NR 511 Week 3 Case Study Discussions Part 1

NR 511 Week 3 Case Study Discussions Part 1

NR 511 Week 3 Case Study Discussions Part 1

Concerning Part 1 of the assignment, you are in a patient scenario. Utilizing the below information, provide answers the questions below:

1. Briefly and clearly provide a summary of  the H&P results as though you were presenting it to your preceptor utilizing the relevant facts from the present case. Apply shorthand usage where necessary as well as approved medical abbreviations when needed. Avoid irrelevant information and redundancy.

2. Provide a differential diagnosis (plural) which might explain the patient’s chief complaint along with a brief statement of pathophysiology for each.

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3. Analyze the differential by using the pertinent findings from the history and physical to argue for or against a diagnosis. Rank the differential in order of most likely to least likely. (This is where you present your argument for EACH DIAGNOSIS in your differential using the patient’s subjective and objective information that was …).

4. Identify any additional tests and/or procedures that you feel is necessary or needed to help you narrow your differential. All testing decisions must … supported with an EBM argument as to why it is necessary or pertinent in this case. If no testing is indicated or needed, you must also support this decision with EBM evidence. (This is where you identify, based on what you know thus far, test or test(s) that you would perform TODAY which would help you narrow your differential diagnosis).

*Do not list all of the possible tests that can … done. You are being evaluated on your diagnostic reasoning skills as well your ability to make decisions that are in-line with current practice recommendations. Just because a test is available does not mean it needs to … done.

NR511 Week 3 Case Study Discussions Part 2

In Part 2 you might be … some additional history, exam or test findings. Using this information and the information in Part 1, answer the following questions:

1. What is your primary diagnosis for this patient? Tell the reader how you came to this conclusion using the information that you were … (i.e., CXR result, lab result). Interpret the results into your diagnosis decision (i.e., tell how this information helped you to narrow your differential to the one diagnosis that you chose).

2. Identify the corresponding ICD-10 Code for the diagnosis.

3. Provide a treatment plan for this patient’s primary diagnosis which includes:

4. a) Medication-all prescriptions and OTC medications should … written in RX format with an EBM to support:

·         Medication Name & Medication Strength

·         Dispensing quantity:

·         Sig: …………..RF:

1. b) Any additional testing necessary for this particular diagnosis-typically done when you need more information to confirm a diagnosis or differentiate the diagnosis. Do not state all of the possibilities that are available. To assess your diagnostic reasoning skill, you will need to … decisive.

2.  c) Patient education-self explanatory

3.  d) Referral-self explanatory

4. e) F/U plan-include if and when the patient should follow-up *If part of the plan does not warrant an action, you must explain why. ALL medication and testing decisions (or decisions not to treat with medication or additional testing) MUST … supported with an EBM argument as you did in Part 1.

NR 511 Week 3 Case Study Discussions

References

·         Shulman, S., Bisno, A., Clegg, H., Gerber, M., Kaplan, E., Lee, G., Martin, J., & Van Beneden, C. (2012). Clinical Practice Guideline for the

·         Diagnosis and Management of Group A Streptococcal Pharyngitis: A 2012 Update by Infectious Diseases Society of America. Clinical Infectious

·         Disease, 55(10), e89. DOI: 10.1093/cid/cis629

SAMPLE APPROACH FOR WEEK 3 CASE STUDY – PART 2

NR511 Week 3 Case Study Part Two Discussion
Dr. Aje and Class,
  1. What is your primary (one) diagnosis for this patient at this time?
The primary diagnosis for the patient would be allergic conjunctivitis.
Pertinent positive findings: pale boggy turbinates, runny nose with intermittent nasal congestion, itchy, red, tearing eyes with FB sensation, previous dx of seasonal allergic rhinitis
Pertinent negative findings: patient denies having symptoms of sneezing and the patient is non-compliant with allergy medications
Other important information to support my diagnosis is the patient relocated from his home state of Phoenix to Illinois which is a change is climate, air quality and weather conditions. This may have exacerbated his chronic allergy condition (Ackerman, Smith, Gomes, 2016).
  1. Identify the corresponding ICD-10 code.
H10.33
  1. Treatment plan: Treatment with antihistamines would be appropriate.
Have the begin administering his current prescribed Fluticasone nasal spray 50mcg with instructions to spray 2 sprays in each nostril once daily. (Epocrates, 2018).
Reinstate the patient’s current prescription for Loratadine 10mg once daily or as directed. This is an “inverse agonism of histamine H1receptors (Carr, Schaffer, & Donnenfield, 2016)”.
“The most common treatment options for allergic conjunctivitis consist of topical ophthalmic formulations intended to reduce inflammation and provide symptomatic relief (Carr, Schaeffer & Donnenfeld, 2016)”.  I would prescribe Olopatadine 2%. I would instruct the patient to administer 1-2 drops in each eye daily for 10 days. Olopatadine has a mast cell stabilizer which will reduce the inflammation and counteract the effects of histamine. 
Additional testing
As I noted in part one of this case study, the patient can undergo allergy testing by having his blood / lab test to determine the Total IgE or quantitative IgE which can detect the IgE antibodies in the patient’s blood. These blood test can detect different allergies such as allergies to medications, pollens dust mites, mold spores, pet dander, insect bites and foods. Other testing which is the most common way to test for allergies is the scratch test also known as the skin test. Results of the skin test are resulted usually in 20 minutes (acai, 2014). Identifying the patients’ triggers will aid in identifying the correct plan of care.
Patient education:
Educate the patient on the importance of thorough handwashing before and after touching his eyes. Not share linens and to avoid direct contact with infected individuals and materials. Cool compresses to the eyes for 10-20 minutes as needed. Notify his PCP of any changes in vision. Instruct the patient to seek emergency medical treatment if his vision becomes poor or diminished, pressure or headache that is not resolved with medication, blurred or double vision.
Referral:
The patient would be referred for immunology studies and allergy testing, a referral to an ophthalmologist for the photophobia and to rule out injuries, traumas, and other conditions other than allergic conjunctivitis.
4.Active problem list:
    Chronic seasonal allergies
    Acute allergic conjunctivitis
5.Are there any changes that you would also make to this patient’s    overall treatment plan at this time?
Because of the patient’s past and present symptoms, I would opt not to change the patient’s treatment plan.
  1. 6Provide a F/U plan.
The patient would be directed to F/U with the in the clinic within 7 days or sooner if s/s are not resolving in 48-72 hours. F/U instructions to be evaluated by the referred ophthalmologist or an ophthalmologist of his choice. In the event of an emergency, the patient should seek emergency medical treatment.
Ackerman, S., Smith, L. M., & Gomes, P. J. (2016). Ocular itch associated with allergic conjunctivitis: latest evidence and clinical management. Therapeutic advances in chronic disease, 7(1), 52–67. doi:10.1177/2040622315612745
American College of Allergy, Asthma & Immunology, 2014.
https://acaai.org/allergies/allergy-treatment/allergy-testing
Carr, W., Schaeffer, J., & Donnenfeld, E. (2016). Treating allergic conjunctivitis: A once-daily medication that provides 24-hour symptom relief. Allergy & rhinology (Providence, R.I.), 7(2), 107–114. doi:10.2500/ar.2016.7.0158
Epocrates Athena Health. (2018). Epocrates Drug. Retrieved from
https://online.epocrates.com/drugs
American College of Allergy, Asthma & Immunology, 2014.
https://acaai.org/allergies/allergy-treatment/allergy-testing

 

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