Reference no: EM132699413

Assignment: Part 1: Health Assessment

Case scenario: A previously healthy 35-year-old lawyer presents to a primary care office with a chief complaint of chest pain and a non-productive cough. The pain started suddenly 2 hours prior to coming to the office while the patient was sitting at his desk. The patient describes the pain as sharp in nature, constantly present but made worse with inspiration and movement, and with radiation to the base of the neck. His blood pressure in the right arm and other vital signs are normal.

On physical examination, the only findings of note are chest wall tenderness and a faint cardiac murmur. The ECG in the office is normal. The patient is observed for an hour in the office and assessed. He is diagnosed with viral pleurisy and sent home on non-steroidal analgesics.

The following day the patient collapses at home and cannot be resuscitated by the paramedic service. An autopsy reveals a Type 1 aortic dissection with pericardial tamponade.

Developing a list of possible conditions that might produce a patient's symptoms and signs is an important part of clinical reasoning.

As an NP in primary care, what would you have done differently?

Discuss the importance of creating a list of differentials for this patient. How could it have changed this outcome?

If a serious diagnosis comes to mind based on a patient's symptoms:

Ask yourself: Have you considered the likelihood of a serious diagnosis and whether it needs to be ruled out by testing or referral?

Because many serious disorders are challenging to diagnose, have you considered ruling out the worst-case scenario?

Ask yourself: Do you have a sufficient understanding of the clinical presentation to offer an opinion on the diagnosis?

What other diagnoses could it be? How might the treatment to date have altered the patient's outcome?

What other diagnostic and laboratory or imaging was needed in order to make a complete differential list? What support tools would you consider using in helping to create a differential diagnosis list?

Are you familiar with the current clinical practice guidelines for the investigation of a suspected condition such as chest pain?

Please support with up-to-date evidence-based standard of care guidelines.

Part 2: Pathopysiology

Mr. F is a 38-year-old man in overall good health who has been complaining about an aching pain in his knees when working around the house and often when simply walking. He has noticed that his knees feel "hard" and tight. His history indicates that he has always been involved in athletics and was on the college football team, but recently family responsibilities and work have not made it easy for him to exercise.

1. Relate Mr. F's case history to the pathophysiology of osteoarthritis.

2. How do anti-inflammatory drugs and analgesics help Mr. F deal with this form of arthritis?

a. Why is moderate, non-weight-bearing exercise recommended?

3. What is the probable prognosis for Mr. F?

Part 3: Pathopysiology

Mr. F is a 38-year-old man in overall good health who has been complaining about an aching pain in his knees when working around the house and often when simply walking. He has noticed that his knees feel "hard" and tight. His history indicates that he has always been involved in athletics and was on the college football team, but recently family responsibilities and work have not made it easy for him to exercise.

1. Relate Mr. F's case history to the pathophysiology of osteoarthritis.

2. How do anti-inflammatory drugs and analgesics help Mr. F deal with this form of arthritis?

a. Why is moderate, non-weight-bearing exercise recommended?

3. What is the probable prognosis for Mr. F?

Part 4: Pathopysiology

Mr. K. is a 57-year-old man who consulted his physician after noticing marked leg pains while playing golf. He had previously noticed increasing fatigue and discomfort in his legs associated with moderate exercise. When sitting for extended periods with legs dangling, his legs became red, and sometimes his feet felt numb. His history indicates he smokes cigarettes and is chronically overweight. His blood cholesterol and other lipid levels are abnormal, and his physician suspects peripheral atherosclerosis as the cause of his discomfort.

1. Discuss the development of atherosclerosis, including the predisposing factors in this case and the pathophysiological changes.

2. Discuss the complications that might develop in this patient. (Pathophysiology, Signs and Symptoms.)

3. Discuss the treatments for all aspects of the patient's condition, including slowing the progress of the

atherosclerosis, maintaining circulation in the leg, and treating complications.

Part 5: Pathopysiology

Mr. K. is a 57-year-old man who consulted his physician after noticing marked leg pains while playing golf. He had previously noticed increasing fatigue and discomfort in his legs associated with moderate exercise. When sitting for extended periods with legs dangling, his legs became red, and sometimes his feet felt numb. His history indicates he smokes cigarettes and is chronically overweight. His blood cholesterol and other lipid levels are abnormal, and his physician suspects peripheral atherosclerosis as the cause of his discomfort.

1. Discuss the development of atherosclerosis, including the predisposing factors in this case and the pathophysiological changes.

2. Discuss the complications that might develop in this patient. (Pathophysiology, Signs and Symptoms.)

3. Discuss the treatments for all aspects of the patient's condition, including slowing the progress of the atherosclerosis, maintaining circulation in the leg, and treating complications.