UOP NRP571 2021 October Week 7 Assignment Latest

NRP571 Advanced Health Assessment IIand Clinical Procedures

Week 7 Assignment

Diagnostic Testing Case Studies

Complete the case studies by answering the questions associated with each scenario.

Case Study 1     

A 25-year-old male experienced a FOOSH (fall on outstretched hand – see images below) while riding his bicycle. He comes in for evaluation of the wrist injury. Initial X-ray suggests that there are no visible fractures. You note on physical exam that he has tenderness at the scaphoid fossa.

PMHx: None

Medications: Advil 200mg q8h PRN pain

SH: Single, non-smoker, denies alcohol or drug use

VS: T: 98.6 BP 145/60 HR 55 R 12 o2 sats 95%

Gen: Well developed male in no acute distress. Lungs CTA with no wheezes, rales, or rhonchi, Heart S1 S1 audibly heard with no murmurs or extra heart sounds. Right wrist with mild edema and slight decreased ROM due to pain. Tenderness noted at the scaphoid fossa.

1. What diagnosis must you always consider with this assessment finding?

2. What will be your treatment at this time? Is there further testing to be ordered?

3. Are there any potential consequences of not treating this? If so, what?

Case Study 2

A 24-year-old female runner just returned three days ago from traveling in Guatemala. She is finishing medication for a UTI. She was running and felt a pop in her right calf but was able to continue her run and iced her leg when she got home. This morning, she woke up with ecchymosis, slight swelling to the upper right ankle, and slight pain with some positions like squatting and climbing stairs.

PMHx: None

Medications: Ciprofloxin 250 mg TID x 3 days, Chloroquine

SH: Single, non-smoker, denies alcohol or drug use

VS: T: 98.6 BP 154/90 HR 78 R 14 o2 sats 99%

Pain scale 6/10

Gen: Well developed female in pain. Lungs CTA with no wheezes, rales, or rhonchi, Heart S1 S1 audibly heard with no murmurs or extra heart sounds. Right posterior ankle with purple ecchymosis, mild edema, and decreased ROM due to pain. Tenderness noted at the Achilles tendon insertion site. Slight positive Thompson's test and knee flexion sign appears negative.

1. What diagnosis should you consider?

2. What imaging studies should you order?

3. What treatment will you start now?

Case Study 3

A 32-year-old white female is concerned with increasing migraines and vision disturbances with vertigo over the past three months. She denies any head injuries or LOC, has never had migraines before, and usually headaches resolve with just rest. For current headaches, she needs to go to sleep and take OTC analgesics which sometimes help. She does not have a headache at this visit. She reports having a similar incident that lasted 5 weeks 2 years ago while in Colorado visiting family. No test was done then, and she never found out what caused it.

PMHx: None

Medications: Excedrin Migraine

SH: Single, non-smoker, denies alcohol or drug use

VS: T: 98.6 BP 118/72 HR 90 R 16 o2 sats 100%

Pain scale 1/10

Gen: Pleasant WF NAD

HEENT:PERRLA, Fundoscopy no papilladema, cup:disc ratio 2:1 no AV nicking.

Neuro: CN II-XII grossly intact, Romberg was positive.

MS: FROM all extremities, DTR's 2 + with positive Babinski right foot.

You are referring to a neurologist and they have requested imagining before seeing her.

1. What imaging is appropriate for this patient?

2. What questions do you need to ask before ordering MRI with contrast?

3. How would you describe an MRI during patient education?

Case Study 4

A 44-year-old well-known Caucasian female patient presents to the clinic. She has experienced increased shortness of breath over the past 3 days. She has a well-documented history of asthma which is normally controlled by her asthma medications. The patient tells you she recently had a cold and this has triggered her shortness of breath.

PMHx: asthma, hypothyroidism

Meds: synthroid 137mcg qd, proventil inhaler 2 puffs qid prn

SHx: single

Allergies: NKDA

VS: T 97.7 BP 122/60 HR 88 R 12 02 sat 90%

Gen: well-developed female in NAD

Lungs: clear BS throughout with diminished in both bases with expiratory wheezes heard in both lungs

1. What is the likely diagnosis?

2. What test would be appropriate for this patient?

3. How might the information obtained from testing be helpful to the practitioner?

Case Study 5

A 50-year-old Hispanic male presents to the clinic as a new patient with a concern about increased shortness of breath over the last 6 months when climbing stairs. He also reports a productive cough. He has just relocated to southern California and “thinks this may be allergies.”

PMHx: previous health care minimal in Mexico

Meds: no Rx; his wife gave him some OTC Claritin

SHx: married, smokes 2 packs/day x 30 years

Allergies: NKDA

VS: T 98 BP 126/80 HR 84 RR 24 O2 Sat 90%

Gen: well-developed male in NAD

Lungs: clear bilaterally, but diminished BS throughout, no rales, rhonchi, or wheezing, however, slightly increased expiratory phase (I:E ratio 1:3)

1. What is in your differential diagnosis?

2. What test would be appropriate in this patient?

3. How might the information obtained from testing be helpful to the nurse practitioner?