NR 511 Week 3 Open Forum SNAPPS Presentation

Sample Answer for NR 511 Week 3 Open Forum SNAPPS Presentation

Hi, my name is Nicole Moore and this is my snaps oral presentation for NR 511, Differential Diagnosis and Primary Care practicum with Dr. Roger Green. Te is a 52 year old Hispanic female who works as an RN case manager at a nearby hospital with history of hypertension, hyperlipidemia, and diabetes. She currently takes Metoper 25 milligrams daily, pravastat 40 milligrams daily. And her most recent A one C was 8.2 The patients presenting to clinic accompanied by her husband for an acute care visit, the patient’s chief complaint, acute right flank pain, that started two days ago and radiates to the growing. She describes the pain as intermittent and it can alternate between shooting, stabbing, and being dull. She states that walking and breathing makes the pain worse, and sitting slightly forward in the chair helps improve the pain. She has taken Tylenol and IIbprofin, but both have been ineffective. She reports her pain ten out of ten. She states she urinates frequently and sometimes experiences Diptheria. She reports a recent heavy menstrual starting November 5, that lasted more than a week. 

This is after not having a menstrual cycle for more than six months. She reports that her water intake is low, Reporting that she mainly drinks soda beverages and rarely water. She states that her diet is high and fat and reports eating fast food, fried foods for most meals, and she denies a routine exercise regimen. On physical exam, the patient appeared to be in great discomfort and distress. She had a positive CVA tenderness on the right side. I collected a urine Dipstic and UA. The urine Dipstic in office today showed a result of yellow cloudy urine, a ph of 5.5 and positive for traces of protein and leucocytes, and also positive for a small amount of blood. It was negative for nitrates, gluclose, Billy Ruben or ketones. At the beginning of the visit, the patient’s blood pressure was 160/96 then repeated again closer to the end of the visit. The blood pressure was 148/99 Hydrochlorothiazide 12.5 milligrams daily was initiated based on the chief complaint of right flank pain accompanied with dysurea and urinary frequency for more than one week.

 And the urine dipstick in office today showing positive blood and traces of leucocytes. I believe the top appropriate differential diagnosis is nephyalthiasis or kidney stones. Additional possible differentials to consider are acute pylonephritis, cystitis or UTI, and appendicitis. When analyzing acute pyl nephritis, the positive findings were positive CVA tenderness, unilateral flank pain, hematuria, urea frequency or urinary frequency, a ph of 5.5 positive leucocytes with the urine dipstick. Then negative findings. Patient denies nausea, vomiting, fevers, chills, and headache, analyzing UTI or cystitis. Positive findings are urinary frequency, hematuria and positive CVA tenderness. For the negative findings, the patient denies burning with urination, fevers, chills, foul smelling, urine or sensation of incomplete bladder emptying. Then lastly, when closely analyzing appendicitis, the positive findings are urinary frequency, dysuria, positive leucocytes with the urine dipstick, and then negative findings. Patient denies severe abdominal pain absent from Mcburnie Point or Mcburnie sign, and then denies fever, nausea, and vomiting.

 When looking at probing questions, I will ask the preceptor. If a kidney stone is present, what is the likelihood the patient will pass the stone. And then also, based on the results of the urine dipstick, how can it be determined whether the kidney stone is calcium versus uric acid? Lastly, if the pending kidney ultrasound shows a kidney stone is not present, how will that change the plan of care? Lastly, for the management plan, a kidney ultrasound was ordered while we wait for results flow max or temulosin 0.4 milligrams by mouth daily was ordered. This is to help relax the utters and help pass the stone. Then as far as pain management, Tramadol, 50 milligrams, 01 to two tabs every four to 6 hours as needed, was started. Then the patient was encouraged to increase fluid intake to maintain urinary output of two to three liters per day. She was also encouraged to increase her fiber and reduce her fat in the diet. Then, most importantly, the patient was advised, if her symptoms persist or worsen, to report to the ER for further evaluations or immediate medical attention. As far as for self directed learning, I will look up the difference or the different signs and symptoms to help determine between a diagnosis of nephrolathitasis verse acute pylonephriitis. Thank you.

Sample Answer 2 for NR 511 Week 3 Open Forum SNAPPS Presentation

Hello everyone. Today I’m presenting a patient who comes in with chief complaint of, she’s a 32 year old female with chief complaint of sore throat, nasal congestion, and has a history of, only history is a history of asthma. The onset of symptoms was two days ago. She, she works in a daycare and took the day off today due to her excessive nasal drainage, feeling ill, and associated headaches. She denies fever, chills, cough, or short of breath. She does not know what makes symptoms worse or better, has not tried anything for her symptoms. Her headache, she describes it as pressure, pain in the in the forehead at four at a ten. Has not taken anything for her headache either. When I, with the review of symptoms, I found that she has a history of asthma and azema. She uses inhalers for asthma and Usa pain for Ema. She reports associated headache with sore throat and nasal congestion and nice feeling short of breath with the need to use her inhaler for asthma at this time. Sinus pressure and she knows or watery eyes. Nia, vomiting, fever, chills on physical exam, her eyes watery with conjunctible ejection.

 I see dark circles under her eyes. Her nasal passages are buggy and pale with clear binorea. She has a muffled voice. Her oral ference is read inflamed. No noted lesions or abnormal drainage or exudate. She has palpable lymph nodes which indicates inflammation due to excessive lymph node drainage. Lung sounds are all clear. I didn’t hear any, you know, short of breath, wheezing, or like a cough. Herbatalsigns are blood pressure, 162 of our 98 which is elevated, it’s concerning. Our temperature is 99.6 which is a low rate fever, pulse is 77 and respirations was 18. For differential diagnosis, I would consider allergic, its common cold nasal oral fynitisytictis. I would probably rank them in the same order, with the first one being allergic rhinitis and the second one maybe just a common cold. For the common cold, because she works with children, she puts her at a higher risk for getting cold, especially around this time of the year. But I would probably rule out the common cold just because she denies fever. Cough with phlegm or any kind of productive phlegm for naso or oral pharyngitis. She doesn’t really have a high temperature. I didn’t see any Tnsular exudate or inflamed nasal passages. So I don’t know that I would give her that as a priority diagnosis for sinusitis, the patient sinus. When I palpate, she denied any pain or thick sputum. The only thing that is probably significant is that she has a frontal headache and a low she’s got a low grade fever. She reports a sore throat, but has no obvious consular date to consider consider this a diagnosis. And then we have allergic rhinitis or hay fever. I probably would consider this the number one because she has a history of asthma which this is a Putzerta harvest for allergic rhinitis. This diagnosis is mainly based on health history. 

And if I, you know, taking a thorough health history and if she has more than one of these sense and symptoms which include nasal congestion, I know you itchy water your eyes and nasal passages or sneezing in flame nasal passages or sneezing. She reports a clear nasal drainage and feeling of males sinuses are boggy and pill. She has a muffle voice and mouth breathing well. I noted her mouth that she’s breathing with her mouth. She reports headache and has a slight temperature Voice six. She has a muffle voice, which is another symptom of head fever. She has a slight fever and headache. I don’t see any reason to consider this being a bacterial infection or that there is a need to give antibiotics at this time. My plan of cure would include, first of all, I will probably probe the question as to how would I know if this diagnosis is viral or bacterial. And I probably wouldn’t know unless I took a very thorough physical exam In a history of present illness, I could collect a nasal swab, nasal and throat swab to rule out nasal and strep peryngitis. Right now, nothing really leads me to believe this is bacterial in nature. The slight temperature is expected, allergic. She deny fever, chills, abnormal date Lung cells are clear, no short of breath or cough.

Noted. I would probably her planting care would be first of all, to remove any allergen that might be causing her allergy symptoms. The use of air purifiers or to stay in air conditioning would be recommended. I would ask her to use a decongestion, which probably after 12 hour 0.05% nasal spray. She has to do two sprays, nasal, two times a day in each nostril for three days then stop. This will help with the running nose and stuffy, stuffy, runny nose. And even I would also tell her to use an antihistamine nasal Acyllstine hydrochloride 130 7 milligrams per spray. She has two spray, two sprays, nasal leave two times a day in each nostril or she can also take oral antihistamines that would be Ste 02.5 milligrams, up to 10 milligrams per day for the sending symptoms of allergies. She can also do saline nasal spray, a 0.65% nasal solution. This helps to promote the allergen from the nasal, helps to remove the allergen from the nasal passage. She is to do two sprays nasal every 2 hours. Every 2 hours is needed. I would also ask for her sore throat to gargle warm salt water. Hss needed throughout the day would just drink warm, warm teas or anything to soothe her sore throat. And I would tell her to follow up in a week if she if the size and symptoms that she’s experiencing do not resolve. As far as diagnostics, I would do a nasal five or CBC for usopils just to rule out, you know, bacterial versus viral. And that’s it. Thank you.

Hello, my name is Maria and I will be presenting my snap oral presentation. My patient is a 64 year old female who presented to the clinic with complaining of pain in the bladder, urinary urgency and frequency. It started three days ago. The location of the pain is super pubic area, left flank pain. She described the pain as intermittent in the last two days. However, starting today it has been constant and it has increased severity and frequency of the pain. She does complain of the urea pain described as burning sensation upon urination pain level nine out of ten, relieved with minutes of cessation of urinary stream. Characteristics of the abdominal pain is described as pressure dull, with severity of five out of ten, which is aggravated when the bladder is full and distended and it is relieved immediately after the bladder is emptied. Aggravating factors she describes as moving, walking, and when bladder is full, She has taken Advil, 200 milligrams, two tablets every 6 hours as needed, and there’s no other treatment that she has started.

 Review of systems we would start with. She denies chills, body aches, denies night sweats, denies shortness of breath, wheezing palpitation positive for abdominal pain, denies nausea and vomiting. Denies upper quadrant pain positive for left flank pain. Denies denies diarrhea and constipation. She does have positive pain upon urination. Reports urgency and frequency, No vaginal discharge or itching or odor reported swollen lymph nodes. Lymph glands denies headaches, vertigo, syncope or confusion. She does complain of fatigue on physical examination. Her physical examination is unremarkable, alert oriented times four vital signs are stable. Bmi 23.9 She has the lung sounds clear in all lung fields. Negative for wheezing, crackles, cardiovascular status, no corrodid breweries. Pupils equal to plus bilateral normal capillary refill, regular rate rhythm, abdominal tenderness, guarding noted pom palpation of the super pubic area. 

Negative for rebound tenderness. She is negative for Bloomberg, negative for Murphy Sine, negative for costovertebral angle tenderness, normal mood and effect. She does have positive leucocytes and ph of five upon uptick, we did send out the urine for culture and sensitivity. She does have negative forbilarubin, negative nitrates, and negative blood in the urine and no ketones in the urine. My three differential diagnosis would be cystitis, polyonephritis, and nephrolythiasis. Let’s analyze these three. My most likely diagnosis for this patient would be cystitis due to the positive for this condition is sure superpubic abdominal pain. Furthermore, the patient has history of UTI’s previously reported polyenephritis is an infection of the kidney or upper urinary tract. Pertinent positive for this condition which are present in include abdominal pain, urgency frequency, surea hematua, cloudy urine. Although pylonephritis has many of the same symptoms, asysthitis. Pertinent negatives include a fibril, lack of nausea, vomiting, lack of flank back pain, lack of fatigue, and appearance of being otherwise unwell. The state combined pertinent positive and negative symptoms led for me to believe that polyenephritis is not a possible diagnosis for this case. Least likely would be nephralothiasis, which is a renal calculi, a common cause for blood in the urine. The patient has negative blood in the urine. Its development of stones is related to decreasing urine volume, increasing excretion. Stone forming components such as calcium, uric acid sustain, and phosphate renal calculi present with excruciating pain. One question that I asked to my preceptor is, how would we decide which antibiotics to start when waiting for a urine culture? She did state that since bacrum is no longer considered first line of treatment due to increased resistance, Macrobid is her treatment of choice at this time for this current patient unless if it’s contraindicated or if patient is allergic to this medication. The plan for this patient would be to send the urine for culture sensitivity, which will be back within 72 hours. We started the patient on macrobid 100 milligrams every 12 hours orally for five days, instructed to take it with food. Do not take 2 hours within PPI’s. Also ibuprofen, 800 milligrams every 8 hours as needed for five days has been prescribed. Heating pads as needed for cramping. Instructed to call if symptoms worsen in 48 hours and complete entire antibiotic course instructions reviewed with the patient to wipe front and back, increase hydration, and no bubble baths for a week. Call if the symptoms worsen, otherwise follow up in one week. My self directed learning question would be what are some non hygiene related causes Syditis and how might it be avoided or treated? Thank you.

Sample Answer 3 for NR 511 Week 3 Open Forum SNAPPS Presentation

Hi guys. My lady MC is 33 years old female who present to clinic with complaint of sudden abdomal pain started two days ago. Her chief complaint was abdominal pain. Pain is mainly located on left lower quadrant, radiating to left lower back. When pain starts, it’s usually short and sharp with eight out eight out of ten she described as it comes and go and pain was accompanied with nausea, vomiting. She woke up in the middle of night from sudden abdominal pain and vomited ones duration about 10 minutes. The whole bar movement was loose One time without any malana. She ate outside food, sushi for lunch and mood for dinner. Nothing relieved her pain when it started and then she hasn’t been eating since yesterday. From the fear of food may make symptoms worse. Physical isn’t found with no tenderness on left floor quadrant and CVA which is cast a verbal angle and the pain is intermittent. But at random time, her review of system in general, she appears well nourished, but weak. And she denies any dizziness, light headness, chest pain, palpitation, short of breath, cough or ezing. Then abdominal pain still present. It comes and go. Denies any diarrhea, constipations or blood in stools or incontinence. And she has no hesitancy or frequency, or pain while urinating. All muscular skeletal is normal. Feels weak in general from not eating well. She’s anotimes.

 Four, she follow all the comments. Her pertinent physical exam is her abdomen, which was soft and round without any distension, contour mass, or any pulsation, no tympany or dullness noted. And then there was normal Murphy sine Burne sign and the Bloomberg sign. I narrowed it down to three differential diagnosis. It was acute pyelonephritis, diverticulitis and gastroenteritis. Number one, acute pyelonephritis, Pertinent positive findings are she had a left back pain. In other words, it can be flank pain. But she didn’t have any tenderness on her left CBA and there was no Pyuria fever, tachycardia or hypotension. Number two, diverticulitis positive findings are pain on her left low quadrant and changed her bowel movement pattern. But negative signs are she didn’t have any low graded fever, leukocytosis, or any changes in vowel movement. Only like one episode of diarrhea.

That that was it. Number three, gastroanthritis. Pertinent findings are vomiting one to 4 hours after ingestion of food without any allergic skin or respiratory symptoms and diarrhea within 24 hours of one set of symptoms. Number one, it’s unlikely acute pelo nepritis because there was no tenderness on CVA. Left CVA and she denies any lower urinary tract symptoms. It’s hard to determine that she has diverticulitis because her pain is sharp and short, but not steady. She never had fever and never noticed any movement changes lately, Terocolitis related to food poisoning might be pertinent positive and then most likely because she ate outside food which was like raw fish and then they might have contaminated. And she projected vomiting and diarrhea approximately 4 hours after ingestion and she had a watery diarrhea like within 24 hours, most likely it’s anterocolitis. Second, maybe diverticulitis, and then least likely acute pyolonephritis. There were knowledge gaps distinguishing differential diagnosis from physcal assessment. Initial approach before meeting the patient was diverticulitis, since Cycamocolin diverticulitis is the most common, whereas my preceptor approach to maybe acute pyle nephritis. But after physical exam my preceptor narrow down to enterocolitis since there was no tenderness on her left lower quadrant or left lower back. 

The confusing part to novice practitioner was how to differentiate out of multiple abdominal pain related to this diagnosis. But my preceptor answer that obtaining history and physical exam is important to narrow it down and in order further necessary diagnostic tests, if needed, order to rule out diverticulitis. Colonoscopy might be necessary, but based on patient’s age, any family history or duration of symptoms might be like least likely diverticulitis, but more likely enterocolitis, which should resolve within a few days with hydration. My question to receptor was number one, why did we not think she has diverticulitis? Number two, the patient complained of flank pain. What makes you rule out pyelonephritis? Number three, what made it think differently not to be other bowel disease like irritable bowel syndrome rather than entrocolitis. Plan was in order to conform entrocolitis stool, blood tests or imaging tests like abdominal ultrasound or CT scan may be necessary. In rare cases, entrocholitis may be a depends to necrotic colitis. It is important to order necessary tests. Acute treatment include antibiotics, or antivirals, or antiparascetic drugs. Depends on the result of diagnostic tests. And educate patient to avoid triggered food, like uncooked food or hydrate by taking ouluidsn In case when symptoms are severe, costeroids can be used to reduce inflammation. Follow up, expect her current state of enterocolitis. It might be resolved within a few days since the patient’s symptom already seemed to be subsiding. She was advised to have follow up in one week if symptoms worsen, like fever, chills, or abdominal pain. And also educated patient to take prescribed medications as advised. That’s all. Thank you so much.

Good morning. I have a patient who complained of fatigue for past two months. A 34 years old female works at bank. Generally healthy presented with complain of fatigue bilateral lower extremity itching, dry skin and hair loss for past two months. She feels tired most of the time days, especially the days when she’s working. She said her symptoms gradually worsening over past few months. Um, she said she’s not taking any medications to relieve the fat, fatigue or tiredness, but she said she rest, that helps with the tiredness. No past medical history or surgical history, She denies weight gain, weight loss, or having any symptoms of depression. The review of system is generalized tiredness, denies cold intolerance, positive for generalized dry skin, negative for dizziness and lightheadedness, negative for any shortness of breath. She said she denies any increased urination, thirst or hunger, and negative for genital urinary system.

 After doing the physical examination, the result is normal vital sign. Her blood pressure is 110/65 heart rate is 62, respiration is 18, and normal temperature is 98.6 BMI is 28, weight is 150 pound, and height is 5.1 Her skin is pink, not pale, generalized dry skin and bilateral or extremities has some itching scars, dry horse thin hair, consenti pink vision is 2020. Thyroid is firm, acceptable size for her age and gender. Long sounds clear, regular rate and rhythm. She’s alert oriented times four cranial nerve is intact and no numbness and tingling. After doing the history and physical examinations, I believe it could be hypothetism, anemia, or diabetes. After analyzes the positive and negative findings, I placed hypotherism as my first differential diagnosis. Has positive fatigue positive finding of dry skin, positive of itchy skin, and positive of hair loss. My second differential diagnosis is Diabetes Litis. The positive and negative findings are positive findings as fatigue positive is itchy skin and positive for dry skin, but negative for blur vision, negative for frequency of urinations, negative for weight loss, and negative for thirst or hunger. 

My third differential diagnosis, anemia. The findings are positive for fatigue, positive for pale skin, negative for pale skin, negative for Contentiba, negative for dizziness and lightheadedness, negative for irregular heart heart rate, and negative for shortness of breath. I asked my preceptor if there’s anything I am missing or I should have asked the patients. She told me maybe I should have included menstrual history or a sleeping pattern because sleep apnea can also cause fatigue or tiredness. And then after physical examination and my differential diagnosis, I have appropriate plan to confirm and manage problems. I will order CBC seven TSST four, fasting glucose, hemoglobin one C, and urine analysis To confirm my diagnosis, CBC patients already had her lab work done. I am reviewing the CBC seven hemoglobin one, fasting glucose and urine analysis all came back within normal limit. In urine, there’s no ketones or glucose present. The patient SH and free fours are abnormal. Tss is 5.99 and her four is 0.5 G per DL, which suggests she has hypothyroidism. I discuss the result with the patient and suggest her that she has a hypothyroidism. I will order Libothyroxin 25 micrograms, one tablet daily in empty stomach. I will educate my patient, take her medication regularly, every morning in empty stomach. I will educate my patient on the importance of taking medications every day and regular follow up to monitor her thirt function. Doses of the medication needs to adjust depending on the lab result. I will have my patients follow up in three months and repeat her SS and free four to evaluate if the medication is helping or if a Dot adjustment is needed. I will also provide education on balanced diet exercise. I will ask one of my nurses to call in few days to check on the patient if she’s tolerating her medications. Livothyroxin is generic and easily available medication. It is also cheap. One issue for self learning that I have noticed that I will review the type of hypothyroidism because I am not too familiar with the type of hypothyroidism. Thank you.

Hi everyone. For my snaps presentation, I am going to discuss a patient who was seen in the ER and then came to the clinic for his follow up with his primary care physician. The patient was a 71 year old male who again was seen in the emergency room last week. So the reason why he went to the emergency room, so he had Mexican food for dinner and started experiencing painful heartburn symptoms shortly after. The heartburn was then complicated by breathing issues. So he felt like he needed to go to the emergency room. At the emergency room, they did labs in EKG. He was given a breathing treatment in antacid, and then he was sent home. He now reports to our clinic for his follow up with his primary care. The onset of the health concern. Again, this happened about one week ago. The location of his pain, it was in his abdomen and his chest duration of the concern, it is still partially ongoing, so the heartburn symptoms have subsided. However, he is still having some difficulty breathing. The characteristics, it was a burning feeling in his chest followed by shortness of breath and difficulty breathing. Aggravating factors, The breathing was worsened by movement. And then he said there weren’t really any relieving factors. He had tried taking his inhaler at home and did not get any relief, and that’s why they decided to go to the emergency room. Then timing the heartburn subsided, he was given the antacid. However, the wheezing does continue and it was audible upon oultation. The current severity, I would say is low during the time of his emergency room visit, I would say it was moderate severity. Then a review of systems, we got the history from the patient of all the events that occurred. We looked at his lab work and everything from the emergency room. We were able to see everything that they did there. And then we were also able to see the notes that they put in on the patient at the emergency room. Then our physical assessment, we did his vital signs. We did a cardiac assessment, a respiratory assessment, and then a pain assessment. Thing was negative during the cardiac assessment, no complaints of chest pain at this time. And then when reviewing his labs from the emergency room, nothing was flagged, so there were no EKG changes and no cardiac markers were present. Then his respiratory assessment, however, upon osultation, there is audible wheezing and then even whenever we’re just talking with the patient, you can tell that he does get a little short of breath if he over exerts himself. The three differentials that I chose were acid reflex, myocardial infraction, and an asthma attack. The reason why I thought that it might have been acid reflex, the patient did say that he ate spicy foods. The reason why I wasn’t sure if it was acid reflex is I had never really known heartburn to cause breathing problems and then an asthma attack. So, the patient does have a history of asthma and he was spicy foods could exac bring on the asthma attack. I wasn’t, and then the breathing treatment did make it better in the ER. However, I thought it was weird. I didn’t think it was an asthma attack because it was brought on immediately just after eating, then the myocardial infection. So the patient was stating that he was having chest pain, but when he arrived at the ED, he was negative for any EKG rhythm changes, or any cardiac markers on his lab work. Then a couple of questions that I had. Basically, what exacerbated the breathing problems? Why an oral antacid is more effective than an oral pill? And I will get to this next, and then if there were any other medications that could have exacerbated this reflex, which could have exacerbated the acid reflex. At this time, I don’t believe that there weren’t any other medications that would have exacerbated it. Then I will talk about, my first question is, well, down in the self directed learning, my plan, again in the ED I think they did, the biggest thing is just to rule out any other differentials as they did, making sure that everything’s negative for cardiac or on the cardiac work up and then you’re able to go from there. Once you know that it’s not a myocardial infunction, then you can deduce and determine between the others, The medication that I would propose that I would prescribe for the patient would be liquid mylanta. You can actually get this over the counter. The patient would take ten to 20 mills of the medication whenever before he ate the food. Or you can take it after as well. But it’s more effective if you can take it before eating, then patient education, just watching the spicy foods that he’s eating. And then educating the patient basically on what happened. I’ll get into this more on the self directed learning as well. Then when the patient should follow up, he should follow up with primary care after having the emergency room visit. However, he should return back to the emergency room if the chest pain did not subside or if his breathing began to worsen again and was not relieved by his at home inhaler. Some considerations for cost availability and client preferences. The patient might not want all of the tests if they know that they’re having acid reflux. They might deny the EKG and those other costs. However, if they weren’t sure what they were having, it would be best to still get the EKG so that way we can monitor that, then making sure that whatever medication that we prescribe will either be covered by insurance or maybe available over the counter is a cheaper option. Then self directed learning. I had asked my preceptor again maybe what exacerbated the breathing problems. Basically, we discussed then how the patient essentially gave himself a chemical burn in his lungs. It went down his trachea and into the lungs when eating that spicy food. Those little particles are able to travel up and if he already sometimes has a little difficulty breathing or a little bit of asthma, it could have just then exacerbated whenever those acid particles got into the trachea. Yeah, and I think that is all that I have for you. Thanks.

Also Read

NR 511 Week 3 Assignment SNAPPS Presentation

NR 511 Week 5 Barriers to Preventative Care

NR 511 Week 5 iHuman Virtual Patient Encounter- Abdominal Assessment

NR 511 Week 6 Barriers to Health Equity

NR 511 Week 7 iHuman Virtual Patient Encounter- Musculoskeletal Assessment

NR 511 Week 8 Reflection on Learning

Hi, my name is Prisca Si Regar, and this is my set presentation. Patient came in to establish primary care chip complaint, to establish primary care physician to manage his diabetes HPI statement. D R is a 37 male who came in who came in to establish a primary care physician. He had two urgent care, physics and the blood sugar and hemoglobin one C, we check. And he was diagnosed with diabetes about a month ago. He took the medication from the urgent care but didn’t know the name and he didn’t have it with him. The patient complained of feeling thirsty and feeling tired for the last couple of months. The pertinent review of system patient denies any headache, dizziness, blood fision, chest pain, palpitation, shortness of breath, or change in urinary or bowel habits. The patient felt very thirsty and feeling tired. Non drug allergy. Past medical history denies any tobacco or alcohol or recreational drug use. The patients not on any current medication. Pertinent pysical M. Patient height 69.9 weight, 187, BMI 27.2 blood pressure, 124/84 Temperature 97.9 blood sugar upon arrival is 514. Patient was given a Hemloc. Hemoloclisp, 12 units, a sub. In general, patient not in acute distress but just feeling tired. Patient is alert, oriented the pupil, react to light the neck, supple lung sounds, clear heart rate, normal beat S1s2, abdomen tenderness, no distension, bowel sounds, pressing extremities, there are no edema and no cough tenderness. Based on the HNPind, the appropriate differential will be type two diabetes with hyperglycemia, type one diabetes, and DKA. Analyzing the differential and comparing and contrasting pertinent, positive and negative findings from the diagnosis. The patient most likely type two diabetes. I think the type two is the highest on my differential diagnosis given the age that the patient got it at the letter H. Type one is usually most common in children and teenagers. Dka just the symptoms of the and due to hyperglycemia and also for patient taking the medication as prescribed that caused his blood sugar so high. And I have a question to the Dr. Consider the patient. H is 37. I asked the preceptor if there’s any lab to confirm if the patient has type one or type two diabetes. And the plan we discussed to the patient of the insulin, but the patient refused to start on insulin. I proposed the plan to start the patient on Metformin 500 milligram BID and also the Glypocyte five milligram twice a day. The patient self directed learning. One issue that I will want to learn more is the patient, the patient is 37, is too young to have type two diabetes. And I need to further learn more like how to confirm if the patient have type one and type two diabetes. Type two diabetes is developed when the patient usually often over 40 years old. The fact that the patient is 37, I just have a doubt that the patient might have a type one diabetes. We asked the patient to go home. We send the patient with blood sugar monitoring and strip and also the lens to advise the patient to check the sugar at home routine before meal before going to bed. Also educate patient on like a diet, also diet and exercise. And to return to the clinic within one month, hopefully the patient with coming to the clinic in one month, we will know like what patient a blood sugar and I’ll go for the next plan to manage his diabetes. Thank you.

Hi, my name is Roe Lofton and I will be presenting my, my patient’s case. My gentleman that came into the clinic. This is 18 year old male. Chief complaint was cough and nasal congestion. This gentleman came in in no acute distress. He had complaints of sharp right eye pain, redness, and swelling times three days. The pain was aggravated with sleeping on his right side and when touching the site, he hadn’t taken any medications to alleviate his symptoms at all. Some pertinent review of systems. So head, ear, eyes, nose and throat. He had right eyelid pain and swelling and redness. There was a right bump over his right eyelid. Respiratory wise, there was no cough or congestion, no shortness of breath, cardio, no chest pain. He was alert and oriented, he denied any nausea, vomiting, or diarrhea. His pertinent physical assessment, So, for constitutional there was no acute distress. He was of stated age and had a clean appearance and he was a febrile cardio. He had a normal rate and rhythm. Respirations were clear to oscultation bilaterally. For his head, ear, eyes, nose, and throat, There was a right eye lump that was tender to the touch and some edema of the upper right eye lid. His extraocular eye movements were intact. 2020 vision on the smell and eye chart, there was no noted drainage from his eye lid. His sclera was clear and his lymph nodes were not palpable. Upon examination, in examining his nose, his naris were clear bilaterally, there, there was no drainage or lumps noted. His ears, his ear canals were free of cerumen, there were no drainage. I was able to visualize the tympanic membrane, which was light gray in color and intact with no bulging at all. Neurologically, he was again AN O times four. He had a normal mood and affect. Based on his HPI and his clinical presentation, an appropriate differential would most likely be hordeolum or Stye. And looking at other differential diagnosis and ranking them in order of likeliness with hordeolum, it’s the likely diagnosis. The lumps on his eyelid was really close to his eyelashes, meaning that it could have been some follicular involvement there. The lump, it was edematous and painful to palpitation. The patient did mention that there was a small amount of drainage noted that was white in color. This diagnosis is also just likely with the way that it presented the node, the lump right on his eyelid. As I mentioned, right at the eyelash, there wasn’t visible drainage at the time of my examination. But with the patient’s history of some drainage, I’m thinking that this is really a style that he has over his eye. Another differential would have been a, which also affects the eyelid and presents with inflammation. However, this patient’s lump came overnight when you have a chelasion, it presents as a slow developing mass. The inside of his eyelid wasn’t red and he didn’t have any visual distortion. A little less likely that it’s las, another differential could have been an epidermal inclusion cyst, but these are also usually slow growing and can form after a trauma or after surgery. This patient denied any eye trauma. Cyst are usually painless until they rupture. This lump was definitely painful to the touch during the examination with my preceptor. Some of the questions that I asked was, should we try and drain this lump to give the patient more comfort? Maybe that would help us explore what the possible diagnosis was a little more. I also wanted to know, would we give him any antibiotic ointment? It did appear to be red and swollen, but it wasn’t warm to the touch. I wasn’t really clear about if it truly was a cellulitis or should we give antibiotics, or should we really just focus on a more conservative approach with having him do warm compresses at home. Also with further probing with the patient, he was forthcoming with saying that there was some drainage that was coming out. Likelihood, more of it having a little bit of cellulitis. Yes, that connected the dots for me as to why we most likely would give him some antibiotic ointment because it’s not usually recommended with a Hordeolum. I did diagnose it as a Hordeolum of the right upper eyelid plan. Why this Tylenol for the pain is needed and he can use that as directed it over the counter. I did prescribe him some ather myocin 5 milligrams/gram of this opthalmic ointment to apply to his right eyelid. Twice a day for seven days. A warm compress, several times a day to help facilitate drainage. He’ll follow up in two weeks. If symptoms have not gotten better or have worsened, my self directed learning will be to read up on Hordeolum versus All Zion and the clinical presentation. Thank you.