Regis NU664B Discussions Latest 2022 October (Full)

NU664B Primary Care of Family I

Week 1 Discussion

Telehealth / Transgender

Imagine that you are a primary care provider in the middle of your busy Thursday. Your 10:30 a.m. telehealth appointment is as follows:

HPI: An otherwise healthy 35-year-old transgender woman on hormone suppressant therapy presents with a chief complaint of sinus congestion and runny nose that began 2 days ago. She tells you that her sinus infections always start off this way, and she has a wedding to go to this coming weekend and does not want to be sick for this event. She is requesting antibiotics and is quite insistent that she requires this treatment.

Past Medical History: Unremarkable. History of seasonal allergies and recurrent sinus infections. She does have some history of episodes of elevated blood pressure without a diagnosis of hypertension.

Family History: Noncontributory. No one else at home is sick.

ROS (completed by the medical assistant):

Constitutional: The patient denies fevers, chills, sweats, and weight changes.

EYES: The patient denies any visual symptoms.

EARS, NOSE, AND THROAT: No difficulties with hearing. Endorses sinus congestion and rhinitis.

Cardiovascular: Patient denies chest pains, palpitations, orthopnea, and paroxysmal nocturnal dyspnea.

RESPIRATORY: No dyspnea on exertion, no wheezing or cough.

GI: No nausea, vomiting, diarrhea, constipation, abdominal pain, hematochezia, or melena.

GU: No urinary hesitancy or dribbling. No nocturia or urinary frequency. No abnormal urethral discharge.

Musculoskeletal: No myalgias or arthralgias.

Neurologic: No chronic headaches, no seizures. The patient denies numbness, tingling, or weakness.

Complete the following:

Initial Post by Wednesday (Day 3) at 11:59 p.m.

List 10–20 additional questions of subjective information that you would need to elicit from your patient to help formulate your differential diagnoses and plan. You may not ask questions that were already addressed in the HPI/ROS. Make sure to watch the telehealth modules which include how to complete the physical exam via telehealth. You will need two scholarly references for the questions that you ask of your patient. See the rubric for more detail.

TIP | Watch the following videos on Telehealth:

Introduction to Conducting Physical Exams via Telehealth with Devices (1:51 Minutes)

Introduction to Conducting Physical Exams via Telehealth with Devices Video Transcript

Telehealth Physical Exam: ENT (9:10 Minutes)

Telehealth Physical Exam: ENT Video Transcript

Initial Response Post by Friday (Day 5) 11:59 p.m. Choose a classmate’s questions to answer:

Every peer post should only have one response post. Please do not reply to a peer if a response is already posted.

You are answering as the patient. Make it case appropriate but imaginative. Be creative and answer thoroughly. No references are needed.

NU664B Primary Care of Family I

Week 3 Discussion

Hispanic / Nondocumented Patient with Acute Illness

Imagine that you are a primary care provider in the middle of your busy Thursday and your 2:00 p.m. appointment is as follows:

HPI: A 75-year-old patient of Hispanic descent arrives in an immigrant healthcare clinic with fever, chills, a sore throat, and a nonproductive cough. She speaks some English. The patient appears very ill, with dry mucous membranes, dark circles under the eyes, and pale skin. The patient appears anxious and is reluctant to make eye contact or speak. The health history reveals that the patient lives with extended family in a home setting, including infants and elderly. All of the family members are undocumented residents of the United States.

Past Medical History: Hypertension, Asthma.

Family History: Father (Deceased 81 / Stroke); Mother (Alive 95 / HTN, COPD, Diabetes)

Complete the following:

Initial Post by Wednesday (Day 3) at 11:59 p.m.

List 10–20 questions of subjective information that your patient will need to provide to help you formulate your differential diagnoses and plan. Include two scholarly references for the questions that you ask of your patient. See the Grading Rubric for more detail.

Initial Response Post by Friday (Day 5) 11:59 p.m. Choose a classmate’s questions to answer:

Every peer post should only have one response post. Please do not reply to a peer if a response is already posted.

You are answering as the patient. Make it case appropriate but imaginative. Be creative and answer thoroughly. No references are needed.

NU664B Primary Care of Family I

Week 6 Discussion

Patient with Hypertension

Imagine that you are a primary care provider in the middle of your busy Thursday. Your 10:30 a.m. telehealth appointment is as follows:

HPI: A 50-y-old Spanish-speaking female who is bilingual returns to your office for a follow-up BP check. She is a schoolteacher and has been your patient for many years. She arrives 45 min late for her appointment. At her previous visit 4 weeks ago, her BP was 160/90 mm Hg on atenolol 50 mg QD (Tenormin, beta-blocker, max dose 100 mg QD), and you increased the atenolol to 75 mg QD at that time.

Today she feels well, and her BP is 140/85 mm Hg on 2 measurements and her HR is 50 bpm.

Labs: CBC (WNL), Creatinine 2.0 mg/dl (normal range 0.5–1.3 mg/dl), potassium 3.8 MEQ/L (nml range 3.5–5 MEQ/L), and a 24 h urine protein of 1.3 g (normal <150 mg/d), similar to her previous lab results 6 month ago.

Allergies: NKDA

Family History: Father (deceased 85 y/o CVA); Mother (deceased 91 y/o MI)

Physical Exam

Vitals: BP 140/85, HR 50, RR 18, Wt 132 lbs, Ht 5’1”

HEENT: PERRL, Funduscopic exam notes cotton wool spots present.

Respiratory: Lungs were clear bilaterally with good aeration.

Cardiac: RRR, S1/S2 auscultated. 2+ pitting edema bilaterally.

Abdominal: Unremarkable

Integumentary: Intact.

Vascular: Capillary refill +3

Complete the following:

Initial Post by Wednesday (Day 3) at 11:59 p.m.

List 10–20 questions of subjective information that your patient will need to provide to help you formulate your differential diagnoses and plan. Include two scholarly references for the questions that you ask of your patient. See the Grading Rubric for more detail.

Initial Post by Wednesday (Day 3) at 11:59 pm

Initial Response Post by Friday (Day 5) 11:59 p.m. Choose a classmate’s questions to answer:

Every peer post should only have one response post. Please do not reply to a peer if a response is already posted.

You are answering as the patient. Make it case appropriate but imaginative. Be creative and answer thoroughly. No references are needed.

NU664B Primary Care of Family I

Week 8 Discussion

Memory Loss

You are the nurse practitioner in family practice. You are seeing a new patient today: a 70-year-old African American woman, Selah, who is accompanied by her daughter, Britt, to the appointment. The PMH of the patient includes HTN, DM, Hyperlipidemia, TIA × 2, and Osteoarthritis of both knees, with multiple falls resulting in two diagnosed concussions. The daughter is concerned because she feels as if her mother's memory isn't what it used to be. Britt states that her mother sometimes misplaces things and forgets events, as well as the names of people she has known for a long period of time.

Helpful hint: Don't forget to ask OLDCARTS for each condition and about medication.

Complete the following:

Initial Post by Wednesday (Day 3) at 11:59 p.m.

List 10–20 questions of subjective information that your patient will need to provide to help you formulate your differential diagnoses and plan. Include two scholarly references for the questions that you ask of your patient. See the Grading Rubric for more detail.

Initial Response Post by Friday (Day 5) 11:59 p.m. Choose a classmate’s questions to answer:

Every peer post should only have one response post. Please do not reply to a peer if a response is already posted.

You are answering as the patient. Make it case appropriate but imaginative. Be creative and answer thoroughly. No references are needed.

NU664B Primary Care of Family I

Week 11 Discussion

Atopic Dermatitis

Imagine that you are a primary care provider in the middle of your busy Thursday and your 4:15 pm appointment is as follows:

HPI: A 9-year-old boy, Taumi, with a history of recurrent skin infections presents with extensive redness and pruritus of the popliteal and antecubital fossae, arms, and abdomen. He’s scratched the lesions, especially at night, with the result that his sleep was disturbed. Despite the use of chronic moisturizing therapy and topical corticosteroids, he is having a seasonal flare of his condition. When he was 6 years old, he also experienced bronchial asthma with a persistent cough. This is not the first time he’s experienced this type of rash and has had issues since he was 4 years old. His mothers, Patricia and Fran, are bringing him into the clinic today for another exacerbation. They have tried the following: diphenhydramine 25mg q8h prn, hydrocortisone 2% QID, Zyrtec 10mg QD, and Aquaphor QID. The medications help some, but he’s still uncomfortable.

Family history: His father has asthma, and his younger sister has allergic rhinitis and cow’s milk allergy.

Physical Exam:

Vitals: BP 102/60, HR 68, RR 18, Wt 88 lbs (22 kg), Ht 4’11”

HEENT: Injected conjunctivae and presence of Dennie-Morgan lines. There was a ‘cobblestone’ appearance of his posterior pharynx.

Respiratory: Lungs were clear bilaterally with good aeration.

Cardiac and abdominal examinations were unremarkable.

Integumentary: Skin examination demonstrated scattered scaly eczematous patches along with the flexural areas of his upper and lower extremities. Impetigo “crust-like” lesions with serum oozing were found on the left elbow.

Complete the following:

List 10–20 questions of subjective information that your patient will need to provide to help you formulate your differential diagnoses and plan. Include two scholarly references for the questions that you ask of your patient. See the Grading Rubric for more detail.

Initial Response Post by Friday (Day 5) 11:59 p.m. Choose a classmate’s questions to answer:

Every peer post should only have one response post. Please do not reply to a peer if a response is already posted.

You are answering as the patient. Make it case appropriate but imaginative. Be creative and answer thoroughly. No references are needed.