Feb 23, 2024 NURS 6512 Week 5 Assignment 2: Digital Clinical Experience: Focused Exam: Cough
NURS 6512 Week 5 Assignment 2: Digital Clinical Experience: Focused Exam: Cough NURS 6512 Week 5 Assignment 2: Digital Clinical Experience: Focused Exam: Cough Patient Information Initials: D.R Age: 8 years old Gender: Male Struggling to Meet Your Deadline? Get your assignment on NURS 6512 Week 5 Assignment 2: Digital Clinical Experience: Focused Exam: Cough done on time by medical experts. Don’t wait – ORDER NOW! Meet my deadline Click here to ORDER an A++ paper from our Verified MASTERS and DOCTORATE WRITERS on NURS 6512 Week 5 Assignment 2: Digital Clinical Experience: Focused Exam: Cough SUBJECTIVE DATA: Chief Complaint (CC): “I guess I’m kind of sick. . . I’ve been coughing a lot’ History of Present Illness (HPI): The patient Danny Riviera is a boy aged 8, who comes to the clinic reporting that he has had a cough for the past 4 days. His description of the cough states that it is watery and clear. His cough becomes worse at night, which affects his sleep. As such, he does not focus at school and suffers from fatigue. His right ear has pain. His mother decided to use over-the-counter cough medicine, which offered temporal relief. Danny states that he suffers from a frequent runny nose as well as a cold and sore throat. He is also exposed to secondhand smoke from his father. He has also suffered pneumonia in the past year. However, he does not have a fever, breathing difficulties, abdominal pain, and chest tightness and chills. Medications: The patient admits to taking home medications. He also takes a daily vitamin. He also takes a purple cough medication. Allergies: NKDA Past Medical History (PMH): Denies asthma diagnosis. Reports immunizations as current. Reports past frequent coughs and pneumonia. Past Surgical History (PSH): None reported. Sexual/Reproductive History: No history of reproductive disorders. Personal/Social History: Reports living in a house with his parents and grandparents. Reports feeling safe at home. Reports park with playground near home. Reports father smokes at home. Denies pets at home Immunization History: Immunizations are current. Significant Family History: He has a father, mother, and both grandparents. Reports father with a history of asthma as a child. Denies family history of allergies. Review of Systems: General: The patient looks fatigued and also coughs whilst having the interview. He also appears stable. Denies fever, appetite loss, weight loss, chills, or night sweats. HEENT: The mucus membrane is moist; nasal discharge is clear, while he shows redness and clobbestoning at the back of his throat. His eyes are dull while the conjunctiva is pink in color. The right tympanic membrane appears red and inflamed. The patient’s right cervical lymph nodes appear enlarged with a certain tenderness. Respiratory: Lacks acute distress, increased respiratory rate at 28, breath sounds are clear to auscultation, speaks in full sentences while the bronchoscopy is negative. His chest wall was resonant when percussed while the fremitus was expected and equal bilaterally. Cardiovascular/Peripheral Vascular: No chest pain, chest tightness, palpitations, edema, cyanosis, dyspnea. Psychiatric: No depression, anxiety, or history of psychotic disorders. Neurological: Report’s headache. Denies dizziness, loss of consciousness, or vision changes. Lymphatics: Right cervical lymph nodes are tender on palpation. OBJECTIVE DATA: Physical Exam: Vital signs: Blood Pressure 120/76 O2 Sat 96% Pulse 100 Resp. Rate 28 Temperature 37.2 c General: The patient looks fatigued and also coughs whilst having the interview. He also appears stable. HEENT: Head is normocephalic and atraumatic. The mucus membrane is moist; nasal discharge is clear, while he shows redness and clobbestoning at the back of his throat. His eyes are dull while the conjunctiva is pink in color. The right tympanic membrane appears red and inflamed. The patient’s right cervical lymph nodes appear enlarged with a certain tenderness. Respiratory: Lacks acute distress, increased respiratory rate at 28, breath sounds are clear to auscultation, speaks in full sentences while the bronchoscopy is negative. His chest wall was resonant when percussed while the fremitus was expected and equal bilaterally. Cardiology: No murmurs, gallops, or rubs in S1 and S2. Lymphatics: Right cervical lymph nodes are tender on palpation Psychiatric: No mental issues noted. Diagnostics/Labs: Routine lab works were ordered including complete blood count, and white blood cell count to determine any signs of infection. Spirometric and peak expiratory flow measurements were collected to further evaluate the patient’s extend of cough. Bronchoprovocation testing was done to rule out differential diagnosis. Other investigations are done to assess the cough and cold include upper airway provocation studies, sinus imaging, CT scan of the thorax, and bronchoscopy (Malesker et al., 2017). For further assessment of the ear pain, nasolaryngoscopy and MRI of the head and neck were ordered. ASSESSMENT: Priority Diagnosis: Acute Viral Rhinitis: It is also known as common cold. It is associated with inflammation of the nasal mucosa lining as a result of respiratory viral infection. It is common among children, characterized by sneezing, running nose, congestion, cough, postnasal drip, sore throat, watery eyes, ear pain, difficulties in swallowing, and fatigue among others (Malesker et al., 2017). The patient in the case study displayed most of the above symptoms, qualifying for a common cold diagnosis. Differential Diagnosis: Acute sinusitis: This normally occurs when a cold virus infects the patient’s sinuses. The patient may display headache, fever, cough which is worse at night, severely stuffed up nose, green, or thick yellow mucus, itchy and watery eyes, and ear pain. The patient in the case study displayed most of these symptoms (Shoukat et al., 2019). However, he denied fever, and the nasal discharge is clear and thin, which disqualifies the diagnosis. Influenza (flu): This is a common viral infection of the respiratory tract among children. It is characterized by fever, headache, running nose, fatigue, cough, eye, and ear pain. The patient in the case study displayed most of the above symptoms (Badyda et al., 2020). Consequently, this condition is common among patients with a history of pneumonia, just like in the provided case study. Ear Infection: Sinus and cold infections can lead to the accumulation of fluids in the patient’s ears behind the eardrum. As a result, viruses and bacteria can grow leading to infection of the ears. Patients may display ear pressure or fullness, ear pain, drainage, muffled hearing, and loss of balance (Badyda et al., 2020). Given that most ear infections among children might start as a common cold, then the patient’s right ear pain and associated upper respiratory symptoms may be as a result of ear infection. Treatment Plan: Previous Diagnosis: Pneumonia and cough which were managed appropriately. Present Diagnosis: Acute Viral Rhinitis Pharmacological Intervention: Cold remedies such as Dimetapp 10mL every 4 hours to a maximum of 6 doses/24 hours (Malesker et al., 2017). Acetaminophen to manage the pain and fever. Dexamethasone/gentamicin drops for ear pain. Non-pharmacological Intervention: Honey and saline nose spray to help with soothing the sore throat and cough, and managing congested nose respectively (Fernandez, & Olympia, 2017). Extra fluid and a cool-mist humidifier are also necessary for helping manage the patients’ cold symptoms. Patient Education: Inform the patient’s mother on the importance of sticking to the treatment plan. It is also important to educate the patient’s parents on expected side effects, and adverse reactions which might call for medical attention (Malesker et al., 2017). Health Promotion: Encourage the patient’s mother to ensure that he is always warm, with a healthy diet, and enough sleep (Badyda et al., 2020). Follow-up: The patient should be advised to report back to the clinic in case of worsened symptoms, or if the prescribed drugs fail to relieve the patient’s symptoms within one week. References Badyda, A., Feleszko, W., Ratajczak, A., Czechowski, P. O., Czarnecki, A., Dubrawski, M., & Dąbrowska, A. (2020). Upper respiratory symptoms in children (3-12 years old) exposed on different levels of ambient particulate matter. DOI: 10.1183/13993003.congress-2020.1303 Fernandez, F. G., & Olympia, R. P. (2017). Ear pain, nasal congestion, and sore throat. URGENT CARE MEDICINE, 77. Badyda, A. J., Feleszko, W., Ratajczak, A., Czechowski, P. O., Czarnecki, A., Dubrawski, M., & D&# 261; browska, A. (2020). Influence of Particulate Matter on the Occurrence of Upper Respiratory Tract Symptoms in Children Aged 3-12 Years. In D24. LUNG INFECTION (pp. A6346-A6346). American Thoracic Society. DOI:10.1164/ajrccm-conference.2020.201.1_ Malesker, M. A., Callahan-Lyon, P., Ireland, B., Irwin, R. S., Adams, T. M., Altman, K. W., … & Weir, K. (2017). Pharmacologic and nonpharmacologic treatment for acute cough associated with the common cold: CHEST Expert Panel Report. Chest, 152(5), 1021-1037. https://doi.org/10.1016/j.chest.2017.08.009 Shoukat, N., Kakar, A., Shah, S. A., & Sadiq, A. (2019). 10. Upper respiratory tract infections in children age 2 to 10 years in Quetta: A prevalence study. Pure and Applied Biology (PAB), 8(2), 1084-1091. http://dx.doi.org/10.19045/bspab.2019.80050 Care Plan : 9.5 of 10 (95.0%) Nursing Diagnosis 3.5 out of 3.5 Nursing Diagnoses: Definitions & Classifications 2018-2020 © NANDA-International, 2017 used by arrangement with Thieme Medical Publishers, Inc., a division of the Thieme Group. All rights reserved. Authorized translation from the English language edition published by Thieme Medican Publishers Inc. No part of this material may be reproduced in any form without the written permission of the agent of the copyright holder, NANDA-International. Direct inquires to [email protected]. Link for more information: http://www.nanda.org/. Status Student Response Model Answer Explanation Points Earned is at risk for is at risk for The correct status for the nursing diagnosis is “is at risk for,” because Danny’s most pressing vulnerability is to an infection that he has not yet, but could, develop. 0.5 out of 0.5 Diagnosis Student Response Model Answer Explanation Points Earned infection infection While a cough can be unpleasant, the most alarming thing it indicates about Danny’s health is that he is at risk for an infection. 0.5 out of 0.5 Etiologies Student Response Model Answer Explanation Points Earned played w/ sick peer played w/ sick peer Danny Rivera is at risk for infection as evidenced by: his playing with a sick peer; how he touches his face often, especially his eyes/nose/mouth; how rarely he washes his hands; and his exposure to secondhand smoke. 0.5 out of 0.5 touches face often touches face often Danny Rivera is at risk for infection as evidenced by: his playing with a sick peer; how he touches his face often, especially his eyes/nose/mouth; how rarely he washes his hands; and his exposure to secondhand smoke. 0.5 out of 0.5 rare hand washing rare hand washing Danny Rivera is at risk for infection as evidenced by: his playing with a sick peer; how he touches his face often, especially his eyes/nose/mouth; how rarely he washes his hands; and his exposure to secondhand smoke. 0.5 out of 0.5 secondhand smoke secondhand smoke Danny Rivera is at risk for infection as evidenced by: his playing with a sick peer; how he touches his face often, especially his eyes/nose/mouth; how rarely he washes his hands; and his exposure to secondhand smoke. 0.5 out of 0.5 Signs & Symptoms Student Response Model Answer Explanation Points Earned N/A N/A Because the infection that Danny may develop hasn’t happened yet, he is not currently presenting with any signs or symptoms, so the correct answer here is “N/A.” 0.5 out of 0.5 Self Assessment Your answer is not automatically evaluated by the simulation, but may be reviewed by your instructor. Prompt Student Response Model Answer Explanation Why would a nursing diagnosis of a cough be incorrect, compared to a risk for infection? Consider the difference between nursing and medical diagnoses. Whereas the cough can be unpleasant and a bother, it is a symptom of something more severe in the sense that it shows that the immune system could be at risk of getting an infection. The most effective nursing care you should prioritize is to educate the patient on avoiding the more serious outcome. While a cough can be unpleasant and frequent, it is actually a symptom of something more alarming: the immune system being at risk for an infection. The most effective nursing care you should prioritize is to educate your patient on avoiding this more serious outcome. Your nursing diagnosis should always take into account what condition is most serious, receiving the greatest benefit from your help. This diagnosis may not be the most obvious physical symptom to you or your patient, so always consider what is jeopardizing a patient’s health the most. Planning 3.5 out of 4 Short-Term Goal Student Response Model Answer Explanation Points Earned To have patient report decreased discomfort and coughing by end of clinic visit. To have the patient and his guardian verbalize and agree to their instructions on how to avoid infection & practice respiratory hygiene, by end of the healthcare visit. A risk-based diagnosis does not require medical interventions as the problem is hypothetical; the goal that does suit the diagnosis involves teaching the patient and his guardian about risk-reduction methods. 0 out of 0.5 Interventions Student Response Model Answer Explanation Points Earned Instruct family and patient on washing hands or using hand sanitizer before eating and after using the restroom Instruct family and patient on washing hands or using hand sanitizer before eating and after using the restroom Many of these instructions work toward shrinking the patient’s likelihood of contact with harmful pathogens, which can lead to infection. Some instructions here also help prevent illness being spread to Danny’s environment and family members, which promotes community health and reduces the patient’s risk of becoming sick again. 0.5 out of 0.5 Instruct family and patient that patient should increase fluid intake Instruct family and patient that patient should increase fluid intake Many of these instructions work toward shrinking the patient’s likelihood of contact with harmful pathogens, which can lead to infection. Some instructions here also help prevent illness being spread to Danny’s environment and family members, which promotes community health and reduces the patient’s risk of becoming sick again. 0.5 out of 0.5 Instruct family to keep their house smoke-free (reducing exposure to environmental pathogens) Instruct family to keep their house smoke-free (reducing exposure to environmental pathogens) Many of these instructions work toward shrinking the patient’s likelihood of contact with harmful pathogens, which can lead to infection. Some instructions here also help prevent illness being spread to Danny’s environment and family members, which promotes community health and reduces the patient’s risk of becoming sick again. 0.5 out of 0.5 Instruct patient on washing hands or using hand sanitizer after coughing or being near someone sick Instruct patient on washing hands or using hand sanitizer after coughing or being near someone sick Many of these instructions work toward shrinking the patient’s likelihood of contact with harmful pathogens, which can lead to infection. Some instructions here also help prevent illness being spread to Danny’s environment and family members, which promotes community health and reduces the patient’s risk of becoming sick again. 0.5 out of 0.5 Instruct patient to avoid touching fingers to eyes, nose, or mouth Instruct patient to avoid touching fingers to eyes, nose, or mouth Many of these instructions work toward shrinking the patient’s likelihood of contact with harmful pathogens, which can lead to infection. Some instructions here also help prevent illness being spread to Danny’s environment and family members, which promotes community health and reduces the patient’s risk of becoming sick again. 0.5 out of 0.5 Instruct patient to cough into tissue, or sleeve if tissue is unavailable Instruct patient to cough into tissue, or sleeve if tissue is unavailable Many of these instructions work toward shrinking the patient’s likelihood of contact with harmful pathogens, which can lead to infection. Some instructions here also help prevent illness being spread to Danny’s environment and family members, which promotes community health and reduces the patient’s risk of becoming sick again. 0.5 out of 0.5 Intervention Rationale Your answer is not automatically evaluated by the simulation, but may be reviewed by your instructor. Prompt Student Response Model Answer Explanation In 1 or 2 sentences, explain how your selected interventions work to accomplish your goal. Ask patients and family memebers to verbalize and agree to their instructions on infection prevention and respiratory hygiene. These interventions will teach Danny and his guardian how to keep their hands and lungs clean in a variety of ways, so that Danny’s risk for infection is reduced as pathogens are eliminated. Infection can be caused by multiple culprits, so it’s important that your patient teaching covers a thorough and specific array of anti-infection habits. Data Collections Student Response Model Answer Explanation Points Earned Ask patient and family members to verbalize and agree to their instructions on infection prevention & respiratory hygiene Ask patient and family members to verbalize and agree to their instructions on infection prevention & respiratory hygiene It is important that your patient and his guardian agree to their instructions, as changing lifestyle habits can be intimidating but necessary for the patient’s health. Having Danny and his father verbalize back their instructions also assures they remember and understand the details. 0.5 out of 0.5 Discussion Of Care Your answer is not automatically evaluated by the simulation, but may be reviewed by your instructor. Prompt Student Response Model Answer Explanation Explain the rationale behind your nursing diagnosis. Hello Danny, since you have been feeling unwell for the last three days, it is my responsibility to ensure that you get in the habit of practicing hand hygiene. Because you are at risk for developing an upper respiratory infection. My goal to you is to you and your family to avoid unnecessary infections by following these instructions. Some of the things that make you sicker are being near sick friend, being exposed to second hand smoke, washing your hands more, and touching your face with hands. I know it sounds like a lot of things but working together, we can reduce the infections in an effective manner. Danny, given that you aren’t feeling well, we want to make sure you don’t develop an infection, which for you just means getting even sicker. We’re going to talk about the ways we can work to prevent that, especially focusing on your risk factors, which are just things that give you a bigger chance of being sick. Some of your risk factors are that you were near a sick friend, have been exposed to cigar smoke, could stand to wash your hands more, and have touched your face with your fingers. I know that sounds like a lot, but if we work together, reducing your risk factors for infection can be easy and effective. A patient should understand their nursing diagnosis and the rationale behind it to increase their sense of involvement and to identify areas for future improvement. Explain your goal for Danny and the interventions and data collections through which you will achieve it. All right. In order to talk to you about how you are not going to get sicker, I will have a conversation with you and your father. Him, you and myself are going to work together to discuss and then have to agree to your goals. And then I am going to have you and your father repeat what you have learned so we can make sure that you have got it down pat. Let’s talk about how we’re going to help you not get sicker! So, I’m going to have a conversation with you and your father about things to do to ensure your health. You, he, and I will work together to discuss, and then have you agree to your goals. Then I’m going to have you and your father repeat what you’ve learned, so we can make extra sure you’ve got it down pat! You should communicate the Care Plan to the patient, allowing them to exercise involvement and agency in their own healthcare. Explicitly ask for Danny’s consent to the Care Plan. Does this sound like a plan? Does this plan I just talked about sound good to you? A patient must consent to all interventions in their Care Plan. Disagreements are opportunities to provide further patient education and to consider alternative options. Inform Danny you will now begin educating him and will then call to educate his guardian. Now, Danny, if you lack other questions, we can start now! Danny, if you don’t have any other questions, we can start our discussion now! It’s time to begin your education interventions, so let your patient know! Intervention & Evaluation 2.5 out of 2.5 Student Response Model Answer Explanation Points Earned Partially Partially While Danny correctly verbalizes and agrees to his instructions for reducing infection risks, his father only agrees to some of his instructions, expressing apprehension toward not smoking inside the house. Your goal has been partially achieved. 2.5 out of 2.5 Intervention & Evaluation Rationale Your answer is not automatically evaluated by the simulation, but may be reviewed by your instructor. Prompt Student Response Model Answer Explanation Did you achieve your goal for your patient and his guardian by the end of the visit, getting each of them to agree to and verbal
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