NR 601 Class Homework
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NR 601 Class Homework
NR 601 week 1 A. K. part 1
NR 601 week 1 A. K. part 2
NR 601 WEEK 1 GERITRICS PRACTICUM PART 1
NR 601 WEEK 1 GERITRICS PRACTICUM PART 2
NR 601 Week 1 MAT ADLT SOAP 2
NR 601 Week 2 MAT ADLT Part 1
NR 601 Week 2 MAT ADLT Part 2
NR 601 Week 2 MAT ADLT SOAP 2
NR 601 Week 3 Part 1
NR 601 Week 3 Part 2
NR 601 Week 4 Part 1
NR 601 Week 4 Part 2
NR 601 Week 6 Part 1 Patient Information
NR 601 Week 6 Part 2 Patient Information
NR 601 Case Study Presentation Summary
NR 601 WEEK 1 GERITRICS
PRACTICUM PART 1
Background
PMH
Surgeries
Vaccination History
Social history
Family history
Habits
Differential Diagnosis:
Abnormal weight loss
Depression, Depressive
Episode F 32.9
Sleep Apnea
Physical Exam and Diagnostics
NR 601 WEEK 1 GERITRICS PRACTICUM POST 2
You meet your first patient of the morning. A.K.
is a 65-year-old Caucasian male who you are seeing for the first time. Both
wife and daughter are present.
Background
He reports that he has had an 18 pound unintentional
weight loss in the last 2 months “I am just not hungry anymore, and when I do
eat, I get full so fast. In fact, it is really hard to eat, and I don’t eat
nearly as much as usual, even though I eat 3 times every day”. He also reports
feeling more tired than usual. “I am not sleeping very well. My wife wakes me
up when I am snoring, or when she thinks I am not breathing. I used to have
sleep apnea, but I don’t think I have it anymore. Besides, that mask is so
horrible to wear.” He reports day time somnolence. He reports that he is at the
clinic today because of his wife and daughter’s concern about his weight loss
and loss of appetite.
PMH
Mr. A.K. has a history of hypertension,
cataracts, and osteoarthritis.
Current medications:
|
Ibuprofen
|
600 mg po TID
|
|
Lisinopril
|
20 mg po QD
|
|
Hydrochlorothiazide
|
25 mg PO QD
|
|
Simvastatin
|
20 mg po QD
|
|
Vitamin D3
|
50,000 units po weekly
|
|
Omeprazole
|
40 mg po QD
|
|
Sudafed
|
50 mg po TID prn
|
Surgeries
April 2010-Right cataract extraction with
Intraocular Lens Placement
June 2010- Left cataract extraction with
Intraocular Lens Placement
November 2011-Left total knee arthroplasty
Allergies: No known drug or food allergies.
Allergies to latex causing difficulty breathing and to bee stings, causing
widespread edema and airway obstruction.
Vaccination History
He receives annual flu shots “most of the time”.
His last one was 18 months ago.
Received a Pneumovax “the day I turned 65”.
His last TD was greater than 10 years ago.
Has not had the herpes zoster vaccine.
Social history
He has an 8th grade education
and is a retired concrete finisher. He lives with his wife of 45 years and his
daughter lives next door. He enjoys working in his back yard garden and
recently tripped over the garden hose last week where his neighbor had to come
and help him up.
Family history
Both parents are deceased. Father died of a
heart attack at the age of 80; mother died of breast cancer at the age of 76.
He has one daughter who is 45 years old and has hypertension. Hypertension,
coronary artery disease, and cancer runs in the family.
Habits
He drinks one 4 ounce glass of red wine nightly;
previous smoker of 30 years; he quit for 10 years, and is now smoking ¼ pack
per day for the last 6 months.
Discussion Part One:
§ Provide the differential diagnoses (DD) with rationale
§ Further ROS questions needed to develop DD.
§ Based on the patient data provided, choose geriatric assessment
tools that would be appropriate to use in conducting a thorough geriatric
assessment. Provide a rationale on why you are choosing these particular tools.
NR 601 MAT ADLT WEEK 1 SOAP 2
NR 601 MAT ADLT WEEK 2 SOAP 2
PMH:
Chronic back pain
Hypertension
CARDIOVASCULAR:
RESPIRATORY:
GASTROINTESTINAL: No reports anorexia,
nausea, vomiting or diarrhea or abdominal pain or blood.
GENITOURINARY: No reports of frequency,
urgency, burning
NEUROLOGICAL: No headache, dizziness,
syncope, paralysis, ataxia, Reports numbness and tingling in the
lower extremities “my feet just burn and tingle all the time and it is so much
worse at night”
No change in bowel or bladder control.
MUSCULOSKELETAL: No muscle, back pain,
joint pain or stiffness.
HEMATOLOGIC: No reported anemia, bleeding
or bruising.
LYMPHATICS: No enlarged nodes. No history
of splenectomy.
PSYCHIATRIC: No history of depression or
anxiety;
ENDOCRINOLOGIC: Diabetic current treatment
includes insulin and oral hyperglycemic; currently taking L-Thyroxine
ALLERGIES: Allergic to amoxicillin, No
history of asthma, hives, eczema or rhinitis.
Physical examination:
Vital Signs
Height: 5 feet 2 inches Weight: 163 pounds BMI:
29.8 BP 110/70 T 98.0 po P 100 R 22, non-labored; Urinalysis:
Protein 2+, Glucose: 4+
HEENT:tinnitus
NECK:
LUNGS: Decreased breath sounds in bases
bilaterally with rales,
HEART: Irregularly irregular rhythm; Unable
to detect S3 or murmur
ABDOMEN: Normal contour;
PV:
NEUROLOGIC:
GENITOURINARY:
MUSCULOSKELETAL: .
PSYCH:
SKIN:
NR 601 MAT ADLT WEEK 2 PART 1 AND PART 2
B.J., a 70-year-old Caucasian female
has been seen in the clinic several times over the last 3 years. However, she
missed her last annual appointment-last appointment was 18 months ago and today
you are the nurse practitioner seeing her. She arrived to the clinic alone and
states she is “here for my check-up”.
Background:
PMH:
Chronic back
2010-Left Anterior Descending (LAD) cardiac
stent placement
Allergies: Amoxicillin
Vaccination History:
She receives an annual flu shot. Last flu shot
was this year
Has never had a Pneumovax
Has not had a Td in over 20 years
Has not had the herpes zoster vaccine
Other
Differential Diagnosis:
Heart Failure,
Unspecified
Rationale:
The reported symptoms of distal tingling and
burning in her feet supports the diagnosis of the condition neuropathy which
includes paresthesia pain, sensation of burning in affected area (Hennion
& Siano, 2013).
Peripheral Arterial Disease
I73.9 (“icddata.com,” 2016)
Peripheral arterial disease (PAD) is
atherosclerosis leading to narrowing of the major arteries distal to the aortic
arch. It can involve both the upper and lower extremities. Progressive
occlusion results in arterial stenosis, reduced blood flow, and
claudication (Hennion & Siano, 2013).
HPI:
Onset: Not specified
Location: lower extremities. Chest
Duration: All the time, worse at night
Characteristics: burning, tingling, fatigue, SOB
Aggravating Factors: activities, exertion,
Nighttime
Relieving Factors: pill taken under tongue
Treatment: pill under tongue
Current medications:
Coreg 6.25 mg PO BID
Allergies: Allergic to amoxicillin, No
history of asthma, hives, eczema or rhinitis.
PMH:
Chronic back pain
Hypertension
Social history:
She graduated from high school, and thought
about college, but got married right away and then had kids a short time later.
Her two sons and their wives live with her, take her to church and to the local
senior center; they do all the cleaning, run errands, and do grocery shopping.
Family history:
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