen on her chest x-ray results, given the diagnosis of pneumonia?

Question 2: Define further what type of pneumonia Ms. Baker has, HAP (hospital-acquired pneumonia) or CAP (community-acquired pneumonia)? What’s the difference/criteria?

Question 3:

A) What assessment tool should be used to determine the severity of pneumonia and treatment options?

B) Based on Ms. Baker’s subjective and objective findings, apply that tool and elaborate on each clinical factor for this patient.

 

Question 4: Ms. Baker was diagnosed with left lower lobe pneumonia. What would your treatment be for her based on her diagnosis, case scenario, and evidence-based guidelines?

Question 5: Ms. Baker has a known history of COPD. What is the gold standard for measuring airflow limitation?

Question 6: Ms. Baker mentions intermittent pain in her bilateral legs when walking and having to rest to stop the leg pain/cramps. Which choice below would be the best choice for a potential diagnosis for this? Explain your reasoning.

DVT (Deep Vein Thrombosis)

Intermittent Claudication

Cellulitis

Electrolyte Imbalance

Question 7: Ms. Baker mentions intermittent pain in her bilateral legs when walking and having to rest to stop the leg pain. What test could be ordered to further evaluate this?

Question 8: Name three (3) differentials for Ms. Baker’s initial presentation.

Question 9: What patient education would you give Ms. Baker and her daughter? What would be your follow-up instructions?

Question 10: Would amoxicillin/clavulanate plus a macrolide have been an option to treat Ms. Baker’ Pneumonia?

Cardiovascular conditions are among the leading causes of hospitalization and death among older adults, even though many of the risk factors that contribute to such conditions are preventable or manageable. In your role as an advanced practice nurse, you must be able to apply sound critical thinking and diagnostic reasoning skills to correctly assess and diagnosis these conditions. You also play an important role in helping patients manage disorders by planning necessary treatments, assessments, and follow-up care.

RESOURCES

Be sure to review the Learning Resources before completing this activity.

Click the weekly resources link to access the resources.

WEEKLY RESOURCES

To prepare:

Review the Week 5 Case Assignment document in the Learning Resources.

Reflect on the patient’s symptoms and aspects of disorders that may be present.

Consider how you might assess, perform diagnostic tests, and recommend medications to treat patients presenting with the symptoms in the case study.

The Assignment:

After reviewing the case and the accompanying case analysis questions, included in the document, answer the 10 questions directly in the Case Assignment document. When providing evidence to support your answers, be sure they evidenced-based, current (no more than 5 years old), and follow current standards of care. Follow APA 7th edition formatting.

Kennedy-Malone, L., & Groenke-Duffy, E. (2023). Cardiovascular disorders. In Advanced practice nursing in the care of older adults (3rd ed., pp. 186-218). F.A. Davis.

Kennedy-Malone, L., & Groenke-Duffy, E. (2023). Peripheral vascular disorders. In Advanced practice nursing in the care of older adults (3rd ed., pp. 258-267). F.A. Davis.

Document: Week 5 Case Assignment (Word Document)