(SOLUTION) NR601 Week 2: COPD Case Study Part 2

Purpose 

Problem-based learning is a methodology designed to help students develop the reasoning process used in clinical practice through problem solving actual patient problems in the same manner as they occur in practice.  The purpose of this activity is to develop students’ clinical reasoning skills using a case-based learning exercise. Through participation in an online discussion forum, students identify learning issues in a self-directed manner which facilitates learning for the entire group. 

Activity Learning Outcomes 

Through this discussion, the student will demonstrate the ability to:

  1. Demonstrate competence in the evaluation and management of common respiratory problems (WO 2.1) (CO 2,3,4,5)
  2. Distinguish between obstructive and restrictive lung disease (CO 2, 4) Develop a management plan for the case study patient based on identified primary, secondary and differential diagnoses. (WO 2.2) (CO 2,4)  
  3. Interpret pulmonary function test results. (WO 2.3) (CO 2, 4)

Due Date:  

Student enters initial post to part one by 11:59 p.m. MT on Thursday; responds substantively to at least one topic-related post of a peer including evidence from appropriate sources AND all direct faculty questions in parts one by Sunday, 11:59 p.m. MT. 

 A 10% late penalty will be imposed for discussions posted after the deadline on Thursday 11:59pm MT, regardless of the number of days late. NOTHING will be accepted after 11:59pm MT on Sunday (i.e. student will receive an automatic 0). Week 8 discussion closes on Saturday at 11:59pm MT. 

Total Points Possible:  50 

Case Study – Part 2

You ordered a CXR and spirometry at the previous visit and he returns today to review the results. Physical exam and symptoms are unchanged since last visit. Vital signs at this visit are: Temp-98.3, P-68, RR-20, BP 152/90, Height 68.9in., Weight 258 pounds, O2sat 94% on RA 

CXR Result: 

No acute infiltrates or consolidations are seen. Cardiac and mediastinal silhouettes are normal. No hilar enlargement is evident. Osseous thorax is intact. 

Spirometry Results: 

Pre-Bronchodilator  Post-Bronchodilator 
  Predicted  Actual  %Predicted  Actual  % Predicted  % Change 
FVC (L)  4.52  3.01  67  3.08  68  2 
FEV1 (L)  3.40  1.58  46  1.60  47  1 
FEV1/FV   .75  .52  —  .52  —  0 

 

Requirements/Questions:

  1. What is your primary (one) diagnosis for this patient at this time? (support the decision for your diagnosis with pertinent positives and negatives from the case)
  2. Identify the corresponding ICD-10 code.
  3. Provide a treatment plan for this patient’s primary diagnosis which includes:
    • Medication*
    • Any additional testing necessary for this particular diagnosis*
    • Patient education
    • Referral
    • Follow up
  4.  Provide an active problem list for this patient based on the information given in the case.
  5.  Are there any changes that you would also make to this patient’s overall treatment plan at this time? Must provide an EBP argument for each treatment or testing decision.

*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 be supported with an evidence-based practice  (EBP) argument. Over-the-counter (OTC) and RXs must be written in full as if handing a script to the patient in the office. 

 

Over-the-counter (OTC) and RXs must be written in full as if handing a prescription to the patient in the office.   

Example:   

Amoxicillin 500 mg capsule  

1 tab po BID q 10 days  

Disp #20 no refills   

 

 

DISCUSSION CONTENT 
Category  Points  %  Description 
Application of Course Knowledge  15  30% 
  1. Student chooses one appropriate diagnosis for the patient; AND 
  2. Diagnosis is supported with strong pertinent positive and negative subjective and objective data from parts 1 & 2; AND 
  3. The ICD code for the diagnosis is correct; AND 
  4. Treatment plan for primary diagnosis includes medication, additional testing, patient education, and referral; AND 
  5. Prescription and OTC medications are written appropriately as a RX and all components are correct; AND 
  6. Treatment decisions (medication, additional testing, referrals) are supported with appropriate EBP arguments; AND  
  7. An accurate problem list is presented based on case information; AND  
  8. Student discusses changes (or not) to the overall treatment plan for the patient for pertinent issues; AND  
  9. An appropriate F/U plan is provided 

(9 critical elements) 
Support from Evidence-Based Practice (EBP)  15  30% 
  1. Discussion post is supported with appropriate, scholarly sources AND 
  2. Sources are published within the last 5 years (unless the most current CPG is used) AND 
  3. A reference list is provided with in-text citations that match AND 
  4. All testing decisions are fully supported with an appropriate EBP argument 

(4 critical elements) 
Interactive Dialogue  10  20% 
  1. Student provides a substantive* response to at least one topic-related post of a peer AND 
  2. Includes evidence from appropriate scholarly sources AND 
  3. Provides a reference list which match in-text citations AND 
  4. Student responds to all direct faculty questions 

(4 critical elements) 
      Total CONTENT Points= 40 pts 
DISCUSSION FORMAT 
Category  Points  %  Description 
Organization  5  10% 
  1. Case study response is presented in a logical format, AND 
  2. Responses are in sequence with the numbered questions AND 
  3. The case study response is understandable and easy to follow AND 
  4. All responses are relevant to the case topic 

(4 critical elements) 
Grammar, Syntax, Spelling & Punctuation  5  10%  Discussion post has minimal grammar, syntax, spelling, punctuation, or APA format errors* 

 
      Total FORMAT Points= 10 pts 
      DISCUSSION TOTAL= 50 pts 

 

SOLUTION

Chronic Obstructive Pulmonary Disease is the primary diagnosis of mine because of this individual. He’s had a cough for six weeks, with completely new onset SOB exacerbated with activity and relieved with sleep. Sputum creation whitish/ yellow. Afebrile, O2 sat ninety four % on space air. No sinusitis or even rhinitis noted. Former smoker of twenty years, with this particular hx affected person is in danger for COPD. Spirometry may be the gold standard for diagnosis. This particular patient’s FEV1/FV ratio was,52 his FEV1/FVC was <70, staged as Gold three: extreme, thirty % predicted (Gold, 2020). The chest x ray was typical, that rules out some other disease processes.

ICD-10 code: J44.9 Chronic obstructive pulmonary disease, unspecified

Treatment for COPD severe: Based on The Global Initiative for Chronic Obstructive Lung Disease (GOLD) recommends the usage of ICS/LABA to enhance lung function, reduce exacerbations, overall health status and symptoms (GOLD, 2020). The inhaled corticosteroid (ICS) reduces the inflammation in the lungs. A bronchodilator is necessary to help you start the lumen in the lungs to make a wider opening for air to flow. The very long acting beta2 agonist (LABA) will keep the breathing passages dilated for an lengthy period than short acting beta two agonist (SABA). Symbicort or maybe Formoterol/ budesonide is a mixture inhaler of ICS/LABA that’s suggested by GOLD. (Gold, 2020). The utilization associated with a (SABA) as a rescue inhaler is suggested to help in intense exacerbations I will recommend albuterol inhaler (GOLD, 2020). Please click the purchase button to access the entire copy at $5