Adult Case Study #433N Initial Patient Presentation : A 46-y
Adult Case Study #433N Initial Patient Presentation : A 46-year-old… Adult Case Study #433N Initial Patient Presentation: A 46-year-old female nurse presents to your clinic reporting shortness of breath and a cough that has been slowly progressive for the past 6 months. The dyspnea has increased in severity to the point that she had to modify her usual daily activities to include rest breaks when walking long hallways and she now avoids climbing stairs. Past Medical History: Intolerance to fatty foods and discussed cholecystectomy with a surgeon a few years ago but made dietary adjustments and has not required surgery. Dysmenorrhea Social History: Non-smoker Surgical nurse with no known contact to cases of tuberculosis. Annual TB skin tests through her employer have been negative. Married x 20 years. No children. Medications: None Allergies: No known medication allergies. Physical Exam:GENERAL: Alert, oriented x 3 and in no acute distress at rest. VITAL SIGNS: BP 100/70 mmHg, RR 18/minute, Pulse 88/minute, Temp. 37°C, Weight 185 lbs., Height 68 in. HEENT: Pupils are equal, round, reactive to light and accommodation. Extra ocular movements intact bilaterally. No tenderness with percussion of the sinuses. Tympanic membranes intact. Mucous membranes of the oral cavity are moist. NECK: Supple, jugular venous pressure is normal, no lymphadenopathy. CHEST: 2:1 anterior-posterior diameter. Expansion is equal bilaterally, no dullness to percussion, course mid-inspiratory crackles are present at both bases. Expiration is not prolonged. Wheezing and rhonchi are not present, and the patient can exhale her vital capacity in less than 3 seconds. HEART: Normal PMI, S2 splits normally with inspiration. No murmurs or abnormal sounds are present. ABDOMEN: Soft with positive bowel sounds. No hepatosplenomegaly, bruits, or tenderness. EXTREMITIES: Full active range of motion, pules 2+ throughout. NEURO: Grossly intact. Section One: Initial InformationPatient Case1. Make a problem list based upon this patient’s initial presentation and exam findings. Labs/Diagnostics: Electrocardiogram: normal sinus rhythm. Chest x-ray shows the following: Image transcription textAFIP… Show more Pulmonary Function Tests: Predicted ObservedTLC52.50 (50%)FVC4.011.52 (48%)FEV13.121.65 (53%)FEV1/FVC.78.86FEF 25-753.432.06 (60%)DLCOSB22.117.70 (35%)Complete blood count (CBC): Hgb: 13 gm/dL WBC: 8600/mm3, differential – normal Platelet: 230,000 mm3 Basic metabolic panel (BMP): Na: 140 mmol/L K: 3.6 mmol/L CL: 106 mg/dL CO2: 24 mmol/L BUN: 25 mg/dL Creatinine: 1.0 mg/dL Glucose: 110 mg/dL Arterial blood gas (ABG): pH: 7.44 pCO2: 30 mm Hg pO2: 76 mm Hg which reduces to 60 mmHg with moderate exercise 93% oxygen saturation reduces to 88% with moderate exercise Additional Labs/Diagnostics: A high-resolution CT scan of the chest shows the following:Image transcription textAFIP… Show more Antibody tests: negative for common fungal agentsSkin tests to PPD, Candida and mumps antigens are all negative. Antinuclear Antibody (ANA): negative Antineutrophil Cytoplasmic Antibodies (ANCA): negative Thoracic lung biopsy was performed for cultures and histology. Lung biopsy shows non-caseating granulomata and patchy interstitial fibrosis consistent with sarcoidosis. Stains for acid fast and fungal organisms are negative. Section Two: Differential Diagnosis & Definitive DiagnosisPatient Case2. Make a differential diagnosis list that is supported by problem-based rationale. Patient Case3. What is this woman’s most likely diagnosis? Section Three: Explanation of ResultsPatient Case4. Identify the abnormal pulmonary function test results and briefly discuss what those abnormal results indicate for the patient. Patient Case5. Does this patient have restrictive or obstructive pulmonary disease? Section Four: Pathophysiology of Disease Process and SymptomsPatient Case6. What is sarcoidosis? Describe the etiology and pathogenesis of sarcoidosis and its many clinical manifestations? Patient Case7. What is a caseating granulomata? Name three disease process that should be considered in a patient with a caseating granulomata. Patient Case8. What is the differential of non-caseating granulomata? Name three disease process that should be considered in a patient with a non-caseating granulomata. Section Five: Disease Course, Management, & OutcomePatient Case9. How would you manage this patient? Your response must include more than a referral. Patient Case10. What is her prognosis? Your response must include an expected survival rate based upon the current severity of her disease. Health Science Science Nursing NUR 650
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