Assignment: Assessing, Diagnosing, and Treating Cardiovascular and Pulmonary Disorders

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Cardiovascular conditions are among the leading causes of hospitalization and death among older adults, even though many of the risk factors that contribute to such conditions are preventable or manageable. In your role as an advanced practice nurse, you must be able to apply sound critical thinking and diagnostic reasoning skills to correctly assess and diagnosis these conditions. You also play an important role in helping patients manage disorders by planning necessary treatments, assessments, and follow-up care.  Tachycardia and Coughing Essay Example

To prepare:

Review the Week 5 Case Assignment document in the Learning Resources.
Reflect on the patient’s symptoms and aspects of disorders that may be present.
Consider how you might assess, perform diagnostic tests, and recommend medications to treat patients presenting with the symptoms in the case study.
The Assignment:

After reviewing the case and the accompanying case analysis questions, included in the document, answer the 10 questions directly in the Case Assignment document. When providing evidence to support your answers, be sure they evidenced-based, current (no more than 5 years old), and follow current standards of care. Follow APA 7th edition formatting.

Ms. Jones: 67 Year-Old with Tachycardia and Coughing

Directions: Answer the following 10 questions directly on this template.

Question 1: What findings would you expect to be reported or seen on her chest x-ray results, given the diagnosis of pneumonia?

Given the diagnosis of pneumonia, it is expected that findings will show infiltrates or white spots. These should be consistent with patchy opacity or lobar/ segmental opacity that mean that the patent has lung consolidation. Consolidation of the lungs is indicative of pneumonia (Barkley & Myers, 2020; Hammer & McPhee, 2018).

Question 2: Define further what type of pneumonia Ms. Jones has, HAP (hospital-acquired pneumonia) or CAP (community-acquired pneumonia)? What’s the difference/criteria?

The type of pneumonia that Ms. Jones has is referred to as community-acquired pneumonia or CAP. This is the type of pneumonia that is contracted while at home living within the community and not in the hospital. It differs from hospital-acquired pneumonia (HAP) because the latter is contracted by an at-risk patent while admitted in the hospital with a different illness. In other words, HAP is a hospital-acquired infection or HAI just like ventilator-associated pneumonia or VAP (Barkley & Myers, 2020; Hammer & McPhee, 2018).

Question 3:

• 3A) What assessment tool should be used to determine the severity of pneumonia and treatment options?

There are two possible assessment tools that can be used to determine the severity of Ms. Jones’ pneumonia and her treatment. They are the PORT Score and the CURB-65 tool (Noguchi et al., 2017). The former has 20 items and is more complicated to use in clinical settings than the latter that only has 5 items and easier to use. For Ms. Jones, therefore, the choice of tool is the CURB-65 tool.

• 3B) Based on Ms. Jones’ subjective and objective findings, apply that tool and elaborate on each clinical factor for this patient.

The CURB-65 pneumonia assessment tool is specifically designed for elderly patients aged 65 years and above. This population demographic is at a higher risk of contracting both CAP and HAP due to significant comorbidities as well as compromised immunity (Hammer & McPhee, 2018). CURB-65 stands for confusion, uremia, respiratory rate, BP, and age > 65 years (Jones et al., 2011). The table below shows the application of the tool to this patient:

Table: CURB-65 score for Ms. Jones

From the above score, it is clear that Ms. Jones only has mild to moderate pneumonia that can be managed as an outpatient (Jones et al., 2011).

Question 4: Ms. Jones was diagnosed with left lower lobe pneumonia. What would your treatment be for her based on her diagnosis, case scenario, and evidence-based guidelines?

According to the case of this patient, my treatment for her based on her diagnosis and evidence-based guidelines would be as follows. It is noted here that the antibiotic selection is empiric (Grace & Robinson, 2017):

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• Start cefuroxime (Ceftin) I g orally once daily for 5 days (Rosenthal & Burchum, 2018).
• Take plenty of fluids
• Have plenty of rest

Question 5: Ms. Jones has a known history of COPD. What is the gold standard for measuring airflow limitation?

According to the GOLD (2017) guidelines, the gold standard for measuring airflow limitation is spirometry.

Question 6: Ms. Jones mentions intermittent pain in her bilateral legs when walking and having to rest to stop the leg pain/cramps. Which choice below would be the best choice for a potential diagnosis for this? Explain your reasoning.

1. DVT (Deep Vein Thrombosis)
2. Intermittent Claudication
3. Cellulitis
4. Electrolyte Imbalance

The best choice for a potential diagnosis for the leg pain or cramps on walking would be intermittent claudication. It is caused by muscle ischemia when insufficient arterial (oxygenated) blood reaches the calf/ leg muscles. Ms. Jones has a history of hyperlipidemia (high LDL cholesterol) and hypertension and therefore is susceptible to atherosclerosis that can narrow the lumen of arteries throughout the body (Hammer & McPhee, 2018).

Question 7: Ms. Jones mentions intermittent pain in her bilateral legs when walking and having to rest to stop the leg pain. What test could be ordered to further evaluate this?

The best tool to evaluate further the intermittent claudication would be an ankle-brachial index. This is a test that compares the blood pressure in the patient’s ankles with that in their arms (Mayo Clinic, 2021). Tachycardia and Coughing Essay Example

Question 8: Name three (3) differentials for Ms Jones’ initial presentation

1. Chronic obstructive pulmonary disease or COPD
2. Atelectasis (lung collapse)

• Viral pneumonia (Hammer & McPhee, 2018).

Question 9: What patient education would you give Ms. Jones and her daughter? What would be your follow-up instructions?

The patient education and follow-up instructions would be:

• An increase in dietary fresh fruits and vegetables
• Moderate physical exercise after assessment of the intermittent claudication
• Adequate sleep and rest
• Absolute compliance to medications
• Avoidance of fatty foods and high-calorie diet
• Review after two weeks.

Question 10: Would amoxicillin/clavulanate plus a macrolide have been an option to treat Ms. Jones’ Pneumonia? Explain why or why not.

Indeed clavulanate-potentiated amoxicillin and a macrolide could have served, but the recommendations and guidelines discourage combination therapy in a case in which there are comorbidities. Ms. Jones has several significant comorbidities already (Rosenthal & Burchum, 2018).

References

Barkley, T.W., Jr., & Myers, C.M. (2020). Practice considerations for the adult-gerontology acute care nurse practitioner, 3^rd ed. Barkley & Associates.

Global Initiative for Chronic Obstructive Lung Disease [GOLD] (2017). Pocket guide to COPD diagnosis, management, and prevention: A guide for health care professionals. https://goldcopd.org/wp-content/uploads/2016/12/wms-GOLD-2017-Pocket-Guide.pdf

Grace, C.J., & Robinson, B. (2017). Empiric antibiotic selection. http://www.antimicrobe.org/e62.asp

Hammer, D.G., & McPhee, S.J. (Eds). (2018). Pathophysiology of disease: An introduction to clinical medicine, 8^th ed. New York, NY: McGraw-Hill Education.

Jones, B.E., Jones, J., Bewick, T., Lim, W.S., Aronsky, D., Brown, S.M., … Dean, N.C. (2011). CURB-65 pneumonia severity assessment adapted for Electronic Decision Support. Chest, 140(1), 156–163. https://doi.org/10.1378/chest.10-1296

Mayo Clinic (February 23, 2021). Ankle-brachial index. https://www.mayoclinic.org/tests-procedures/ankle-brachial-index/about/pac-20392934

Noguchi, S., Yatera, K., Kawanami, T., Fujino, Y., Moro, H., Aoki, N., Komiya, K., Kadota, J., Shime, N., Tsukada, H., Kohno, S., & Mukae, H. (2017). Pneumonia severity assessment tools for predicting mortality in patients with healthcare-associated pneumonia: A systematic review and meta-analysis. Respiration, 93(6), 441-450. https://doi.org/10.1159/000470915

Rosenthal, L.D., & Burchum, J.R. (2018). Lehne’s pharmacotherapeutics for advanced practice providers. Elsevier.  Tachycardia and Coughing Essay Example