nurs6531 week 4 discussion (dq1+dq2) latest 2017 december

Week 4 discussion

DQ1

Blood Clots

Blood clots form in various locations of the body and are not
unique to any specific age group or gender. While there are certain risk
factors that may make a patient more likely to develop blood clots, essentially
any patient is a potential candidate. Unfortunately, blood clots often go
unrecognized until something happens. Even if the patient identifies a problem
and seeks medical care, blood clots are frequently misdiagnosed resulting in
serious medical complications and sometimes death. Why does this happen? How
can you, as the advanced practice nurse, protect your patients from
misdiagnosis?

Consider the following case studies:

Case Study 1:

A 44-year-old African American male had a partial colectomy
to have a cancerous tumor removed. The patient did really well after surgery
and was discharged from post-op recovery to the surgical unit at a medical
center. Approximately one hour after surgery, the patient complained of gas
pains and shortness of breath. The patient continued to complain of gas pains
after administration of morphine sulfate. Providers failed to diagnose a
pulmonary embolism that resulted in the loss of the patient’s life.

Case Study 2:

A 50-year-old white male went to the emergency department
with complaints of right leg pain. The patient is an avid runner, and knowing
this, the provider diagnosed the patient with a right leg muscle strain. The
patient was sent home with Flexeril as needed and Motrin 800 mg q8h as
needed. One week later, the patient
followed up with his primary care doctor with continued right leg pain. His
doctor instructed him to continue to take the muscle relaxant and Motrin, and
advised that the pain should subside in 5–10 days. The following day the right
leg pain increased, prompting the patient to return to the emergency
department. Multiple providers failed to diagnose a blood clot in the patient’s
right leg.

To prepare:

Review Part 11 of the Buttaro et al. text in this week’s
Learning Resources.

Select one of the cased studies provided. Reflect on what
went wrong in this case study, as well as why patient blood clots continue to
be misdiagnosed.

Think about how you might have prevented the misdiagnosis of
the patient the case study. Consider strategies for obtaining patient history,
ordering diagnostics, and recommending potential treatment options.

Post on or before Day 3 a description of what went wrong in
the case study that you selected, as well as why patient blood clots continue
to be misdiagnosed. Then, explain how you might have prevented the misdiagnosis
of the patient in the study. Include strategies for obtaining patient history,
ordering diagnostics, and recommending potential treatment options.

DQ2

Types of Anemia

In clinical settings, patients often present with many
different types of anemia. Each type of anemia has its own causes and
implications. For this reason, you must be able to differentiate between types
of anemia as well as identify factors that put patients at greater risk of
experiencing related complications. As you prepare for this Discussion,
consider the following patient case studies:

Case Study 1:

An 82-year-old female presents to the office complaining of
fatigue, dizziness, weakness, and increasing dyspnea on exertion. She has a
past medical history of atrial fibrillation, hypertension, and hyperlipidemia.
Medications include warfarin 2 milligrams po daily, lisinopril 10 milligrams po
daily, and simvastatin 10 milligrams po daily. There are no known drug
allergies. The physical exam reveals a 5’2” older female. Her weight is 128
pounds, blood pressure is 144/80, heart rate is 98, temperature is 98 degrees
Fahrenheit, and O2 saturation is 98%. Further examination reveals the following:

Eyes: + pallor conjunctiva

Cardiac: irregular rhythm. No S3 S4 or M. NO JVD

Lungs: CTA w/o rales, wheezes, or rhonchi

Abdomen: soft, BS +, + epigastric tenderness. No
organomegaly, rebound, or guarding

Rectal: no stool in rectal vault

Case Study 2:

A 28-year old female presents for a routine physical. She
has no complaints. Her personal medical history reveals asthma that is well
controlled with an albuterol inhaler prn and Advair 250/50 1 puff BID. Social
history reveals she is a nursing student who is a non-smoker, rarely uses
alcohol, and is mostly vegetarian. Her physical exam is negative, and she is
sent for a CBC/differential and lipid profile. Laboratory results reveal the
following: Hemoglobin 10, Hematocrit 30.1, MCV increased.

Case Study 3:

A 78-year-old female presents to the emergency room after a
fall 3 days ago. She recently had a right above-the-knee amputation and was
leaning over to pick something up when she fell. She did not want to come to
the hospital, but she is having difficulty managing at home because of the pain
in her left leg where she fell. Her patient medical history reveals RAKA,
peripheral vascular disease, Type 2 diabetes, and stage 3 chronic kidney
disease. Current medications include quinapril 20 milligrams PO daily, Lantus
30 units at bedtime, and Humalog to scale before meals. There are no known drug
allergies. The physical exam is negative and x-rays reveal no acute injuries.
Laboratory studies reveal a normal white blood cell count: Hgb of 8 and HCT 24.
The MCV is normal.

To prepare:

Review Chapter 213 in Part 18 of the Buttaro et al. text.

Select one of the three case studies. Reflect on the
provided patient information including history, physical exams, and lab
reports.

Think about a differential diagnosis. Consider the role the
patient history, physical exam, and lab reports played in the diagnosis.

Reflect on the pathophysiology of the type of anemia that
you diagnosed, as well as potential treatment options. Consider the causes of
this type of anemia. Think about whether the patient should be referred for
specialized care.

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