Discussion Post: Primary Adult Care- Nursing
Part I
What changes in prescriptive authority have taken place in the United States in the past ten years? What are the implications of limited prescriptive authority for the advanced practice registered nurse (APRN)?
Part II
Mary is a 72-year-old grandmother of six, who recently moved to your area to be closer to her older son who recently lost his wife. She lives with her son and two teenage grandsons. Mary has not had a physical check in about 5 years, but she does not report any significant health issues. She has a history of hypertension that has been controlled with Lisinopril for the past five years. Discuss your health promotion priorities for Mary.
Discuss what hints you would ask the patient, what physical check elements you would include, what further testing you would want to have performed, differential and working diagnosis, treatment plan, including inclusion of complementary and OTC therapy, referrals and other team members needed to complete patient care.
Part III
Sally is a 22-year-old female who recently became bothered by a rash that is itchy, red, inflamed, and dry. She also has scaly areas that she says are getting worse. The rash is only around her umbilicus and on her elbows. Both of her parents have psoriasis, but she doesn't believe this is the problem, because it appears to be different from her parents' lesions. She is living in Florida, is under a lot of stress in high school, and just recovered from a lingering upper respiratory infection (URI).
Discuss what hints you would ask the patient, what physical check elements you would include, what further testing you would want to have performed, differential and working diagnosis, treatment plan, including inclusion of complementary and OTC therapy, referrals and other team members needed to complete patient care.
Part IV
Callie is a 32-year-old female with complaints of a hoarse voice for the past three days, painful swallowing without drooling, fever with a Tmax of a 103 yesterday with chills, and occasional body aches. She presents to the clinic with a temperature of 99, while other vital signs are within normal limits. Cervical lymph nodes are mildly enlarged and tender. Both tympanic membranes (TM) are full and erythematous without bulging or drainage and no facial pain. Pharynx is erythematous and swollen without exudate. She has no other complaints and no significant past history; she has no sick contacts.
Discuss what hints you would ask the patient, what physical check elements you would include, what further testing you would want to have performed, differential and working diagnosis, treatment plan, including inclusion of complementary and OTC therapy, referrals and other team members needed to complete patient care.
Part V
Mason is a 55-year-old homeless man, who you are seeing today for the first time. He is a smoker and states that he has frequent colds and a routine morning cough. He used to be short of breath just walking up hills, but states that he now has difficulty breathing with everyday activities and is having trouble trying to find food because he cannot walk very far. He just wants medicine to help him survive on the streets. On examination, you find him using his accessory muscles to breath. His vital signs are 99°, 100 beats per minute, 28 respirations/min., blood pressure 140/90. Breath sounds are distant with end expiratory wheezes. He has a slight barrel chest and neck vein distention.
Discuss what hints you would ask the patient, what physical check elements you would include, what further testing you would want to have performed, differential and working diagnosis, treatment plan, including inclusion of complementary and OTC therapy, referrals and other team members needed to complete patient care
Part VI
Jennifer is an 84-year-old who recently returned from London with her husband. She comes to your clinic as a walk-in from the airport because she does not feel well. She has felt shaky, a little short of breath, and slightly light-headed for the past 2 to 3 hours. She did not take her Norvasc or Lisinopril this morning because she didn't feel well. She presents to you slightly diaphoretic. Her BP is 90/50, HR is 155, RR 20. She is alert and oriented.
Discuss what hints you would ask the patient, what physical check elements you would include, what further testing you would want to have performed, differential and working diagnosis, treatment plan, including inclusion of complementary and OTC therapy, referrals and other team members needed to complete patient care
Part VII
A 30-year-old male comes in complaining of 2 days of loose to watery diarrhea, 4 to 5 times a day with significant nausea and one episode of vomiting today. He has a temperature of 100.5 on presentation and HR of 102. His skin is slightly pale, and he is complaining of abdominal cramping. He states that he was in his usual state of health prior to the diarrhea and denies any unusual travel or food. His abdomen is generally tender with no rebound or guarding.
Discuss what hints you would ask the patient, what physical check elements you would include, what further testing you would want to have performed, differential and working diagnosis, treatment plan, including inclusion of complementary and OTC therapy, referrals and other team members needed to complete patient care
Part VIII
Harold is a 66-year-old male who presents with chills, a 101° fever, and low back pain. His wife tells you that he has been having leaking of his urine for the past 2 to 3 days, a loss of appetite, and that Tylenol is not helping his back pain. Harold tells you that he feels like he constantly has to have a bowel movement, but he has not had any diarrhea, and does not feel constipated. Discuss what hints you would ask the patient, what physical check elements you would include, what further testing you would want to have performed, differential and working diagnosis, treatment plan, including inclusion of complementary and OTC therapy, referrals and other team members needed to complete patient care.
The response must include a reference list. One-inch margins, double-space, Using Times New Roman 12 pnt font and APA style of writing and citations.