I need 1 reply comment to each post with a credible sources, citation and years above 2013 in APA format.
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
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
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.”
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.
1.) Pulmonary Embolism
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
Try it now!
How it works?
Follow these simple steps to get your paper done
Place your order
Fill in the order form and provide all details of your assignment.
Proceed with the payment
Choose the payment system that suits you most.
Receive the final file
Once your paper is ready, we will email it to you.
Custom Writings Help is a Quality-Oriented Company in Online Writing as a result of hiring exceptional professionals to execute clients' tasks.
At Custom Writings Help,We understand the struggle of research paper writing, and that is why at Custom WritingS Help, we are all out to help you. We pride ourselves on having a team of clinical writers. The stringent and rigorous vetting process ensures that only the 'BEST' Writers are chosen for the job. We have highly qualified Ph.D. and MA writers working with us; we equally offer these experienced writers specific bonuses and incentives to make them deliver highly original, unique, and informative content at reasonably low prices.
Thesis Writing Service
Worlwide, Many Masters Students are struggling with Thesis Completion. A thesis is likely to be the longest and most challenging piece of work a student has ever completed. However, unlike essays and other assignments, a student can pick a particular interest topic and work on their initiative. Fortunately, we are there for you. At Custom Writings Help, you are assured of an authentic, imaginative, informative, linguistically great, and advantageous thesis that adheres to all your needs. So, why continue considering different writers when you have discovered the best in the field?
Not a single student can avoid writing custom papers. However, a total lack of experience, skills, and time makes it very hard to produce a superb writing piece. Therefore, if you are seeking professional help, turn to us. Our specialized and experienced writers compose a variety of model papers, including custom essays, college term papers, research papers, book reports, MBA essays, executive summaries, dissertations, Ph.D. theses, admission essays, and research proposals for college and university students at any level.
Most of the students disregard the critical principles of essay writing and compose papers below sensible guidelines. Therefore, with Custom Writings Help, one should not worry about his/her essay. Our Writers compose informative and engaging content on all complexities and topics. We write meaningful and smart essays while prioritizing all aspects that bring about a good grade, such as impeccable grammar, proper structure, zero-plagiarism, and conformance to guidelines.
Coourse Work Writing
Don't let the seemingly never-ending onslaught of writing assignments get you down. If you are looking where to get course work assistance online, the writers at Custom Writings Help are here to assist you with all of your writing needs. We undertake to unique delivery of papers that meet the professor's requirements. The content is proofread, edited, and checked plagiarism before submission to customers. No matter how big or small your work is, we will deliver on time. Try US Now! !
Dissertation Writing Service
High-Quality Dissertation Writing Services are rare. They require Ph.D. academicians – not easily found. However, are an exception. The years, time, and resources we have invested in the dissertation world has given us a competitive advantage over others. Choose to come to Custom Writings Help; You will find perfect Ph.D. consultants who have written hundreds of dissertations theses ready to help you. Let our dissertation-writing services help you craft your dissertation, for you are assured we will give you the results.