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QUESTION
Title:
response to a discussion board of less than two sentences -two assignments in one
Paper Details
FIRST ASSIGNMENT
i just need a response to a discussion board of less than two sentences with a reference
Community Acquired pneumonia (CAP): Pneumonia is an infection of the lung parenchyma, usually affect the lower respiratory tract. Dianne is a known COPD patient who now present with fever, dyspnea, productive cough, pleuritic chest pain and crackles which were most prominent in the right middle and lower lobes. Based on this findings, Dianne is most likely to have CAP.
Influenza: With influenza, there could be fever, productive cough and dyspnea. It is often associated with running nose, muscle pain and sore throat which wasn’t present in this scenario. Nevertheless, influenza is considered until CXR and lab report established.
Acute Bronchitis: In acute bronchitis, patient often presents with productive cough but it usually affects the upper respiratory tract.
Asthma: In asthma patients, cough is not productive, and patient is usually afebrile but because of the acute dyspnea and expiratory wheeze, asthma was considered as an alternative.
Tuberculosis (TB): This was considered as an alternative due to Dianne ‘s history of cough and long standing COPD. COPD is usually treated with steroid components which could cause low immunity, thereby predisposing Dianne to TB. TB is often associated with hemoptysis (McCance, Huether, Brashers and Rote, 2014).
. Final Diagnosis with Supportive Assessment Findings
The diagnosis is Community Acquired Pneumonia (CAP). Dianne present from the community to the emergency room with cough, fever, shortness of breath, pleuritic chest pain and tiredness. From Dianne history, she did not attend any healthcare setting recently nor come in contact with any healthcare staff. Her physical examination also reveals: diaphoresis, tachypnea, fever, hypoxia as well as diffuse right lung crackles. The chest x-ray was reported to have bilateral consolidative process, complete blood count showed elevated white blood cell. Though the sputum grain stain report was not revealed, with these findings, it is highly suggestive of community acquired pneumonia. One criteria for diagnosing CAP is, if a patient has not recently been in any healthcare settling for at least two weeks (McCance, Huether, Brashers and Rote, 2014).
Community-acquired pneumonia (CAP) is commonly described as an acute infection of the lung parenchyma acquired in the community. It is often caused by bacterial infection and is established with clinical and radiological evidence of consolidation of part or parts of one or both lungs. CAP can be detrimental if not treated early and appropriately. It is one of the most significant infectious diseases that can lead to complications and death (McCance, Huether, Brashers and Rote, 2014).
Søgaard et at., (2014) research study indicate that, the reason that CAP is so common relates to the very high prevalence of specific risk factors such as low immunity in patients with asthma, COPD, lung cancer and human immune virus patients. More so, major factor driving increasing pneumonia incidence and persistently high mortality may be a growing prevalence of elderly individuals with chronic diseases necessitating frequent hospitalizations and use of immunosuppressive therapy. So many microorganisms may cause CAP, in reality a relatively small number of pathogens predominate, Streptococcus pneumoniae (pneumococcus) bacteria is the most common pathogen causing CAP. Macrolides such as azithromycin or a respiratory fluoroquinolone such as levofloxacin oral as outpatient or intravenous as inpatient are the first line antibiotic treatment therapy recommended for CAP. This could be modified or changed once sensitivity is established (Woo and Wynne, 2012).
Normal Versus Abnormal Auscultation, Palpation and Percussion Findings of the Lungs
Auscultation
In the normal patient, breath sounds should be quiet, rhythmic and effortless. Adventitious breath sounds are extra and abnormal sounds detected in addition to the expected breath sounds, these are sounds that are not normally heard in the lung fields. It includes; wheezes, rhonchi, rales or crackles and friction rubs. Fine crackles are common in the newborn because of insufficient clearing of secretions, it generally clear between age five or six (Goolsby, Grubbs and Laurie 2014).
Palpation
Normally, the chest wall is intact with full symmetric expansion during deep inspiration with no tenderness, deformity, or masses. Abnormal palpation would reveal pain, lumps, masses, deformities, asymmetry, or tenderness. Palpation of both lungs could reveal symmetric tactile fremitus. Fremitus is decreased or absent when the voice is higher pitched or soft or when the transmission of vibrations from the larynx to the surface of the chest is impeded by a thick chest wall, an obstructed bronchus, COPD, or pleural effusion, fibrosis, pneumothorax, or an infiltrating tumor (Goolsby, Grubbs and Laurie 2014).
Percussion
When chest wall is percussed, it sets the chest wall and underlying tissues in motion by producing audible sound and palpable vibrations. Percussion helps you establish whether the underlying tissues are air-filled, fluid-filled, or consolidated. Percussion provides an estimate of the relative amounts of air, fluid, and solid matter in a space and is helpful in identifying the margins of organs, including the lung. Posterior percussion of the lung should reflect resonance. Abnormal percussion will reflect hyper-resonance or dullness. Hyper-resonance suggests air trapping, which occurs with COPD or tension pneumothorax. Dullness is detected over the actual site of consolidated lung or pleural fluid. Dullness is found with pneumonia, severe atelectasis, or pleural effusion (Goolsby, Grubbs and Laurie 2014).
Conclusion
CAP continues to be a cause of considerable morbidity and mortality in most parts of the world. It is one of the most frequent infectious cause of death in patients in the USA and around the globe. Since aging is a significant risk factor for pneumonia and given that in many areas of the world, such as USA the population is aging, an increase in incidence in the next decades is anticipated. Therefore, as clinicians, we need to continue to fully assessment and treat pneumonia appropriately with follow up visits in order to reduce the high incidence of patients with complications arising from pneumonia.
Reference
Goolsby, Jo, M., Grubbs, Laurie. (2014). Advanced Assessment: Interpreting Findings and Formulating Differential Diagnoses, 3rd Edition. [South University]. Retrieved from https://digitalbookshelf.southuniversity.edu/#/books/9780803645011/
McCance, K., Huether, S., Brashers, V. & Rote, N. (2014). Pathophysiology: The Biologic Basis for Disease in Adults and Children. Retrieved from https://digitalbookshelf.southuniversity.edu/#/books/9780323088541/cfi/6/4/8!/4/2/22/14/
I want him to assess either of this textbook or library, pls
SECOND ASSIGNMNET
Community acquired pneumonia is common in older adults and those with respiratory disease are at an increased risk. “Community-acquired pneumonia (CAP) should be suspected if the patient's history includes dyspnea, high fever, tachycardia, evidence of consolidation on examination, or presence of symptoms for 2weeks or more,” (Buttaro, Trybulski, Bailey, & Sanberg-Cook, 2013). By completing a detailed health history, the practitioner can rule out or include diagnoses pertinent to the patient’s chief complaint.
In Ms. Steinberg’s case, she presented for evaluation due to a productive cough accompanied by fever for the past three days. Physical examination of the patient revealed hypoxia, shortness of breath, expiratory wheezes in the left lung fields and coarse crackles in the right lung fields. Through information obtained in the patient’s social history and past medical history, the practitioner was able to learn of the patient’s diagnosis of COPD and her previous smoking history. Smoking decreases the elasticity of the lungs and also decreases cilia motility, which prevents the removal of particles (Smoking Facts: Health Effects, 2017). This increases the risk of pneumonia since the particles can remain in the lungs and become a breeding ground for bacteria.
Based on the patient’s symptoms and the physical assessment, this author chose community acquired pneumonia and bronchitis as differential diagnoses. Asthma, emphysema, exacerbation of COPD, and influenza were also considered. However, based on additional lab and radiologic findings, community acquired pneumonia is the correct diagnosis for the patient. The complete blood count showed an elevated white blood count, and infiltrates were markedly noted of the chest x-ray. These findings - when combined with the physical exam findings - are indicative of a patient with community acquired pneumonia. Hospital acquired pneumonia was ruled out since the patient has not recently been hospitalized or in a long-term care facility.
In regards to the normal versus abnormal findings of the thorax and lung fields, several clues are available to help guide in the diagnosis. Upon palpation of the thorax, the practitioner should feel tactile fremitus and the patient should not feel any tenderness to palpation. When percussing over the thorax, lungs normally have a resonant or dull sound depending where on the thorax the practitioner is percussing. Hyper-resonant sounds can be noted over lung fields with airway disease (Bickley & Szilagyi, 2017). Lastly, auscultation provides the practitioner the ability to hear movement of air thru the lungs. Clear lung sounds can be described as vesicular or broncho-vesicular. Adventitious sounds are based upon the particular airway disease affecting the lungs; these may be wheezes, rhonchi, or crackles. Each has a distinct quality. In the provided case study, the patient had both wheezing and crackles noted, though the wheezing was also audibly noted.
References
Bickley, L., & Szilagyi, P. (2017). Bate's Pocket Guide to Physical Examination and History Taking (8th ed.). Philadelphia, PA: Wolters Kluwer.
Buttaro, T., Trybulski, J., Bailey, P., & Sanberg-Cook, J. (2013). Primary Care: A collaborative Practice (4th ed.). St. Louis, MO: Elsevier.
Smoking Facts: Health Effects. (2017). Retrieved from The American Lung Association: http://www.lung.org/stop-smoking/smoking-facts/health-effects.html
nsg6020_Wk3A1_AngelaReed.docx
I need less than three sentences, refence
Goolsby, Jo, M., Grubbs, Laurie. (2014). Advanced Assessment: Interpreting Findings and Formulating Differential Diagnoses, 3rd Edition. [South University]. Retrieved from https://digitalbookshelf.southuniversity.edu/#/books/9780803645011/
McCance, K., Huether, S., Brashers, V. & Rote, N. (2014). Pathophysiology: The Biologic Basis for Disease in Adults and Children. Retrieved from https://digitalbookshelf.southuniversity.edu/#/books/9780323088541/cfi/6/4/8!/4/2/22/14/
08:01 PM
I want him to assess either of this textbook or library, pls
| Subject | Nursing | Pages | 5 | Style | APA |
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Answer
Assignment one- response to a discussion board on Dianne’s case study
The approach to this assignment was legit since the discussion board outlined appropriate differential diagnoses in relation to Dianne’s case study. All concepts are clearly outlined with regards to assignment questions and the topic of focus, that is Community-Acquired Pneumonia. It is clear that there was a high mastery of content, proper skills on developing a critically acceptable paper (Deane, 2013), and proper language in conveying the intended facts on subject of matter. Moreover, the outlined references are in conjunction with topic at hand, meaning quality research was developed when tackling this assignment.
Assignment two- response to a discussion board on Ms. Steinberg’s case study
The introduction part is compelling, since it gives a clue on general study coverage. The discussion was based on scientific facts by providing a description of all symptoms that were examined and categorization of differential diagnosis in alignment with the grading rubric. The paper is precise (Grabe, 2014), giving the instructor an easy time to identify main points, paper weaknesses and determining how such concepts can be put into practice. Finally, the citations were extracted from appropriate sources with relevant information to the subject matter.
References
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Grabe, W., & Kaplan, R. B. (2014). Theory and practice of writing: An applied linguistic perspective. Routledge. Deane, P. (2013). On the relation between automated essay scoring and modern views of the writing construct. Assessing Writing, 18(1), 7-24.
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