iHuman Case Study Constance Barn 70Yrs Old Female Cc (Chronic Dyspnea)shortness of Breath, Exams of Nursing

Download iHuman Case Study Constance Barn 70Yrs Old Female Cc (Chronic Dyspnea)shortness of Breath and more Exams Nursing in PDF only on Docsity! iHuman Case Study: Constance Barn 70Yrs Old Female Cc: (Chronic Dyspnea) Shortness of Breath Latest 2024 Questions – 100 % 1 How can I help you today? 2 Are there any other symptoms or concerns we should discuss? 3 When did your difficulty breathing start? 4 Does anything make your difficulty breathing better or worse? 5 Are you short of breath when lying down? 6 Are you short of breath at rest? 7 Do you sleep with pillows to help you breathe? 8 Do you have any pain or symptoms associated with your difficulty breathing? 9 How severe is your difficulty breathing? 10 Do you wheeze? 11 Do you become short of breath with exertion? 12 Do you awaken at night short of breath? 13 Does anyone in your family have difficulty breathing? 14 Do you feel faint or like you might faint? 15 Do you have a problem with fatigue/tiredness? 16 Have you been having fevers? 17 Have you noticed any swelling in any part of your body? 18 Do you have a problem with generalized weakness? 19 Do you have a cough? 20 Do you have unusual heartbeats? 21 Do you have a sensation of a “pounding heart” in your chest? 22 Do you have any pain in your chest? 23 Does your chest feel tight or heavy? 24 Can you tell me about any current or past medical problems you have had? 25 Do you have high cholesterol? 26 Do you have heart disease and/or have you ever had a heart attack? 27 Do you have a history of heart failure? 28 Have you ever been told that you have a murmur or valve problems? 29 Do you have asthma? 30 Do you have a history of lung disease? 31 Do you now or have you ever had cancer? 32 Any previous medical, surgical, or dental procedures? 33 Have you ever been hospitalized? 34 Do you have any allergies? 35 Are you taking any over the counter or herbal medications? 36 Are there any disease that run in your family? 37 Are you taking any prescription medications? 38 Do you drink alcohol? If so, what do you drink and how many drinks per day? 39 Do you now or have you ever smoked or chewed tobacco? 40 Do you have diabetes? 41 Have you ever fainted? 42 Were you short of breath just before you fainted? 43 Have you had tuberculosis? 44 Do you have a family history of blood clots in your legs or lungs? 45 Do you have a history of deep vein thrombosis or pulmonary embolism? 46 Have you ever been diagnosed with thyroid problems? 47 Have you recently traveled? Where? 48 Have you ever been diagnosed with a bleeding disorder? 9 26-year PPD smoker 10 Hyperactive bowel sounds When this assignment was completed, ALS and Myasthenia Gravis were missing from the DDX as well as the MNM – per professors grading, these were the two that were missing for both sections. Previous score was DDX = 85%, Ranking = 85%, MNM = 69%, so follow as written below, and should score 100%for all Differential Lead Alternate MNM 1 COPD X 2 Asthma X 3 CHF X 4 Acute coronary syndrome X 5 Anemia X 6 MI X 7 CAD X 8 A-Fib X 9 Mitral regurgitation X 10 Cardiomyopathy/hypertrophic X 11 Mitral valve stenosis X 12 GAD X 13 Aortic regurgitation X 14 Pneumonia X 15 HTN/pulmonary X 16 A-Flutter X 17 TIA X 18 OSA X 19 CKD X 20 Heart block X 21 Hyperthyroid X 22 Hypothyroid X 23 Pleural effusion X 24 Deconditioning X 25 Ischemic heart disease X 26 Achondroplasia X 27 Carotid Stenosis X 28 Aortic Stenosis X X 29 ALS X X 30 Myasthenia Gravis X X 31 Angina, stable X 32 Pulmonary embolism X X 33 Pericarditis X 34 Neurocardiogenic syncope X 35 Atherosclerosis X Aortic Stenosis Diagnosis – 100% Recommended further diagnostics: Lipid panel – per clinical practice guidelines, coronary artery disease is common in patients with stenosis and patient should be screened/treated for hypercholesteremia to reduce the risk of ischemic event. Medications/Treatments • Surgical intervention with mechanical valve replacement. • Anticoagulant therapy is necessary in patients with mechanical valve to prevent valve thrombosis and thromboembolic events. • In conjunction with warfarin/coumadin for adults with mechanical prosthetic aortic valve replacement and risk factors for thromboembolism, patient should take aspirin 75 to 100mg daily. • Start on statin therapy – indicated in all patients with calcific aortic stenosis for primary and secondary prevention of atherosclerosis. • ACE inhibitor would be appropriate due to potential benefits on LV fibrosis as well as for controlling the patients hypertension. • Discontinue amlodipine – calcium channel blockers can depress LV systolic function in patients with aortic stenosis, can cause edema. Suggested consults/referrals: • Cardiology • Cardiothoracic surgery Management Plan Diagnostics – 100% 1 12 lead EKG 2 BNP 3 Cardiac stress test 4 Chest Xray, PA and Lateral 5 CBC 6 Coronary angiogram 7 ABG’s 8 Echo TEE 9 Echo TTE 10 Holter cardiac monitor 11 PFT 12 Lexiscan Pd Case History = * Mrs. Barn is a 70 year old woman who has noticed the gradual onset of progressive dyspnea on exertion over more than one year ECG reveals a LBBB * CBC shows a HCT of 36, WBC of 6.1 * CXR is unremarkable without infiltrates, cardiac or pulmonary anomalies = | @& jit’. Case History * Mrs. Barn is a 70 year old woman who has noticed the gradual onset of progressive dyspnea on exertion over more than one year * ECG reveals LVH * CBC shows a HCT of 36, WBC of 6.1 * CXR is unremarkable without infiltrates, cardiac or pulmonary anomalies © PED + Nocrackles * + Grade III/VI systolic murmur, no S3, no JVD * Consider each disease on the differential diagnosis...  Severe Aortic Stenosis: Signs Transvalvular Gradient > 50 mmHg * Combined findings have +LR of 8 — Delayed & diminished carotid upstroke — Murmur loudest at right RUSB & ¥ S2 * Signs that make severe AS less likely — Absence of systolic murmur (-LR = 0.0) — Absence of transmission of murmur to neck (-LR = 0.1) Aortic Stenosis: Tests * CXR — Minimal CXR changes until later stages with HF — Aortic valve calcification +LR 3.9 ; -LR 0.5 for severe AS + EKG — LVH: +LR 2.1; -LR 0.5 for severe AS + Echocardiogram — Test of choice — Recommended if murmur 2 grade III/VI — TTE usually sufficient to confirm AS & its severity  AS Treatment + Mortality increases dramatically with symptoms + Surgery indicated for symptomatic patients with severe stenosis * Options include mechanical valves, bioprosthetic valves and TAVI Case Conclusion + Adiagnosis of aortic stenosis was made * Patient underwent valve replacement with mechanical AV * Chronically anticoagulated + DOE improved postoperative.