Poor Patient Outcome
Relying solely on the classic features of a disease may be misleading. That’s because the clinical presentation of a disease often varies: the symptoms and signs of many conditions are non-specific initially and may require hours, days, or even months to develop.
Generating a differential diagnosis; that is, developing a list of the possible conditions that might produce a patient’s symptoms and signs — is an important part ofclinical reasoning. It enables appropriate testing to rule out possibilities and confirm a final diagnosis.
This case portrays a poor patient outcome after a misdiagnosis.
Case scenario
A previously healthy 35-year-old lawyer presents to a primary care office with a chief complaint of chest pain and a non-productive cough. The pain started suddenly 2 hours prior to coming to the office while the patient was sitting at his desk. The patient describes the pain as sharp in nature, constantly present but made worse with inspiration and movement, and with radiation to the base of the neck. His blood pressure in the right arm and other vital signs are normal.
On physicalexamination the only findings of note are chest wall tenderness and a faint cardiac murmur. The ECG in the office is normal. The patient is observed for an hour in the office and assessed. He is diagnosed with viral pleurisy and sent home on non-steroidal analgesics.
The following day the patient collapses at home and cannot be resuscitated by the paramedic service. An autopsy reveals a Type 1 aortic dissection with pericardial tamponade.
Written Assignment:
Developing a list of possible conditions that might produce a patient’s symptoms and signs is an important part ofclinical reasoning.

As an NP in primarycare what would you have done differently?
Discuss the importance of creating a list of differentials for this patient. How could it have changed this outcome?

If a serious diagnosis comes to mind based on a patient’s symptoms:

Ask yourself; Have you considered the likelihood of it and whether it needs to be ruled out by testing or referral?
Because many serious disorders are challenging to diagnose, have you considered ruling out the worst case scenario?
Ask yourself: Do you have sufficient understanding of the clinical presentation to offer an opinion on the diagnosis?
Whatother diagnosis could it be? How might the treatment to date have altered the patient outcome?
What other diagnostic and laboratory or imaging was needed in order to make a complete differential list? What support tools would you consider using in helping to create a differential diagnosis list?
Are you familiar with the current clinical practice guidelines for the investigation of a suspected condition such as chest pain?

To view the Grading Rubric for this Assignment, please visit the Grading Rubrics section of the Course Resources.
Assignment Requirements:
Before finalizing your work, you should:

be sure to read the Assignment description carefully (as displayed above);
consult the Grading Rubric (under the Course Resources) to make sure you have included everything necessary; and
Utilize spelling and grammar check to minimize errors.

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Topic: Compare and contrast metaethical theories

Thread: Now that you have learned about competing ethical theories, write a 500-600 word thread that compares and contrasts a Christian ethical theory with a competing ethical theory. Since we have already looked at ethical relativism in DB 1, you should choose from any theory in the Moral Reasoning textbook except ethical relativism. That means you can choose from Virtue Ethics, Natural Law, Ethical Egoism, Utilitarianism, Duty Ethics, Social Contract Theory, and Moral Realism (or any combination of these) in contrast to a Christian ethical theory such as Divine Command, Divine Nature, or Christian Revelational Ethics (or a combination of these).

1. How do these each system define “the good?” How does each claim to know “the good?”
2. What, if anything, do these systems have in common? What, if anything, are their key differences?
3. Which theory do you think is the stronger ethical theory? Defend your answer. This final question should take up the majority of your thread.

Be sure to carefully define your terms. You are encouraged to support your position with rational arguments, fitting examples, and expert sources. Any quotes or information used from sources other than yourself must be cited using footnotes in current Turabian format and will not count towards the total word count.

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