NUR 600 Discussion 6.1: Cardiovascular Diagnoses
Sample Answer for NUR 600 Discussion 6.1: Cardiovascular Diagnoses
My common diagnosis is heart failure, and my less-common diagnosis is endocarditis. Working in critical care, I’ve seen a lot of heart failure exacerbations but have yet to see endocarditis. Signs and symptoms of heart failure (HF) include dyspnea on exertion or rest, orthopnea, and edema. The patient could also experience weight-gain secondary to fluid retention, bibasilar crackles on auscultation, tachycardia, and hypoxia (Grubbs & Davis, 2019). With endocarditis, the health care provider (HCP) would find signs and symptoms indicative of a systemic infection, such as fevers, chills, arthralgias, malaise, and fevers (Grubbs & Davis, 2019). As the infection progresses, the patient will develop petechiae, anemia, weight loss, a new or worsening heart murmur, and emboli (Grubbs & Davis, 2019).
A detailed history and physical (H&P) are required for both diagnoses. The H&P for HF requires the HCP to obtain a detailed account of underlying medical conditions and functional capacity to exercise (Malik et al., 2022). For endocarditis, the HCP would get a thorough history of any infectious process and note skin changes, such as petechiae. Upon auscultation, the HCP would hear new heart sounds (Gupta & Mendez, 2022).
For diagnosis, there are overlapping studies like a chest x-ray (CXR) and echocardiogram. If there is a strong suspicion of endocarditis, a transesophageal echocardiogram (TEE) would be recommended, along with blood cultures (Gupta & Mendez, 2022). The purpose of the TEE vs. a transthoracic echocardiogram (TTE) is that the images will be more precise with the TEE due to the proximity to the heart. Positive blood cultures and a positive echocardiogram are required to diagnose endocarditis. For HF, a CXR, echocardiogram, CBC, BNP, CMP, and cardiac catheterization are recommended (Grubbs & Davis, 2019). Interpreting the H&P, imaging, and lab results will assist the HCP in a proper differential diagnosis.
References:
Grubbs, L., & Davis, L. L. (2019). Cardiac and peripheral vascular systems. In M. J. Goolsby & L. Grubbs (Eds.), Advanced Assessment Interpreting Findings and Formulating Differential Diagnoses (4th ed., pp. 187–234). F.A. Davis.
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Gupta, A., & Mendez, M. D. (2022). Endocarditis. In StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK499844/
Malik, A., Brito, D., Vaqar, S., & Chhabra, L. (2022). Congestive Heart Failure. In StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK430873/
Sample Answer 2 for NUR 600 Discussion 6.1: Cardiovascular Diagnoses
Cardiovascular disease is the leading cause of death in the United States (Goolsby and Grubbs, 2019). Issues with the cardiovascular systems can impact other body systems and decrease quality of life. As providers, we must recognize the signs and systems of cardiovascular disease to get the patient early treatment. Early detection and interventions can significantly increase the chances of having a positive outcome (Goolsby and Grubbs, 2019). It is essential to perform an accurate health history and physical assessment of the cardiovascular system.
Chest pain is a prevalent symptom that brings many patients into the hospital. However, chest pain alone is not specific enough to make a clear diagnosis. One common diagnosis associated with chest pain is gastroesophageal reflux disease (GERD), and a less common diagnosis associated with chest pain is Myocardial Infarction (MI).
It is essential to utilize the seven attributes of a symptom to differentiate between an MI and GERD. A person with GERD will describe the pain as a burning sensation or pressure in the substernal area (Goolsby and Grubbs, 2019). The pain is worse when lying down and commonly occurs after eating. The person may feel diaphoretic or nauseous (Goolsby and Grubbs, 2019). During an MI, the pain will present as a sudden, sharp pain/ pressure in the substernal region and may radiate to the arm or neck (Goolsby and Grubbs, 2019). The person may be diaphoretic, nauseous, weak, tachycardic, and short of breath (SOB) (Goolsby and Grubbs, 2019). Atypical pain is also seen in an MI; this can include jaw pain, fatigue, indigestion, and upper back pain which is more common in women, the elderly, and patients with diabetes (Goolsby and Grubbs, 2019). A thorough health history, including family history, is also essential.
MI can be confirmed with ST changes on an EKG and elevated troponin levels (Abraham et al., 2019). GERD will not show ST changes or elevated troponin level. These two diagnoses must be differentiated as soon as possible because an MI is a medical emergency where GERD can usually be treated with over-the-counter medication and does not require emergency medical care within the hospital setting.
References
Abraham, A. S., Vinson, D. R., & Levis, J. T. (2019). ECG diagnosis: Acute myocardial infarction in a ventricular-paced rhythm. The Permanente journal, (23)19-001. https://doi.org/10.7812/TPP/19-001
Goolsby, M. J. & Grubbs, L. (2019). Cardiac and peripheral vascular systems. In Advanced Assessment Interpreting Findings and Formulating Differential Diagnoses. (4th ed., 187-234). F.A Davis Company.
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Sample Answer 3 for NUR 600 Discussion 6.1: Cardiovascular Diagnoses
Cardiovascular Diagnoses
Cardiovascular disorders are among the health problems that affect a significant proportion of the population globally in the modern world. The disease burden attributed to cardiovascular disorders is high. Patients incur high healthcare costs and decrease in their overall quality of life. Nurses and other healthcare providers must utilize evidence-based interventions to improve outcomes for the affected populations. This paper explores a most common cardiovascular disorder and a least common one and their differentiation.
Hypertension is one of the most common cardiovascular disorder. It is characterized by the elevation of blood pressure above 130/90 mmHg. If left untreated, hypertension causes other health problems such as stroke, heart attack, renal failure, and cardiomegaly. Patients affected by hypertension experience symptoms that include nosebleeds, headaches, edema, shortness of breath, vision changes, vomiting, anxiety, seizures, and chest pain (Mills et al., 2020; Oliveros et al., 2020).
One of the least common cardiovascular diagnoses is rheumatic heart disease. It is a complication of heart valves that arises from rheumatic fever. Patients with a history of untreated or poorly treated streptococcal infection develop this condition. The diagnosis is reached when a patient presents with specific symptoms alongside a recent history of strep infection. The most common symptoms include fever, joint pain and swelling, nodules, lattice-like skin rash, chest pain, shortness of breath, and lethargy (Beaton et al., 2022; Marijon et al., 2021).
One of the ways to differentiate between hypertension and rheumatic heart disease is by obtaining comprehensive history from the patient. A patient with hypertension will not have a history of strep infection. The other approach is by undertaking diagnostic investigations such as electrocardiogram. The blood pressure is elevated in hypertension while it is not in rheumatic heart disease.
Overall, hypertension and rheumatic heart disease are some of the cardiovascular health problems with considerable population impact. Hypertension is more common as compared to rheumatic heart disease. They differ based on symptoms and diagnostic findings.
References
Beaton, A., Okello, E., Rwebembera, J., Grobler, A., Engelman, D., Alepere, J., Canales, L., Carapetis, J., DeWyer, A., Lwabi, P., Mirabel, M., Mocumbi, A. O., Murali, M., Nakitto, M., Ndagire, E., Nunes, M. C. P., Omara, I. O., Sarnacki, R., Scheel, A., … Steer, A. C. (2022). Secondary Antibiotic Prophylaxis for Latent Rheumatic Heart Disease. New England Journal of Medicine, 386(3), 230–240. https://doi.org/10.1056/NEJMoa2102074
Marijon, E., Mocumbi, A., Narayanan, K., Jouven, X., & Celermajer, D. S. (2021). Persisting burden and challenges of rheumatic heart disease. European Heart Journal, 42(34), 3338–3348. https://doi.org/10.1093/eurheartj/ehab407
Mills, K. T., Stefanescu, A., & He, J. (2020). The global epidemiology of hypertension. Nature Reviews Nephrology, 16(4), Article 4. https://doi.org/10.1038/s41581-019-0244-2
Oliveros, E., Patel, H., Kyung, S., Fugar, S., Goldberg, A., Madan, N., & Williams, K. A. (2020). Hypertension in older adults: Assessment, management, and challenges. Clinical Cardiology, 43(2), 99–107. https://doi.org/10.1002/clc.23303
NUR 600 Module 6 Discussion Treatments for Genitourinary Tract Disorders
- Describe urinary tract infection, causes, symptoms and treatment
A bacterial infection in the urinary tract causes urinary tract infections. It is normally caused by the bacteria known as Escherichia coli (E. coli) (Devnikar et al., 2024). Other bacteria can also cause a urinary tract infection, but E.coli is the most common. The symptoms of a urinary tract infection can vary. Normally, the symptoms include a strong, persistent urge to urinate, a burning sensation when urinating, frequent urinating, small amounts of urine, urine that appears cloudy, and alterations in color (Devnikar et al., 2024). At times, a strong smell and pain may be prevalent with infection. In older adults, confusion may indicate a urinary tract infection. Treatment for a urinary tract infection usually includes antibiotics, which must be taken until the prescribed antibiotics are complete.
- Discuss treatment for benign prostatic hyperplasia
Treatment for benign prostatic hyperplasia will depend on how severe it may be. A mild case would not require treatment as a more severe case may precipitate. Patients can get treatment, such as medications or surgery (Arcangelo et al., 2017). Medications include alpha-blockers and 5 alpha-reductase inhibitors, which are prescribed to relax the muscle of the prostate to allow an improved urine flow (Arcangelo et al., 2017). The most common surgery is a transurethral resection of the prostate (Arcangelo et al., 2017).
- Describe overactive bladder, causes, symptoms and treatment
An overactive bladder is when the bladder muscles contract involuntarily and leads to a sudden and urgent need to urinate. It can be related to nerve damage or other bladder infections (Arcangelo et al., 2017). Symptoms include a sudden need to urinate and also frequent urination. Patients may also wake up multiple times throughout the night and may even experience incontinence (Arcangelo et al., 2017). Treatment includes lifestyle changes, behavioral therapies, medications, and, in severe cases, surgery (Arcangelo et al., 2017). Medications that can help patients struggling with overactive bladder include anticholinergics or beta-3 agonists to relax the bladder and reduce symptoms (Arcangelo et al., 2017)
- Treatment options and recommendations for different STIs (Chlamydia, Gonorrhea and Syphilis)
Chlamydia is caused by a bacertium known as chlamydia trachomatis (Arcangelo et al., 2017). Antibiotics such as azithromycin or doxycycline are used to treat chlamydia (Arcangelo et al., 2017). Neisseria gonorrhoeae causes gonorrhea, which is treated with ceftriaxone (Arcangelo et al., 2017). Syphilis is caused by the bacteria treponema pallidum, and treatment includes penicillin G and depends on the stage of the infection (Arcangelo et al., 2017). The recommendations for these different STIs include utilizing safe sex and getting tested frequently if having sex with multiple partners.
References
Arcangelo, P. V., Peterson, M. A., Wilbur, V., & Reinhold, A. J. (2017). Pharmacotherapeutics for advanced practice: a practical approach (4th ed.). Wolters Kluwer/Lippincott Williams & Wilkins.
Devnikar, A. V., Solabannavar, S. S., Sonth, S. B., Janagond, A. B., Gokale, S., & Bhurle, A. (2024). Antimicrobial resistance in escherichia coli causing urinary tract infection: A four-year study. Journal of Pure and Applied Microbiology, 18(1), 522–527. https://doi.org/10.22207/jpam.18.1.35