Discussion On HEENT Or Respiratory System

A 52-year-old male presents to the clinic with a productive cough for 5 days. Describe at least 5 more questions the FNP should ask this patient in the health history. Please generate at least 5 differential diagnoses for a cough. Describe how the FNP would clinically manage and follow up this patient based on each differential diagnosis.

Expectations (pls i attached sample. also use OLDCARTS in asking the questions)

  • Length: A minimum of 500 words, not including references
  • Citations: At least one high-level scholarly reference in APA from within the last 5 years
  • 7 Edition

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    Week 2: Discussion Question – Respiratory

    A 52-year-old male presents to the clinic with a productive cough for 5 days.

    Describe at least 5 more questions the FNP should ask this patient in the health history.

    Please generate at least 5 differential diagnoses for a cough. Describe how the FNP would

    clinically manage and follow up this patient based on each differential diagnosis.

    When performing an initial intake of this patient and his symptom of productive cough. I

    would go through the acronym OLD CARTS to assess his cough further. Onset: When did the

    cough start? What factors may have prompted the cough? Location; I could ask if he notices if

    the cough seems to be coming from the upper or lower respiratory tracts. Duration: How

    persistent is the cough? Do you cough constantly or intermittently? Character: I could ask about

    the quality, consistency, amount, and color of the sputum and if there is ever any blood present.

    Aggravating factors: Is there anything that makes the cough worse? Relieving factors: Is there

    anything that makes the cough better? Have you used any cough drops or other over-the-counter

    medications that have helped? Timing: Might be questions about if the cough seems worse at

    night or during the day. And Severity: How bad is the cough, how is the cough affecting your

    normal daily life, quality of life (Dunphy et al., 2019).

    Differential diagnoses and recommendations for follow up for cough could include;

    (1) Bronchiectasis: Supportive interventions such as; assessing adequate oxygenation,

    rest, increasing fluid intake, and using a cool-mist humidifier. Acetaminophen (Tylenol), 500 to

    1000 mg Q6H for fever or malaise (adults). Expectorants such as guaifenesin with

    dextromethorphan for minor cough, throat irritation, 10mL by mouth every 4 hours. Antibiotics

    are not recommended if an acute episode is viral, however they should be considered if

    symptoms persist for longer than two weeks. Erythromycin, 250 to 500 mg by mouth four times

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    per day. Albuterol for patients with wheezes or rhonchi, 2 puffs every 4 to 6 hours. Instruct

    patient to follow up if symptoms do not improve or worsen within 48 hours, high fever, chills,

    chest tightness or pain, and shortness of breath. Recommend annual flu and pertussis

    vaccinations. Refer the patient to a physician if symptoms persist, if in respiratory distress or if

    you suspect pneumonia. (Cash et al., 2020).

    (2) Common Cold/Upper Respiratory Infection: Consider a rapid strep test if the

    patient has had a recent exposure or a throat culture if strep is negative and the patient is

    symptomatic. Treatment recommendations for the common cold are supportive, such as rest and

    fluids. Saline nose drops for moisture. For rhinorrhea and nasal congestion decongestant, nasal

    spray such as pseudoephedrine (Afrin) 0.05% 2-3sprays per nostril twice daily. Warn the patient

    that using nasal sprays longer than 2-3 days can cause rebound congestion and drug abuse. Oral

    decongestants such as; pseudoephedrine (Sudafed) 60 mg every 4-6 hours or 120 mg every 12

    hours for adults. For headache relief Acetaminophen (Tylenol), 500 to 1000 mg every 6 hours or

    ibuprofen (Advil) 200-400 mg every 4-6 hours. Cough suppressants if needed; dextromethorphan

    10 to 20 mg every 6-8 hours. No, follow up recommended unless symptoms persist longer than 7

    days or if the patient is experiencing pain that is worsening in the ears, sinuses, nose, throat,

    neck, or chest, has green or yellow nasal drainage, or has a temperature higher than 100.4. Talk

    to the patient about reducing transmission by covering mouth and nose when coughing and

    sneezing and good hand hygiene. Consult MD if the patient has been reevaluated and given a

    new treatment plan and symptoms are not improving. (Cash et al., 2020).

    (3) Gastroesophageal Reflux Disease: Management depends on the cause and severity

    of the symptoms. Prevention includes; avoiding smoking, avoiding wearing tight clothing and

    belts that may increase abdominal pressure, do not lying down for 3 hours after a meal, avoid

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    large, heavy meals and alcohol. Lose weight if indicated, stop smoking, elevate the head of the

    bed on 6” blocks. Some medications can promote relaxation of the lower esophageal sphincter

    (LES) and may need to be eliminated for symptom improvement, such as; NSAIDs, benzos,

    calcium-channel blockers, and nitrates, to name a few. Medications to reduce GERD symptoms

    may include a proton pump inhibitor (PPI) such as Omeprazole (Prilosec) 20 mg tablet daily.

    PPIs can increase the risk of community-acquired pneumonia and GI infections. Histamine 2-

    receptors agonists (H2 blockers) such as famotidine (Pepcid) can help treat mild and less

    frequent symptoms on an as-needed basis. Schule follows up for 1-2 weeks to reevaluate for

    relief of symptoms. Refer if patients do not improve after trying two different medications (Cash

    et al., 2020).

    (4) Medication-induced cough from ACE-inhibitors: A repeat trial should be

    attempted if the patient’s cough ceases after ACE inhibitors are stopped or if it is decided that the

    patient needs to continue treatment with these drugs. ACE inhibitors should be considered

    entirely or partially causative in a patient with a persistent cough, regardless of the time interval

    between commencement of ACE inhibitor therapy and the onset of cough. Discontinuation of

    therapy is the only consistently successful treatment for ACE inhibitor-induced cough (Cash et

    al., 2020)

    (5) Coronavirus Disease (COVID-19): General therapies for mild symptoms (without a

    positive test result) are generally supportive in nature and might include increasing fluid intake,

    rest, and follow-up with a primary care physician to evaluate outcome. Patients should cancel or

    reschedule travel, adhere to any local limitations, avoid big gatherings, and stay at home if they

    feel unwell, even if the symptoms are mild. If a patient’s screen is positive, they should be

    followed up according to the severity. Patients with minor symptoms should be called every two

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    days for up to 14 days, or until symptoms improve. Patients experiencing more severe symptoms

    should be seen every 24 hours. The WHO does not recommend self-medication with any drug,

    including antibiotics, as a means of preventing or treating COVID-19. Anypyretics such as

    Acetaminophen (Tylenol), 500 to 1000 mg every 4-6 hours. Avoid the use of NSAIDs as they

    may have a negative outcome for the patient. Expectorants such as guaifenesin with

    dextromethorphan can be used to treat minor cough from bronchial/throat irritation. Consult with

    a physician if the pateint has acute respiratory decompensation. Consider sending pateint to the

    hospital if they are exhibiting RED FLAG symptoms such as; severe shortness of breath,

    hemoptosis, chest pain, cool clammy skin, or cyanosis (Cash et al., 2020).

     

    References

    Cash, J. C., Glass, C. A., & Mullen, J. (2020). Family practice guidelines. Springer Publishing

    Company. https://doi.org/10.1891/9780826153425.0018b

    Dunphy, L. M., E, J., Porter, B. O., & Thomas, D. J. (2019). Primary care: Art and science of

    advanced practice nursing – an interprofessional approach (5th ed.). F.A. Davis

    Company.

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Descriptive Epidemiology: Data Sources And Data Collection

Descriptive epidemiology deals with describing disease patterns using three major categories: person, place, or time (Friis & Sellers, 2021). Consider the following example

 

Over the last weekend, six people went to the Alcan City Hospital emergency room with similar symptoms. The laboratory results for the six patients were indicative of an infection due to Escherichia coli (E. coli). Patient interviews revealed they had all eaten a meal at Sam’s Sandwich Food Truck during the Alcan City Fair within 48 hours of going to the hospital. Further inquiries by the Alcan City public health officials identified that the source of the E. coli contamination was the lettuce that Sam’s had purchased from M&L Produce (a produce supplier located in Tempe, Arizona). Epidemiologists from the Arizona State Health Department determined that the lettuce that M&L supplied Sam’s was from a farm located in Xion, California (the key supplier for M&L Produce).

Aside from the six patients who sought treatment, epidemiologists tracked down and conducted interviews with 400 of the fair attendees to identify any potential cases who did not seek treatment and compare data with those who attended but did not become ill. Interview questions pertained to descriptive aspects of the outbreak (person, place, and time). Analysis of data collected on foods eaten allowed the epidemiologists to narrow it down and identify sandwiches served by Sam’s Sandwich Food Truck at the fair on Saturday as the source of infection. Alcan City public health officials were quick to visit the food truck to inquire into their food management and handling. The food truck owner was cooperative and helpful in providing licensing, permits, operations, and sales information.

Descriptive epidemiologic studies are often conducted as precursors to analytic studies. Epidemiologic concepts are used to gather data to better understand and evaluate health trends in populations. Data, such as characteristics of the persons affected, place where an incident occurred, and time of occurrence, are collected and analyzed to look for patterns in an effort to identify emerging health problems. It was in just this way that the HIV/AIDS epidemic was first identified.

In this Discussion, you will apply the epidemiologic concepts of time, place, and person to a specific population health problem. You will also consider methods for obtaining data to study an issue.

To prepare:

  • Examine Table 2.2 in your Curley textbook. Select a topic from the table to use for this Discussion.
  • Locate two scholarly articles that provide background information about the problem.
  • Identify a specific population affected by your selected health problem.
  • Research the patterns of the disease in your selected population using the epidemiologic characteristics of person, place, and time.
  • Consider methods for obtaining data to examine the association you selected.
  • Ask yourself: How would the methods I select influence the accuracy of case identification, definition, and diagnosis?
By Day 3 of Week 2

Post a cohesive response that addresses the following:

  • Describe your selected health problem using the epidemiologic model (person, place, and time), with a focus on the population affected by this problem.
  • Discuss sampling methods you could use to collect primary data to describe and study your health problem.
  • Identify two secondary data sources that you could use to collect the data needed to address this topic.
  • Explain how these methods and sources would influence the completeness of case identification as well as the case definition/diagnostic criteria used.

Strengths And Limitations Of Secondary Data Sources

In this information age, where data are readily accessible and there is both a great demand for accelerated research projects and strict limitations on research funding, using existing data makes sense. Data used in this way are called secondary data; they come in many forms and contain information on just about anything—depending on who collected the information in the first place, and why.

Photo Credit: Getty Images

As a health professional, you have access to a wide range of secondary data sources, including government agencies (such as, the Census Bureau or the Centers for Disease Control and Prevention) and private sources, including local health service providers. Global and international data are available from familiar sources, such as the World Health Organization and the United Nations. In addition, nearly every nation maintains statistics on social, economic, and environmental indicators, which contain a wealth of health information.

As a member of the Walden community, you have access to the Inter-University Consortium for Political and Social Research (ICPSR), the world’s largest archival database of secondary data. You also have access to the Social Change Impact Report (SCIR) data sets—a Walden-owned database. There are also a number of sources and tutorials available to you through Walden’s Office of Research and Doctoral Quality.

No matter the topic—be it vaccination rates, women’s access to mammography, or chronic lung disease—you can probably find an existing secondary data source related to the specific population health problem you are investigating. The next steps are to identify the variables in the data source that you would need to analyze to examine the association of interest and to assess the validity of the data source. For this Assignment, you delve into these issues in greater detail.

To prepare:

  • Consider a variety of population health problems and then select one of professional interest on which to focus for this Assignment.
  • Explore three data sources (data sets) presented in the Learning Resources that could aid you in describing the population and magnitude of the problem you selected. Consider the strengths and limitations of each data source.

The Assignment

In 3–4 pages (not including title page and references), analyze the data sources you selected by addressing the following:

  • Briefly identify the population health problem you selected.
  • Identify each data set you selected.
  • Identify the variables in each data set you would need to examine the association of interest.
  • Assess the validity of each data set. Has it been used for prior studies/publications?
  • Explain challenges you might face as a researcher in identifying a proper data set or securing permission to use it.

Physician Assisted Suicide- Three Circumstances That You Feel This Would Be Appropriate 1 1/2 Pages

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