Overview/Description:
Throughout this course, you were provided case studies that focused on cardiovascular, pulmonary, genitourinary, and musculoskeletal disorders. You will pick one of these cases to analyze and create a comprehensive care plan for acute/chronic care, disease prevention, and health promotion for that patient and disorder. Your care plan should be based on current best practices and supported with citations from current literature, such as systematic reviews, published practice guidelines, standards of care from specialty organizations, and other research based resources. In addition, you will provide a detailed scientific rationale that justifies the inclusion of this evidence in your plan. Your paper should adhere to APA format for title page, headings, citations, and references. The paper should be no more than 10 pages typed excluding title page and references.
Criteria:
Case Study Evaluation
Analyze the disorder addressing the following elements: pathophysiology, signs/symptoms, progression trajectory, diagnostic testing, and treatment options.
Differentiate the disorder from normal development.
Discuss the physical and psychological demands the disorder places on the patient and family.
Explain the key concepts that must be shared with the patient and family to achieve optimal disorder management and outcomes.
Identify key interdisciplinary team personnel needed and how this team will provide care to achieve optimal disorder management and outcomes.
Interpret facilitators and barriers to optimal disorder management and outcomes.
Describe strategies to overcome the identified barriers.
Care Plan Synthesis
Design a comprehensive and holistic recognition and planning for the disorder.
Address how the patient’s socio-cultural background can potentially impact optimal management and outcomes.
Demonstrate an evidence-based approach to address key issues identified in the case study.
Formulate a comprehensive but tailored approach to disorder management.
Week 1: Cardiology Clinical Case
HPI
A 52-year-old Irish American male is discharged from the hospital. He was hospitalized for four days after a stent placement, following admission from the emergency room with angina symptoms. This patient presented to the emergency room with four hours of crushing chest pain. He was short of breath with exertion and diaphoretic. The patient thought he was having a heart attack and was afraid to come to the hospital. The symptoms lasted for four days before the patient sought help. The patient had been suffering from similar symptoms for the past six months but thought that he just out of shape. It was worse upon admission to the hospital. Prior to this,
the symptoms disappeared with rest.
His symptoms were relieved in the emergency department with medication and he was transferred to the cardiac floor for catheterization.
The patient’s symptoms were highly debilitating upon his admission to the emergency department.
Prior to his admission to the hospital for this event, the patient was not very active because of his angina symptoms. The pain that he had was substernal and crushing and radiated to his neck and jaw. His symptoms resolve with rest only. He has not sought any therapeutic maneuvers.
He is currently asymptomatic and is here for a follow-up visit from his hospitalization to discuss his risk factors. The patient is still concerned that he may have other episodes of angina, even after the stent placement.
PMH
The patient has not sought care for his problems in the past. He had been treated for hypertension and high cholesterol in the past but stopped medication on his own. Besides that, he has had no other significant illnesses.
He was hospitalized for a cholecysectomy ten years ago.
This patient had a baseline EKG at his doctor’s office when he was first prescribed his blood pressure medication. Otherwise he’s had no other investigations for heart disease besides his cholesterol levels checks.
Results of Laboratory Investigations Following Hospitalization
Total cholesterol – 210
LDL- 200
HDL- 25
Triglycerides – 250
Fasting blood sugar – 140
HgbA1c – 7.5
CXR – hyperinflation of the lungs – no infiltrate
EKG – no change from baseline.
Risk Factors:
• High blood pressure
• Hypercholesterolemia
• Type 2 diabetes
• Android obesity
• Cigarette smoker
• Positive family history
Past surgical history of Cholecysectomy, almost 10 years age without any complications.
ROS
Review of systems is otherwise negative
DISCHARGE MEDICATIONS
Tenormin XL 50 mg daily Lipitor 10 mg daily Glucophage – 500mg BID Baby ASA daily
Patient is now compliant with the prescribed regimen, but wasn’t in the past. The medicines were prescribed by the physician who discharged him from the coronary care unit.
ALLERGIES/REACTIONS
Patient has no known drug allergies
SOCIAL HISTORY
The patient is a high school graduate and a licensed carpenter and is anxious to get back to work because of finances. His income is around $50,000.00 per year. His wife is currently disabled
with uncontrolled type 2 diabetes. The patient has disrupted self-efficacy because he is not sure whether he can care for his wife, who needs his help, now that he is sick. They live paycheck to paycheck and cannot afford a vacation. They have three grown-up children who have left home and do not live in the area. The patient has lived in the same city all his life. He does not participate in sports or any other physical activity. The streets of his neighborhood are not safe for exercising; the crime rate is high. There is little community socialization and most people are at
the poverty level.
He is the sole bread winner in the family. His stress level is very high because of the impending bills that he needs to pay while he is not able to work. He believes that a man should be able to care for his family and be strong enough not to suffer from any illnesses himself.
The patient and his wife live in a one-bedroom apartment in an inner city, quite isolated from their community. They do not have any relatives living in the area nor do they socialize with neighbors. He has little emotional or social support. He is stressed most of the time and is now suffering from depressive symptoms such as sleeping excessively and over eating.
This patient has health insurance through the union to which he belongs, but it does not offer complete coverage of all his prescription medications. Though he goes to a clinic that is associated with the hospital, he does not always see the same primary care provider. HABITS
• Diet Habits
The patient usually eats one large meal a day after work. He skips breakfast most of the times and eats fast food for lunch. He eats few fruits and vegetables; mostly pasta and meat at home.
He feels that he got all the exercise he needed when he was a young man, and the exercise he gets as a carpenter now is sufficient to keep him healthy.
Smoking: He smokes 1 pack per day from the past 30 years
Alcohol: Does not drink
Substance Use: Denies street drug use
• WORK HABITS
He’s always been a carpenter; has no hobbies and reads at home.
• FAMILY HISTORY
He has two older brothers who are being treated for high blood pressure and type 2 diabetes. Both brothers were diagnosed with these disorders in their early forties.
Both parents are deceased; father from heart disease, and mother from breast cancer.
PHYSICAL EXAMINTAION
Vital Signs: BP: 160/92 left are sitting; P:60 ; R: 16; T: 98; Wt: 220#; Ht:– 70” HEENT: WNL
Lymph Nodes: None
Lungs: Decreased breath sounds throughout, no adventitious sounds
Heart: RRR without murmur
Carotids: Right bruit
Abdomen: Android obesity, WC = 44 inches
Rectum: Not examined
Genital/Pelvic: NA
Extremities, Including Pulses:
Decreased pedal pulses BL with lower leg edema from ankle to mid calf. Neurologic: Not examined
EKG: No change from baseline
Criteria Weight
Case Study Evaluation
• Analyzed the disorder addressing the following elements: pathophysiology, signs/symptoms, progression trajectory, diagnostic testing, and treatment options.
• Differentiated the disorder from normal development.
• Discussed the physical and psychological demands the disorder places on the patient and family.
• Explained the key concepts that must be shared with the patient and family to achieve optimal disorder management and outcomes.
• Identified key interdisciplinary team personnel needed and how this team will provide care to achieve optimal disorder management and outcomes.
• Interpreted facilitators and barriers to optimal disorder management and outcomes
• Described strategies to overcome the identified barriers.
10
10
10
10
10
10
10
Care Plan Synthesis
• Designed a comprehensive and holistic recognition and planning for the disorder.
• Addressed how the patient’s socio-cultural background can potentially impact optimal management and outcomes.
• Demonstrated an evidence-based approach to address key issues identified in the case study.
• Formulated a comprehensive but tailored approach to disorder management.
20
20
20
10
APA Style/Format: Free of grammatical, spelling, or punctuation errors. Citations and references are written in correct APA Style. 10
Total 150
