Saint Thomas University Nursi

Chief Complaint

(CC) “It burns when I urinate” “I had a severe headache yesterday with difficulty to speak” “I have been having frequents headaches lately”

History of Present Illness (HPI) A 68-year-old Caucasian male who reports to have increase on the frequency of urination with urgency for the last 5 days. He also present dysuria and nocturia. A 64-year-old African American female who reports having a severe pulsatile diffuse headache yesterday with sudden difficulty to talk with last for about two hours. She did not seek medical attention. This morning she woke up with no problems but is here today due her husband advise. A 25-year-old Hispanic female presents to your clinic with a headache located on right temporal area, pulsatile.

PMH Benning prostatic hyperplasia diagnosed 3 years ago, UTI 6 months ago, Lithotripsy left kidney 10 years ago. No issues after treatment Atrial Fibrillation, Hypertension. Is allergic to Non-steroidal Anti-inflammatory drugs Aspirin Frequent headaches since I was 15, with menses.

Drug Hx Rosuvastatin 20 mg

Olmesartan 20 mg

Losartan 50 mg

Xarelto 15 mg BID

Ibuprofen for Headaches

Subjective

Fever and chills, no changes in vision or hearing, no difficulty chewing or swallowing. No sexually active, nocturia, dysuria.

Yellowish urethral secretion. Feels Palpitations, joint pain with yesterday’s episode Light makes headache worst Nausea associated with headaches. No vomiting, Headaches improve usually with rest, ibuprofen, and sleep, but it is annoying to have to sleep all-day

Objective Data

VS B/P 150/96; Pulse 89; RR 16; Temp 99.4; Ht 6,1; wt 180; B/P 131/80; temperature 98.2°F; (RR) 18; (HR) 84, irregular; oxygen saturation (PO2) 96%; B/P 108/64; Pulse 86; RR 16; Temp 98.6;

General well-developed male, no acute distress well-developed female, no acute distress 25-year-old female appears well developed and well-nourished, healthy appearing, wearing dark glasses in a dim room

HEENT Atraumatic, normocephalic, PERRLA, EOMI, arcus senilus bilaterally, conjunctiva and sclera clear, nares patent, nasopharynx clear, edentulous.

Atraumatic, normocephalic, PERRLA, EOMI, conjunctiva and sclera clear; nares patent, nasopharynx clear, good dentition.

no injection, anicteric, PERRLA, EOMs intact, without pain to movement; normal vision

Lungs CTA AP&L

CTA AP&L

CTA AP&L

Card S1S2 without rub or gallop S4 present Irregular heart beat with normal rate S1S2 without rub or gallop

Abd No tenderness normoactive bowel sounds x 4; No tenderness normoactive bowel sounds x 4;

benign, normoactive bowel sounds x 4;

Rectal exam Warm, swollen and painful prostate gland Non contributory Non contributory

Integument good skin turgor noted, moist mucous membranes intact without lesions masses or rashes. intact without lesions masses or rashes.

Neuro No obvious deformities, CN grossly intact II-XII No obvious deficits and CN grossly intact II-XII Cranial nerves II to XII intact; sensation intact, DTRs 2+ throughout.

Functional neurological exam is WNL

answer the following questions:

What other subjective data would you obtain?

What other objective findings would you look for?

What diagnostic exams do you want to order?

Name 3 differential diagnoses based on this patient presenting symptoms?

Give rationales for your each differential diagnosis.

What teachings will you provide?

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Saint Thomas University Nursi

For this Discussion, you will take on the role of a clinician who is building a health history for one of the following cases. Your instructor will assign you your case number.

Case 1Case 2Case 3Chief Complaint
(CC) “I am here today due to frequent and watery bowel movements”“I have pain in my belly”“neck swelling”History of Present Illness (HPI)A 37-year-old European American female presents to your practice with “loose stools” for about three days. One event about every three hoursA 25-year-old female presents to the emergency room (ER) with complaints of severe abdominal pain for 2 weeks . The pain is sharp and crampy It hurts if I run, sit down hard, or if I have sexA 42-year-old African American female who refers that she has been noticing slow and progressive swelling on her neck for about a year. Also she stated she has lost weight without any food restrictionPMHNo contributory Patient deniesPatient denies PSHAppendectomy at the age of 14 Surgical removal of benign left breast nodule 2 years agoDrug Hx
No medsBirth controlNo medication at the timeAllergiesPenicillinNKANKASubjectiveFever and chills, Lost appetite Flatulence No mucus or blood on stoolsNausea and vomiting, Last menstrual period 5 days ago, New sexual partner about 2 months ago, No condoms, he hates them No pain, blood or difficulty with urinationMild difficult to shallow, Neck feels tight, Pt states she feels PalpitationsObjective Data PEB/P 188/96; Pulse 89; RR 16; Temp 99.0; Ht 5,6; wt 110; BMI 17.8B/P 138/90; temperature 99°F;  (RR) 20; (HR) 110, regular; oxygen saturation (PO2) 96%; pain 5/10 B/P 158/90; Pulse 102; RR 20; Temp 99.2; Ht 5,4; wt 114; BMI 19.6 Generalwell-developed female in no acute distress, appears slightly fatiguedacute distress and severe pain42-year-old female appears thin. She is anxious – pacing in the room and fidgeting, but in no acute distress. HEENTAtraumatic, normocephalic, PERRLA, EOMI, arcus senilus bilaterally, conjunctiva and sclera clear, nares patent, nasopharynx clear, edentulous.
Atraumatic, normocephalic, PERRLA, EOMI, conjunctiva and sclera clear; nares patent, nasopharynx clear, good dentition. Piercing in her right nostril and lower lip.
Bulging eyes NeckSuppleDiffuse enlargement of the thyroid glandLungsCTA AP&L
CTA AP&L
CTA AP&LCardS1S2 without rub or gallopS1S2 without rub or gallopS1S2 without rub, TachycardiaAbdpositive bowel sounds (BS) in all four quadrants; no masses; no organomegaly noted; diffuse, mild, bilateral lower quadrant pain noted Mild diffuse tenderness.

  • INSPECTION: no masses or thrills noted; no discoloration and skin is warm to; no tattoos or piercings; abdomen is nondistended and round
    • AUSCULTATION: bowel sounds (BS) are normal in all four quadrants, no bruits noted
    • PALPATION: on palpation, abdomen is tender to touch in four quadrants; tenderness noted on light palpation, deep palpation reveals no masses, spleen and liver unremarkable
    • PERCUSSION: tympany heard in all quadrants, no dullness noted in abdominal area

benign, normoactive bowel sounds x 4GU Non contributory• EXTERNAL: mature hair distribution; no external lesions on labia
• INTROITUS: slight green-gray discharge, no lesions
• VAGINAL: normal rugae; moderate amount of green discharge on vaginal walls
• CERVIX: nulliparous os with small amount of purulent discharge from os with positive cervical motion tenderness (CMT)
• UTERUS: ante-flexed, normal size, shape, and position
• ADNEXA: bilateral tenderness with fullness; both ovaries without masses
• RECTAL: deferred
• VAGINAL DISCHARGE: green in color Non contributoryExtno cyanosis, clubbing or edemano cyanosis, clubbing or edemano cyanosis, clubbing or edemaIntegumentgood skin turgor noted, moist mucous membranesintact without lesions masses or rashesThin skin, Increase moistureNeuroNo obvious deformities, CN grossly intact II-XIINo obvious deficits and CN grossly intact II-XIINo obvious deficits and CN grossly intact II-XII

Once you received your case number, answer the following questions:

  1. What other subjective data would you obtain?
  2. What other objective findings would you look for?
  3. What diagnostic exams do you want to order?
  4. Name 3 differential diagnoses based on this patient presenting symptoms?
  5. Give rationales for your each differential diagnosis.

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Saint Thomas University Nursi

Introduction & PICOT Question Assignment

Your Introduction must include:

  • Your PICOT question.
  • Purpose of or rationale for the scholarly project:
    • Provide an evidence-based explanation of why it is necessary to complete your scholarly project and what benefit will be gained (health promotion, fiscal, and efficiency).
  • Background on the problem or population of interest:
    • Using primary sources, provide data on your topic.
    • Providing the background will demonstrate the focused need for your project.
  • Significance of the problem to nursing and health care:
    • State how your problem or population of interest aligns with the larger interest of health care in the community.
    • Create a context to why your topic is important.
  • Benefit of the project to nursing practice:
    • State what will be gained from your project.
    • Describe the expected outcomes of your project to practice within your population and setting.
    • Relate the outcomes to evidence-based guidelines and outcomes.
    • Describe how your project may influence other populations or settings.

Submission Instructions:

  • The introduction is original work and logically organized.
  • The paper is 2-3 pages in length and follows current APA format including citation of references.
  • Incorporate a minimum of 4 current (published within the last five years) scholarly journal articles or primary legal sources (statutes, court opinions) within your work.
  • Journal articles and books should be referenced according to the current APA style (the library has a copy of the APA Manual).
  • PICOT Questions and an Evidence-Based Assignment (Links to an external site.)
    Grademaster Pro. (2021, February 6). PICOT questions and an evidence-based assignment. https://grademaster-pro.com/picot-questions-and-an…
    • Introduction
      An introduction provides some background information so that readers understand the issue. It explains why the issue is important. It also describes what is known about the issue. Additionally, the introduction states what is needed to find out or what action needs to be taken and why. Finally, it presents how the writer plan to do the project.
    • What is a PICOT Question?
      A PICOT Question is a question that is formatted in an accepted format, and used to develop answerable, researchable questions, especially in nursing. PICOT question mainly answers four main areas including population, intervention, control, outcome, and time.
    • Formulating a PICOT Question
      To formulate a PICOT question, there are three critical elements that should be addressed. The three elements include population, the proposed intervention, the control to compare with the intervention, the expected outcome, and the time within which the intervention will be considered.
      • For example:
        In women of age 60 and above at risk of developing osteoporosis, is educations and medication for one year effective in reducing the complication of osteoporosis compared to none?
        • In the example given above, the question breaks down as follows:
          • Population – Women of age 60 and above
          • Intervention – Education and medication
          • Control – None, which means there is no intervention
          • Outcome – Reducing the complications of osteoporosis
          • Time – One year

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