NURS6531 Week 5 Discussion Latest 2020 MAY

NURS6531 Primary Care of Adults Across the Lifespan

Week 5 Discussion

Examining Chest X-Rays

Chest x-rays are an invaluable diagnostic tool as they can help identify common respiratory disorders such as pneumonia, pleural effusion, and tumors, as well as cardiovascular disorders such as an enlarged heart and heart failure. As an advanced practice nurse, it is important that you are able to differentiate a normal x-ray from an abnormal x-ray in order to identify these disorders. The ability to articulate the results of a chest x-ray with the physician, radiologist, and patient is an essential skill when facilitating care in a clinical setting. In this Discussion, you practice your interprofessional collaboration skills as you interpret chest x-rays and exchange feedback with your colleagues.

Consider the three patient case studies and x-rays

Note: By Day 1 of this week, your Instructor will assign you to post on one of these patient case studies and x-rays:

Case Study 1

35-year-old Asian male presents to your clinic complaining of productive cough for two weeks. Stated he has had mild intermittent fever with myalgia, malaise and occasional nausea.

SH: works as a law clerk

PE: NP noted low grade fever (99 degrees), with very mild wheezing and scattered rhonchi.

An x-ray film is presented which shows a cloudy lung that appears slightly distended.

Case Study 2

This is a 44-year-old Caucasian male being seen at your clinics with complaints of complaints of cough for 4 days and worsening. Stated he has had high grade fever. States he feels weak and has been in bed most of the last two days. Complains of exertional dyspnea, followed by dyspnea at rest, non-productive cough and pleuritic chest pain

MEDS: Zovirax, Diflucan, magic mouth wash, Zofran, mycostatin, filgrastin

PMH: HTN, Hep C, HIV/AIDS, thrush

SH: Past IV Drug abuse; lives in a group home;

PE: VS: Ht: 5’7, Wt: 150#, BMI 23,

Anorexic male, febrile, tachypneic, tachycardic, with rales and rhonchi. You note decreased in breath sounds, dullness, and egophony

An x-ray film is presented which shows petechial markings on the lungs and which are cloudy in appearance.

Case Study 3

 A 50 year old Caucasian female presents to the clinic with complaints of cough for almost 2 weeks. Positive productive green sputum with associated chills, sweating, and fever up to 101.5. She manages a daycare and states that many of the children have had upper respiratory symptoms in the last two weeks. PMH: DM diagnosed 7 years ago, controlled on medications.

MEDS: Glyburide 10mg qd

PE: She looks ill with continuous coughing and chills.

BP 100/80, T: 102, HR: 110; O2Sat 97% on RA.

Lungs: +Crackles, increased fremitus

Labs: CBC 17,000 cells/mm3 , blood sugar is 120

An x-ray film is presented which shows cloudiness on the lungs and which also shows some scarring on the lungs.

To prepare:

Review Part 10 of the Buttaro et al. text in this week’s Resources, as well as the provided x-rays.

Reflect on what you see in the x-ray assigned to you by the Course Instructor.

Consider whether the patient in your assigned x-ray has an enlarged heart, enlarged blood vessels, fluid in the lungs, and/or pneumonia in the lungs.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the "Post to Discussion Question" link and then select "Create Thread" to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!

By Day 3

Post an explanation of the primary diagnosis, as well as 3 differential diagnoses, for the patient in the case study you were selected or were assigned. Describe the role the patient history and physical exam played in the diagnosis. Then, suggest potential treatment options based on your patient diagnosis.

Read a selection of your colleagues’ responses.

By Day 6

Respondto at least two of your colleagues on two different days who selected or were assigned a different case study than you did by providing additional observations and insights. Respond to questions posed to you during the week.