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iHuman Case Study Bundle by Johnson Mabel, Katherine Harris and Alvin Stafford New Complete Solution
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iHuman Mabel Johnson Case Study
iHuman Mabel Johnson Case Study Mabel Johnson iHuman Mabel Johnson_Case Study Evidence-Based Management of Osteoarthritis... [Show More] Evidence-Based Management of Osteoarthritis The case expert analysis describes the different management options for Mabel Johnson's case, osteoarthritis. Apart from the rheumatic condition, Mabel Johnson has co-morbid conditions such as peptic ulcer disease and renal disease. Noninvasive options of treatment are best utilized in this case due to the existence of contraindications to most pharmacological options. The interventions primary aim at improving the quality of life for the patient through the elimination of pain, improvement of muscular functional capacity, increase in muscular size and strength. Physical therapy such as resistance training and aerobic exercise achieve the therapeutic objectives without inflicting further harm or encouraging disease progression. Noninvasive biomechanical interventions such as orthotics and knee braces offer alternative remedies. Some orthotics include elevated wedge insoles while knee braces include valgus-type and sleeve-type knee braces. While braces improve the proprioceptive acuity of the joint, orthotics reduce the load on the joint. Pharmacologic interventions for Mabel Johnson include analgesics such as tramadol or narcotic-type analgesics in combination with NSAIDs like acetaminophen. The presence of gastric and renal insufficiencies preclude the use of COX-2 inhibitors as NSAIDs. Despite having gastric protective properties, COX-2 inhibitors would lead to thromboembolic conditions in the elderly due to their platelet aggregation properties. In end-stage disease, the patient can also consider total or partial joint replacement surgery. Some areas for improvement in the patient encounter include identification of chronic illnesses pre-existing with OA and early initiation of appropriate treatment options. First, it's essential to identify any preexisting conditions such as peptic ulcer disease and kidney diseases in the patient before formulating the treatment plan since the use of some NSAIDs is contraindicated in these conditions. Such drugs include nonselective NSAIDs, for instance, aspirin, that impair the protection of the gastrointestinal tract and increased cardiovascular risk through platelet aggregation. The clinician must also assess the extent and severity of symptoms such as pain and reduced function. Early initiation of low-intensity exercise is instrumental in reducing the pain and improving functional capacity while slowing down disease progression. Utilization of these non-pharmacologic interventions would have avoided the need for knee replacement surgery (Gur, Cakin, Akova, Okay, & Kucukoglu, 2002). Evidence-based techniques such as models of training can help improve clinical skills. Studies have shown that the different types of exercise including concentric- eccentric, isokinetic and concentric training, have unique benefits on the symptoms of osteoporosis (Gur, Cakin, Akova, Okay, & Kucukoglu, 2002). Additionally, the studies also explain the various methods of training. Such exercise procedures can be utilized together with measurement scales to gauge the progression symptoms of OA. Clinical evaluations after every physical therapy session through the use of the Algofuntional Index gauges the presence of side effects like joint effusion and the effectiveness of the intervention (Rogind et al., 1998). Clinical symptoms of OA potentially lead to accidents including falls and reduce the level of activity in the elderly thus impairing the quality of life. Caregivers such as nurses should ensure care to the patients is holistic and unconditional at all times (Gur, Cakin, Akova, Okay, & Kucukoglu, 2002). According to Watson’s caring theory, nurses should make decisions that strengthen human relationships and uphold human dignity (Pajnkihar, Stiglic, & Vrbnjak, 2017). Therefore, nurses are expected to establish good relations with patients with knee OA and continuously encourage them to remain adherent to treatments such as physical therapy. Studies have shown that despite the pain and function impairment in knee OA, patients can remain adherent to moderate physical exercise (Nejati, Farzinmehr, & Moradi-Lake, 2015). The information from Mabel Johnson's case and similar articles offer application concepts that can be utilized in the clinical setup. First, clinicians need to obtain comprehensive histories from patient to help formulate safe and effective treatment plans. Secondly, patient evaluation through physical examination will facilitate grading the severity of disease and thus the potential therapeutic interventions. Finally, all patients present differently. Therefore, clinicians should tailor all treatment models to the specific patient needs to ensure safety and success. An article that aligns the analyzed case above includes: Nejati P, Fatzinger A, Moradi-Lakeh M. The effect of exercise therapy on knee osteoarthritis: a randomized clinical trial. Medical Journals of the Islam Republic of Iran. 2015; 29:186. Published 2015 Feb 25. References Gur, H., Cakin, N., Akova, B., Okay, E., & Kucukoglu, S. (2002). Concentric versus combined concentric-eccentric isokinetic training: effects on functional capacity and symptoms in patients with osteoarthritis of the knee. Archives of Physical Medicine and Rehabilitation, 83(3), 308-316. Nejati, P., Farzinmehr, A., & Moradi-Lake, M. (2015). The effect of exercise therapy on knee osteoarthritis: a randomized clinical trial. Medical Journal of Islamic Republic of Iran, 186. Pajnkihar, M., Stiglic, G., & Vrbnjak, D. (2017). The concept of Watson's carative factors in nursing and their (dis)harmony with patient satisfaction. Peer-Reviewed and Open Access, 5, e2940. doi:10.7717/peerj.2940 Rogind, H., Bibow-Nielsen, B., Jensen, B., Moller, H., Frimodt-Moller, H., & Bliddal, H. (1998). The effects of a physical training program on patients with osteoarthritis of the knees. Archives of Physical Medicine and Rehabilitation, 79(11), 1421- 1427. [Show Less]
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iHuman Case Study Katherine Harris New Solution
iHuman Case Study Katherine Harris Ihuman Katherine Harris iHuman Case Study _ Katherine Harris iHuman Case Study: Katherine Harri... [Show More] s V3.1 PC 1. Do you recommend limited or involved the use of antibiotics in the treatment of these diseases and other unconfirmed bacterial illnesses and why? What are the standards regarding the use of antibiotics in the pediatric population, and what assessment findings would warrant prescribing an antibiotic for Asthma symptoms? Asthma is a reversible respiratory chronic condition which involves inflammation of the airways, increased mucus production and edema, that may trigger coughing, shortness of breath and wheeze. it can be a lifestyle limiting health condition with no cure but requires close monitoring and adequate management of the symptoms. Childhood asthma, on the other hand, has been classified by most treatment guidelines as mild, moderate and persistent, depending on the severity and persistence of the symptoms, of which differ in the type of medication that is recommended for the management of the symptoms (Baan et al., 2018). a diagnosis of asthma was made based on the findings from the pulmonary function tests that were conducted on Katherine Harris. According to the CDC, the triggers of asthma include indoor or outdoor allergens, medications, mold, pets, exercise, infections, pets and tobacco smoke among others. The clinical report recommends that clinicians should use the most appropriate diagnostic criteria for pediatrics before deciding on what medication to prescribe. For instance, certain instances as acute bacterial sinusitis, pharyngitis, and acute otitis media will benefit from antibiotic therapy. The guideline by the American Academy of Pediatrics (AAP) recommends that acute otitis media be diagnosed based on the evidence of two main condition, that is, evidence of middle ear effusion, which is demonstrated by a moderate to severe bulging of the tympanic membrane or a new onset of otorrhea which is not attributable to otitis externa. However, patients who display more severe symptoms, bilaterally involved and of young age have a higher likelihood of benefiting from antibiotic therapy. Watchful waiting is recommended for older patients with mild symptoms which are unilaterally involved. Consequently, antibiotic therapy is also recommended for cases involving acute bacterial sinusitis with symptoms which have persisted for more than 10 days or worsen as a result of a new onset of daytime cough, nasal discharge or fever after the improvement of a typical viral upper respiratory tract infection (Sheldon, Heaton, Palmer, & Paul, 2018). Diagnostically confirmed pharyngitis with β- hemolytic GAS also require antibiotic therapy appropriately prescribed in terms of dosage and frequency for the shortest time possible. Using antibiotics excessively or inappropriately leads to antibiotic resistance which makes it hard to treat other infections in the future. 2. Using national guidelines and evidence-based literature, develop an Asthma Action Plan for this patient. The action plan for this patient will include the daily treatment, long term control of asthma, how to deal with a worsening state of asthma or an attack, and when it is necessary to seek medical attention in the course of treatment (Tesse et al., 2018). Classificatio n of Asthma Symptom frequency Treatment Patient education Seek medical attention Mild Less than 2 Bronchodilato Provide In case the intermittent days in a rs which are information symptoms week short – 2 on how to persist for puffs of take the more than Albuterol medication, twice in a after every 4- proper week or the 6 hours PRN. inhaler patient has techniques, used short- and acting beta environment antagonists al triggers to (SABA)for avoid. more than 2 to 3 weeks. Mild More than 2 Low dose Provide If daily use persistent days in a corticosteroid information of SABA is week and inhaler – 80- on how to required use of SABA 240 mcg/day take the for more beclomethaso medication, than 2 to 3 ne or 180-600 proper weeks. mcg/day inhaler Pulmicort. techniques, SABA PRN and for environment exacerbations al triggers to . avoid. Moderate Symptoms Low dose Provide When persistent occur daily steroid information symptoms or for more inhaler, plus adherence to persist. one night in LABA, LTRB, daily a week but or prescription, not every theophylline proper night. or medium inhaler dose steroid techniques, inhaler. SABA and PRN for environment exacerbations al triggers to . avoid. High dose Severe Symptoms corticosteroid Provide When persistent occur all inhaler plus, information symptoms through the LABA and adherence to persist. day and 7 oral daily nights in a corticosteroid prescription, week. if needed - 2 proper mg/kg/day inhaler but should techniques, not exceed 60 and mg/ day. environment SABA PRN al triggers to for avoid. exacerbations . 3. Do the etiology, diagnosis, and management of a child who is wheezing vary according to the child’s age? Why or why not? Which objective of the clinical findings will guide your diagnosis? Why? When is a chest x-ray indicated in this case? Wheezing is associated with breathing difficulties as a result of narrowing of the airways and is characterized by a high pitch whistling sound that is heard during respiration. As such, any complication or infection of the airways might have a significant impact that might lead to a total restriction of the airways in such a patient. Nasal flashing, murmurs and retractions, are signals indicating distress in respiration. The earliest symptom is a nonproductive cough, followed by expiratory wheezing, tachypnea, shortness of breath, tachycardia, prolonged expiratory phase, and hyper- resonance (Hudgins et al., 2019). The use of accessory muscles is a sign of severe asthmatic attach that is accompanied by decreased exercise tolerance and sudden nocturnal dyspnea. Through auscultation, the physician can identify the location and presence of crackles, stridor, and wheezing. however, it might be hard for these physical findings to be realized in pediatric patients who are unable to take deep breaths. Most research has revealed that localized wheezing might not be an indication of asthma, and hence recommend further investigations. It is also recommended that pediatric patients who present with localized wheezing be given bronchodilators such as albuterol as trial treatment (Horak et al., 2016). In case, the drug does not help to stop the wheezing, then the patient is not suffering from asthma, but other underlying pathological conditions of the large central airway. a chest x-ray is indicated for children who present with symptoms of unexplained wheezing, which is not responsive to bronchodilators or is recurrent. References Baan, E.J. (Esmé J), Janssens, H.M. (Hettie), Kerckaert, T. (Tine), Bindels, P.J.E. (Patrick), Jongste, J.C. (Johan) de, Sturkenboom, M.C.J.M. (Miriam), & Verhamme, K.M.C. (Katia). (2018). Antibiotic use in children with asthma: cohort study in UK and Dutch primary care databases. (BMJ Open vol. 8 no. 11.) Sheldon, G., Heaton, P. A., Palmer, S., & Paul, S. P. (January 01, 2018). Nursing management of pediatric asthma in emergency departments. Emergency Nurse: the Journal of the RCN Accident and Emergency Nursing Association, 26, 4, 32-42. Hudgins, J. D., Neuman, M. I., Monuteaux, M. C., Porter, J., & Nelson, K. A. (January 07, 2019). Provision of Guideline-Based Pediatric Asthma Care in US Emergency Departments. Pediatric Emergency Care. Horak, F., Doberer, D., Eber, E., Horak, E., Pohl, W., Riedler, J., Szepfalusi, Z., ... Studnicka, M. (August 01, 2016). Diagnosis and management of asthma - Statement on the 2015 GINA Guidelines. Wiener Klinische Wochenschrift, 128, 541-554. Tesse, R., Borrelli, G., Mongelli, G., Mastrorilli, V., & Cardinale, F. (January 01, 2018). Treating pediatric asthma according to guidelines. Frontiers in Pediatrics, 6. [Show Less]
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iHuman Case Study Alvin Stafford Complete New Solution
iHuman Case Study Alvin Stafford iHuman Case Study - Alvin Stafford iHuman Case Study - Alvin Stafford A.S. - is a 63-year-old male Chi... [Show More] ef Complaint: Worsening shortness of breath Associated Sx/Sx Characteristics: When did you start experiencing worsened shortness of breath? “Last week.” Do you experience pain in any area of your body? “Yes, around the chest region.” Does the difficulty in breathing become worse during the day or at night, or is it consistent the whole day? “It becomes worse at night. Sometimes it even becomes very hard to sleep.” Please describe how it makes you feel. “I feel like I cannot breathe properly, especially when going about my daily activities and I get tired most of the time. My chest is congested, and it hurts so much, especially when I cough.” Is the cough productive? “Yes, with white sputum.” Does your throat hurt? “No.” What makes the symptoms you have just describe worsen? “Cold weather and daily activities.” What about anything that makes the breathing difficulty and chest pain better? “It becomes better when am resting during the day in a warm weather.” Have you taken any drugs or tried any home remedies to relieve your chest pain and shortness of breath? “Yes, I have been using a budesonide inhaler every time I feel like am short of breath, and salbutamol, every night before I sleep. However, I was given these drugs the last time a visited the hospital and diagnosed with bronchial asthma. The drugs have not been of much help ever since my shortness of breath worsened. Ever since you started experiencing shortness of breath and chest pain, have you been able to go through your daily activities? “No, I have been resting most of the day.” Can you rate the severity of the pain on a scale of 0 to 10, with 0 being very mild and 10 the worst? “10, it really hurts.” Have you ever felt the same way before? “Yes, but not as worse as how I have been feeling in the past week.” Have you been taking all your medications as prescribed? “Yes, but sometimes I may forget and take the drugs 1 or 2 hours late, but I still maintain the dosage and frequency.” PMH According to your medical records, I can see that you were diagnosed with hypertension about 8 years ago. Is it correct? You also have a history of gastritis in the past 4 years. You were also diagnosed with bronchial asthma two weeks before your present admission. Is that right? SH What is your marital status? Do you have children? Where do you live? Do you have any pets? Do you take any recreational drugs such as alcohol, or cigarettes or any other drug? FH Are your parents alive? How old are they? Are you aware of any serious medical illnesses that they might have suffered from? What about your siblings? MH Which drugs have you been taking to manage your medical condition in the past? Are you allergic to any medication? ROS Tell me if you have any problems with: high fever, change in appetite or weight, fatigue, sleep, night sweats or chills? Do you have any problems with: headaches or, change in hearing or vision? Do you have any problems with: Chronic cough, SOB, white colored sputum, pain upon inspiration or expiration and wheezing? Do you experience any of the following symptoms: Chest pain or heart racing or missing beats? Do you experience any of the following: abdominal pain, nausea and vomiting and diarrhea ? Do you have problems with: painful urination, blood in urine, itchiness or discomfort of genitalia? Do you experience any of the following: back and joint pain? joint swelling or arthritis, arm or leg weakness, or general body weakness? Have you ever had any of the following symptoms: seizures, anxiety disorder, inability to concentrate, forgetfulness or difficulty with balance? The patient has no issues with changes in vision, or headache, nose, throat or ear problems. No problem with nausea and vomiting. No changes in stool color or defecation pattern but complains about burning sensation while defecating at least twice a month. Worsened shortness of breath/ inability to sleep MSAP Productive cough Related Fatigue Related Tight chest Related Painful inhalation and exhalation Related Sore throat Related Lower back pains Related Other muscle aches Unknown Family medical history of both parents Unknown Physical Examination For the patient’s physical examination, it is important to review the primary vital signs such as blood pressure, body temperature, respiratory rate and heart rate. The general appearance of the patient is also essential. The patient’s lungs must also be examined to observe any signs of wheezing, breathing characteristic and expiratory phase. The heart rate of the patient can also be assessed based on the S1 and S2 RRR, heart tones and murmurs. The patient’s abdomen must also be reviewed for palpitation for tenderness, bowel sounds and check for abdominal bruits. Finally, it is important to check the extremities by conducting a full ROM. Differential Diagnosis list Emphysema: It is a health condition that results from the destruction of alveolar walls as a result of imbalanced proteinase enzymatic activities. It is mainly caused by long- term smoking of cigarettes. Sometimes, it might occur as a result genetic reason. The main sign and symptoms of emphysema are worsened shortness of breath, for more than a month or even years (Virchow, 2016). Other symptoms include a longstanding cough, chest pain, wheezing, increased chest size, or a "barrel chest" as a result of abnormally expansion of the lungs, rounded fingertips (clubbing), hypoxia, hypercarbia and cyanosis (Kochhar, 2013). Chronic Bronchitis: This is a respiratory condition characterized by obstructions of airflow to the lungs as a result of bronchiole edema, hypertrophy of the bronchial smooth muscles, and hyperplasia of goblet cells which produce mucus (Burns, 2013). Some of the clinical presentations of chronic bronchitis include recurrent sputum production, long-term cough, especially during cold nights and early morning, extreme fatigue, slight fever, shortness of breath, and chest discomfort (Poole, Chong, & Cates, 2015). Chronic dyspnea: This is a respiratory disorder characterized by severe shortness of breath which is persistent for a month or more. However, the severity of the condition varies based on the patients physiologic and behavioral responses. The main clinical presentation of the condition is exertional dyspnea (McComb et al., 2018).). In most cases, chronic dyspnea may lead to asthma, myocardial infarction, heart failure, chronic obstructive pulmonary disease, pneumonia, interstitial lung disease, or psychogenic disorders. Etiologically, dyspnea is a multi-factorial disorder in about one-third of admitted patients in the United States. Most diagnosis, about 66% are made based on the clinical presenting sign and symptoms alone. Most patients with dyspnea complain of shortness of breath, tightness in the chest, wheezing, coughing, rapid and shallow breathing (Aakre, & Iyer, 2015). Environmental factors such as chemical exposures may worsen the condition. Patients diagnosed with dyspnea are advised to avoid precipitating factors such as smoking to help manage the condition and reduce the symptoms. Diagnostic test The main diagnostic tests to order, for accurate diagnosis, include: • PFT’s pre and post-bronchodilator testing for determining response. A chest x- ray is also relevant to determine the presence of infiltrates, peribranchial thickening for bronchitis, and lower lobes increased lung markings (Strunk et al., 2015). Patients with emphysema may show the presence of hyperinflation indicated by a low flat diaphragm and enlarged retrosternal space. Renal and liver test to assess the kidney and liver functions. • LABS: ABG’s to assess oxygenating CBC for ruling out anemia and polycythemia, CMP for the evaluation of K, Na, Cl. Total protein albumin for the evaluation of the nutritional status of the patient and finally sputum cultures for gram stain evaluation (Gilotra et al., 2017). Problem statement: Alvin Stafford is a 63 years old man who has been married for about 35 years. He has three kids and lives in a permanent resident near a factory. He was diagnosed with bronchial asthma and given the right medication to manage the condition. Two weeks later, he appeared to the hospital complaining of worsened shortness of breath. He also complained of tightened and painful chest and productive. He is also easily fatigued. Stafford’s most significant active problem (MSAP) is that he was unable to sleep as a result of worsened shortness of breath. His condition worsens at night making it hard for him to sleep. He has been using budesonide inhalers together with salbutamol, once a day to manage his respiratory condition. Assessment Alvin Stafford came to the hospital complaining of worsened shortness of breath. He even stated that he was unable to sleep the night before reporting to the hospital. He also confirmed a productive cough, painful and tightened chest in addition to becoming fatigued very easily. Looking at the patient's age of 63 years old, and the environment that he lives in (around a factory) in addition to his worsened sign and symptoms, it is best if he was hospitalized and treated as an inpatient. His medical history is quite abnormal, given that he was initially diagnosed with bronchial asthma, just a week before his sign and symptoms worsened and given the right medication to manage the condition. The present chief complained might have resulted as a complication of the previous diagnosis. Review of tests During the diagnosis, the patient confirmed symptoms such as wheezing, chest pain, productive cough, fatigue and shortness of breath. The physical examination results on the vital signs were BP: 152/82mmHg, PR:109bpm. His heart and respiratory rates are higher than normal. Other lab test such as renal test showed that the potassium level was at 2.6mmol/L hence, calculated Creatinine clearance was 60ml/min indicating a mid-renal impairment, Red Blood Count (RBC) - (3.8-4.8 x 1012 /l), Neutron- 10.57 ↠‘and Rectus protein- 31.1 ↠‘. All these are indications of acute bronchial asthma. Final Diagnosis For the above diagnostic criteria, the patient has acute bronchial asthma that resulted in chronic dyspnea. Care Plan 1. Continue using 200mcg budesonide inhalers on a need basis to manage the asthmatic condition together with 200mcg of salbutamol every night (Ferry- Rooney, 2013). 2. Use Albuterol to alleviate the symptoms for better health: Albuterol should be taken 5mg daily starting with a single dose immediately. 3. Also, use Flonase spray 50mcg daily to help reduce the shortness of breath. 4. The patient should avoid aggravating factors such as cold, smoking, over- exercise, or even dusty conditions. 5. The patient should visit the hospital every two weeks once released for follow-up check-ups (Teepe et al., 2015). 6. The patient should strictly adhere to the prescription for a better outcome. References Teepe, Jolien, Broekhuizen, Berna Dl, Ieven, Margareta, Loens, Katherine, Huygen, Kris, Kretzschmar, MEE, de Melker, Hester, ... GRACE consortium. (2015). Prevalence, diagnosis, and disease course of pertussis in adults with acute cough: a prospective, observational study in primary care. Strunk, R. C., Colvin, R., Bacharier, L. B., Fuhlbrigge, A., Forno, E., Arbelaez, A. M., Tantisira, K. G., ... Zeiger, R. (September 01, 2015). Airway Obstruction Worsens in Young Adults with Asthma Who Become Obese. The Journal of Allergy and Clinical Immunology: in Practice, 3, 5, 765. Gilotra, N. A., Shpigel, A., Okwuosa, I. S., Tamrat, R., Flowers, D., & Russell, S. D. (January 01, 2017). Patients Commonly Believe Their Heart Failure Hospitalizations Are Preventable and Identify Worsening Heart Failure, Nonadherence, and a Knowledge Gap as Reasons for Admission. Journal of Cardiac Failure, 23, 3, 252-256 McComb, B. L., Ravenel, J. G., Steiner, R. M., Chung, J. H., Ackman, J. B., Carter, B., Colletti, P. M., ... Expert Panel on Thoracic Imaging: (January 01, 2018). ACR Appropriateness Criteria® Chronic Dyspnea-Noncardiovascular Origin. Journal of the American College of Radiology: Jacr, 15, 291. Aakre, C. A., & Iyer, V. N. (March 01, 2015). 73-Year-Old Man with Dyspnea on Exertion. Mayo Clinic Proceedings, 90, 3, 404-407. Poole, P., Chong, J., & Cates, C. J. (July 29, 2015). Mucolytic agents versus placebo for chronic bronchitis or chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews, 7.) Virchow, J. C. (January 01, 2016). Diagnostic challenges of adult asthma. Current Opinion in Pulmonary Medicine, 22, 1, 38-45. Ferry-Rooney, R. (January 01, 2013). Asthma in Primary Care: A Case-based Review of Pharmacotherapy. Nursing Clinics of North America, 48, 1, 25-34. Kochhar, S. (November 01, 2013). Carrying out asthma reviews in primary care. Nurse Prescribing, 11, 11, 538-541. Burns, D. (January 01, 2013). Managing acute asthma in primary care. Nursing Times, 109, 42, 17-8. [Show Less]
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