N582-19A_20Nov Advanced Practice Nursing II Essay.

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N582-19A_20Nov Advanced Practice Nursing II Essay.

Introduction

The client is pale, dyspneic and appears listless. He also notes that he wants to die since he is tired of the fight. He has a relatively normal blood pressure of 120/74mmHg and weight, a high pulse rate of 124 beats per minute and an elevated respiratory rate of 36breaths per minute with diminished sounds. He has a cough with clear mucoid sputum, uses accessory muscle during respiration and has dullness over right lower and middle lung fields on percussion. A chest x-ray indicates a mass RML and RLL, a left side shift of the trachea and absence of cardiomegaly. Other assessment results include Arterial blood gases: pH 7.2, PaO2 55, pCO2 60, HCO3 26.N582-19A_20Nov Advanced Practice Nursing II Essay.

Additional subjective data

Subjective data is characterized by patient data collected from clients view point. It includes their concerns, perceptions and feelings and are often obtained via interviews. In this case, the patient gives his views on his illness age, race and gender. As such, the additional information that the client will share include his working status which is essential in determining the health risks associated with his job and the workplace. He will also clearly identify his stress levels which could help in assessing his mental and physiological status, his current and past medical history should also be added since he presents only a small portion of it which would otherwise lead to an inappropriate diagnosis. A family history is also an essential element of the subjective information which should be added. This will help identify the presence of hereditary diseases that run within the family. A medication history would also be important in determining any management routine for his condition and prevent drug interactions during the formulation of a treatment plan.

In addition, the patient needs to share data on the onset of his shortness of breath, the presence of chest pain, location of pain and degree of severity and the duration of shortness of breath. The characteristics of the condition and its aggravating factors. What does the patient also take to improve their breathing and relieve the symptoms as well as the treatments? I will also determine the presence of allergies and his past medical history. The patient notes that he has no living will and thus I will identify the reason for his decision. An assessment for recent trauma will also be essential in diagnosis.N582-19A_20Nov Advanced Practice Nursing II Essay.

Additional objective information

Objective data describes the patient’s information that is observable and measurable. It is collected through physical examination, observation, diagnostic and laboratory testing. These include level of consciousness, general appearance, weight, height, blood pressure, heart rate and body temperature. In this case, the important additional information that I will be assessing foris the client’s body temperatures which is essential in identifying a fever.N582-19A_20Nov Advanced Practice Nursing II Essay.

The patient will also be observed for general appearance to indicate whether he looks well or unwell, nourishment, grooming orientation and alertness status. His posture will also be assessed to determine his physical stability. This will be informed by the patient’s use of posture correctors and posture aids. I will also assess for respiratory features such as lung sounds, egophony and absent breath sounds. Moreover, a cardiovascular examination will be conducted to measure the vital signs, pulse auscultation and palpation, conduct a chest inspection and palpation, abdomen and extremity examination, lung assessment, cardiac auscultation, palpation and percussion and vein observation. This will assess the s1 s2 heart sounds and the presence of S3 or S4 sounds.N582-19A_20Nov Advanced Practice Nursing II Essay. A deviation from s1, s2 sounds will indicate pathology and likelihood of tachycardia. The investigation of edema pulses will indicate the presence of peripheral arterial disease while a neuro exam will determine the mental status, vital signs, cerebellum, reflexes, pupillary response, sensory and motor functions and cranial nerves. The physical assessment that might indicate hypoxia, confusion vs metastasis include medical history, listening of the lungs and heart, checking for bluish color in the fingernails, lips and skin. A Pulse oximeter will detect hypoxia is also an effective test in determining early hypoxia.N582-19A_20Nov Advanced Practice Nursing II Essay.

National guidelines

The treatment of patients is guided by multiple national guidelines. These include theNational Comprehensive Cancer Network (NCCN) which provides guidelines developed by cancer experts to optimize treatment (Bironzo & Di Maio, 2018). They provide the tests and treatment approaches for lung cancer as well as comprehensive detail of the sequential management interventions and decisions. They also provide information on cancer prevention and screening and supportive care for patients based on evidence. NCCN guidelines provide the most appropriate medications to use in different stages of cancer development. As such, this guideline will be critical in treating the lung cancer client and making necessary management and care decisions. The American Society of Clinical Oncology (ASCO) guidelines also offer updated therapy for treatment of lung cancer in stage IV (Bironzo & Di Maio, 2018). It has new approaches for identifying new practices for non-small cell lung cancer management including the first line of treatment and the expected endpoints.N582-19A_20Nov Advanced Practice Nursing II Essay.

A specific guideline for this case is pulse oxygen guideline. It states that healthy individuals should have 95% or more of oxygen saturation. In this case, if the patient has a lesser SpO2, then immediate assessment should follow to determine the cause.According to the World Health Organization (WHO) (2011), an oxygen saturation of 90% and below indicates hypoxia, a low saturation emergency.N582-19A_20Nov Advanced Practice Nursing II Essay.

Diagnostic Tests

The client will undergo a chest x-ray to check for the presence of tracheal shift which indicates the unequal intrathoracic pressure within the chest cavity. More detailed tests will then follow to confirm the diagnosis. These include computerized tomography (CT) scan which will facilitate the detection of smaller tumors in the lungs that would otherwise not be identified by a chest x-ray.it will also view other surrounding organs for abnormalities and give detailed information in that regard. A spirometry will also be essential in testing the lung functions through the measurement of the amount of air that can be held by the lungs and how fast they can be filled and emptied. Moreover, blood tests will be taken to check the full blood count to detect the functionality statusof the liver and kidney. High concentration of red blood cells and low levels of iron can suggest COPD. An increased level of white blood cells indicate an infection.N582-19A_20Nov Advanced Practice Nursing II Essay.

Treatment plan: medical, nursing, complementary therapies

A medical prescription of first line of treatment, short-acting bronchodilator inhalers, will be conducted to improve the client’s breathing by widening and relaxing the airways. The client will inhale two puffs of albuterol nebulizer, 90 to 180 mcg, for up to 4 times daily. Consequently, smoking abstinence is a critical approach in treating lung cancer patients with COPD. A lung resection would be effective even though it is undermined by the poor physical condition of the patient (Dai, Yang, Cox, & Jiang, 2017). Meditation helps calm the patients mind by focusing on their breathing. Massages and physical activities will also help him with relaxing. Provision of social support through family and group therapies will be essential in reducing stress.The treatment plan for the client will also involve recommendation of proper nutrition. This will help build up energy for activity and immunity to fight infections.N582-19A_20Nov Advanced Practice Nursing II Essay.

Evaluation

Evaluating the client will be guided by the normal range of subjective and objective data including temperatures, pressure, respiration rate, pulse and pulse OX. As such, frequent monitoring of these clinical features will help determine the progress and the effectiveness of the treatment plan formulated. The assessment of the client’s respiratory response to activities of daily life entails monitoring of use of accessory muscles for respiration, oxygen saturation together with respiratory rate and depth. The nutritional status will also be assessed to determine the energy status.N582-19A_20Nov Advanced Practice Nursing II Essay.

Health People 2020 objectives

Health people 2020 strongly attributes COPD to genetic factors. Therefore, prevention should involve screening of the family to reduce emergency department visits by the other members according to the RD-12 objective (HealthyPeaople2020, 2020). Health promotion is also related to the RD-13 objective characterized by increased diagnosis of adults with respiratory health conditions. I am promoting his health and preventing ER visits by recommending smoking cessation, visiting the nurse in the event of complications and maintaining his healthy diet.N582-19A_20Nov Advanced Practice Nursing II Essay.

Patient/Family Teaching

The patients circle of care involves the primary pulmonologist, thoracic oncologist, nutritionist, physical therapist and pharmacist among others. The primary care giver and family are also essential components of the patient’s treatment plan. As such, the wife and children to the client will undergo a family therapeutic session to understand the treatment of their member. Important teachings will include essential dietary changes to be made for the clients recover, type of physical exercises such as walking, jogging and low-impact aerobics, when and how to take albuterol medication and energy conservation techniques as well. A daily diet with 20 to 30 grams of fiber from vegetables, fruits, seeds, nuts, pasta and bread and protein portions from peas, eggs, fish, meat, cheese, milk beans and nuts at least two times a day will help maintain the strength of the respiratory muscles. They will also be taught how to improve the quality of life of the patient through provision of good social support and recovery environment at home. They will also be advised on referrals to pulmonary rehabilitationprogram.N582-19A_20Nov Advanced Practice Nursing II Essay.

Billing

The client will be billed for an outpatient visit using CPT codes 99205, 99215. It is characterized by high levels of medical decision-making, high complexity of the condition, extensive data analysis, complication risks, mortality and morbidity. More codes will be influenced by the tests conducted.N582-19A_20Nov Advanced Practice Nursing II Essay.

Follow-up plan

The client will be required to visit the specialist after every two days after today for assessment of his progress. Depending on the level of improvement, he will be seeing the pulmonologist once a week and eventually after two weeks. If he does not improve, he will be referred to a pulmonary rehabilitation program or a thoracic oncologist for more specialized treatment.

Introduction

The following paper presents the assessment of a 60-year-old white male presenting to the clinic with accelerated decline functions of the lungs. His past medical history reveals a metastatic lung cancer diagnosis a year ago. He complains of difficulties in sleeping on the bed and lack of energy to undertake any activity. He is a smoker with a record of 40 years pack-year history. The client is pale, dyspneic and appears listless. He also notes that he wants to die since he is tired of the fight. He has a relatively normal blood pressure of 120/74mmHg and weight, a high pulse rate of 124 beats per minute and an elevated respiratory rate of 36breaths per minute with diminished sounds. He has a cough with clear mucoid sputum, uses accessory muscle during respiration and has dullness over right lower and middle lung fields on percussion. A chest x-ray indicates a mass RML and RLL, a left side shift of the trachea and absence of cardiomegaly. Other assessment results include Arterial blood gases: pH 7.2, PaO2 55, pCO2 60, HCO3 26.N582-19A_20Nov Advanced Practice Nursing II Essay.

Additional subjective data

Subjective data is characterized by patient data collected from clients view point. It includes their concerns, perceptions and feelings and are often obtained via interviews. In this case, the patient gives his views on his illness age, race and gender. However, he does not provide his working status which is essential in determining the health risks associated with his job and the workplace. He also does not clearly identify his stress levels which could help in assessing his mental and physiological status, his current and past medical history should also be added since he presents only a small portion of it which would otherwise lead to an inappropriate diagnosis. A family history is also an essential element of the subjective information which should be added. This will help identify the presence of hereditary diseases that run within the family. A medication history would also be important in determining any management routine for his condition and prevent drug interactions during the formulation of a treatment plan.N582-19A_20Nov Advanced Practice Nursing II Essay.

SEE Rubric here is where you will complete a ROS and OLDCARTS when did this SOB start onset was it sudden?, location NA duration how long has he had sob like this characteristics how bad is it most severe he ever had, aggrav what makes it worse, relieving what helps did he try anything home 02 albuterol tx associated fever? Allergies? Living will? PMH htn?

ROS should include chest pain – or +, recent trauma?

Additional objective information

Objective data describes the patient’s information that is observable and measurable. It is collected through physical examination, observation, diagnostic and laboratory testing. These include level of consciousness, general appearance, weight, height, blood pressure, heart rate and body temperature. In this case, the important additional information left out is the client’s body temperatures which is essential in identifying a fever. PULSE OX right now?N582-19A_20Nov Advanced Practice Nursing II Essay.

You must include a physical exam here assess genl appearance: posture is he tripoding? Resp lung sounds, egophony, absent breath sounds write why this is important in this scenario

CV in a patient with tachycardia need to assess s1 s2 is there a S3 or S4 what will they indicate, edema pulses, Neuro exam describe physical assessment that might indicate hypoxia ie confusion vs metastasis

National guidelines

The treatment of patients is guided by multiple national guidelines. These include theNational Comprehensive Cancer Network (NCCN) which provides guidelines developed by cancer experts to optimize treatment (Bironzo& Di Maio, 2018). They provide the tests and treatment approaches for lung cancer as well as comprehensive detail of the sequential management interventions and decisions. They also provide information on cancer prevention and screening and supportive care for patients based on evidence. NCCN guidelines provide the most appropriate medications to use in different stages of cancer development. As such, this guideline will be critical in treating the lung cancer client and making necessary management and care decisions. The American Society of Clinical Oncology (ASCO) guidelines also offer updated therapy for treatment of lung cancer in stage IV (Bironzo& Di Maio, 2018). It has new approaches for identifying new practices for non-small cell lung cancer management including the first line of treatment and the expected endpoints.N582-19A_20Nov Advanced Practice Nursing II Essay.

Pick a treatment guideline tell me what it says for this patient best guess and describe the research utilized to support the intervention. For instance, the guideline states if the pulse ox is less than 88 to apply oxygen aim for a saturation of 90 % (I made this up) This intervention is supported by 5 RCT the highest level of evidence Type II

Diagnostic Tests

The client will undergo a chest x-ray to check for the presence of tumors. More detailed tests will then follow to confirm the diagnosis. These include computerized tomography (CT) scan which will facilitate the detection of smaller tumors in the lungs that would otherwise not be identified by a chest x-ray.it will also view other surrounding organs for abnormalities and give detailed information in that regard. A spirometry will also be essential in testing the lung functions through the measurement of the amount of air that can be held by the lungs and how fast they can be filled and emptied. Moreover, blood tests will be taken to check the full blood count to detect the functionality statusof the liver and kidney. A sputum cytology will also be done. Lastly, a biopsy will be employed to confirm the diagnosis and rule out the differential diagnosis.This will involve the collection of a lung tissue sample followed by its examination under a microscope.N582-19A_20Nov Advanced Practice Nursing II Essay.

Consultation

The client will be referred to a pulmonologist for specialized lung treatment. This physican is specialized in the treatment of lung diseases and therefore, he will assist with diagnosis and formulation of an appropriate treatment plan of the patient. A thoracic oncologist will also be consulted for expert advice and treatment.

Medical and nursing diagnoses

Considering the client’santeroposterior (AP) diameter of 1:1. the patient is able to fill the lungs with air but the emptying process is altered and hence cannot breathe out fully giving the client a barrel chest. This is a common symptom in individuals with Chronic obstructive pulmonary diseaseCOPD, emphysema, and Cystic fibrosis (CF) respiratory conditions he is likely to be suffering. His most probable diagnosis is COPD evidenced by the presence of chronic cough with clear sputum, lack of energy, shortness of breath, the use of accessory respiratory muscles, increased respiration time, paleness, dyspnea, diminished breath sounds and decreased arterial gases. The nursing diagnosis for the client is Activity Intolerance related to imbalances between the supply and demand of oxygen caused by inefficiency in breathing. It is evidenced by excessively increased RR, shortness of breath and exertional dyspnea.N582-19A_20Nov Advanced Practice Nursing II Essay.

Treatment plan: medical, nursing, complementary therapies

The treatment plan for the client will involve recommendation of proper nutrition. This will help build up energy for activity and immunity to fight infections. A medical prescription of first line of treatment, short-acting bronchodilator inhalers, will be conducted to improve the client’s breathing by widening and relaxing the airways. The client will inhale two puffs for up to 4 times daily. Consequently, smoking abstinence is a critical approach in treating lung cancer patients with COPD. A lung resection would be effective even though it is undermined by the poor physical condition of the patient (Dai, Yang, Cox, & Jiang, 2017). Meditation helps calm the patients mind by focusing on their breathing. Massages and physical activities will also help him with relaxing. Provision of social support through family and group therapies will be essential in reducing stress.

Evaluation

Evaluating the client will be guided by the normal range of subjective and objective data. As such, frequent monitoring of these clinical features will help determine the progress and the effectiveness of the treatment plan formulated. The assessment of the client’s respiratory response to activities of daily life entails monitoring of use of accessory muscles for respiration, oxygen saturation together with respiratory rate and depth. The nutritional status will also be assessed to determine the energy status.N582-19A_20Nov Advanced Practice Nursing II Essay.

Health People 2020 objectives

Health people 2020 strongly attributes COPD to genetic factors. Therefore, prevention should involve screening of the family to reduce emergency department visits by the other members according to the RD-12 objective (HealthyPeaople2020, 2020). Health promotion is also related to the RD-13 objective characterized by increased diagnosis of adults with respiratory health conditions. SO HOW ARE YOU PROMOTING HIS HEALTH AND PREVENTING ER VISITS? Smoking cessation, visiting nurse, diet etc….N582-19A_20Nov Advanced Practice Nursing II Essay.

Patient/Family Teaching

The patients circle of care involves the primary pulmonologist, thoracic oncologist, nutritionist, physical therapist and pharmacist among others. The primary care giver and family are also essential components of the patient’s treatment plan. As such, the wife and children to the client will undergo a family therapeutic session to understand the treatment of their member. Important teachings will include essential dietary changes to be made for the clients recover, type of physical exercises, when and how to take medication and energy conservation techniques as well. They will also be taught how to improve the quality of life of the patient through provision of good social support and recovery environment at home. They will also be advised on referrals to pulmonary rehabilitationprogram.N582-19A_20Nov Advanced Practice Nursing II Essay.

The client will be billed for COPD under ICD-10-CM COPD Codes-J44. Since the patient is tobacco dependent, his billing code will also include an additional code F17.200. More codes will be influenced by the tests conducted.

99201 99202 99203 99204 99205 ….99211 99212 99213 99214 99215 look up describe what applies to this patient

Follow-up plan

The client will be required to visit the specialist after every two days for assessment of his progress. Depending on the level of improvement, he will be seeing the pulmonologist once a week and eventually after two weeks. If he does not improve, he will be referred to a pulmonary rehabilitation program or a thoracic oncologist for more specialized treatment.N582-19A_20Nov Advanced Practice Nursing II Essay.

Introduction

Additional subjective data

Subjective data is characterized by patient data collected from clients view point. It includes their concerns, perceptions and feelings and are often obtained via interviews. In this case, the patient gives his views on his illness age, race and gender. However, he does not provide his working status which is essential in determining the health risks associated with his job and the workplace. He also does not clearly identify his stress levels which could help in assessing his mental and physiological status, his current and past medical history should also be added since he presents only a small portion of it which would otherwise lead to an inappropriate diagnosis. A family history is also an essential element of the subjective information which should be added. This will help identify the presence of hereditary diseases that run within the family. A medication history would also be important in determining any management routine for his condition and prevent drug interactions during the formulation of a treatment plan.N582-19A_20Nov Advanced Practice Nursing II Essay.

Additional objective information

Objective data describes the patient’s information that is observable and measurable. It is collected through physical examination, observation, diagnostic and laboratory testing. These include level of consciousness, general appearance, weight, height, blood pressure, heart rate and body temperature. In this case, the important additional information left out is the client’s body temperatures which is essential in identifying a fever.N582-19A_20Nov Advanced Practice Nursing II Essay.

National guidelines

The treatment of patients is guided by multiple national guidelines. These include theNational Comprehensive Cancer Network (NCCN) which provides guidelines developed by cancer experts to optimize treatment (Bironzo& Di Maio, 2018). They provide the tests and treatment approaches for lung cancer as well as comprehensive detail of the sequential management interventions and decisions. They also provide information on cancer prevention and screening and supportive care for patients based on evidence. NCCN guidelines provide the most appropriate medications to use in different stages of cancer development. As such, this guideline will be critical in treating the lung cancer client and making necessary management and care decisions. The American Society of Clinical Oncology (ASCO) guidelines also offer updated therapy for treatment of lung cancer in stage IV(Bironzo& Di Maio, 2018). It has new approaches for identifying new practices for non-small cell lung cancer management including the first line of treatment and the expected endpoints.N582-19A_20Nov Advanced Practice Nursing II Essay.

Diagnostic Tests

The client will undergo a chest x-ray to check for the presence of tumors. More detailed tests will then follow to confirm the diagnosis. These include computerized tomography (CT) scan which will facilitate the detection of smaller tumors in the lungs that would otherwise not be identified by a chest x-ray.it will also view other surrounding organs for abnormalities and give detailed information in that regard. A spirometry will also be essential in testing the lung functions through the measurement of the amount of air that can be held by the lungs and how fast they can be filled and emptied. Moreover, blood tests will be taken to check the full blood countto detect the functionality statusof the liver and kidney. A sputum cytology will also be done. Lastly, a biopsy will be employed to confirm the diagnosis and rule out the differential diagnosis.This will involve the collection of a lung tissue sample followed by its examination under a microscope.

Consultation

The client will be referred to a pulmonologist for specialized lung treatment. This physicism is specialized in the treatment of lung diseases and therefore, he will assist with diagnosis and formulation of an appropriate treatment plan of the patient. A thoracic oncologist will also be consulted for expert advice and treatment.N582-19A_20Nov Advanced Practice Nursing II Essay.

Medical and nursing diagnoses

Treatment plan: medical, nursing, complementary therapies

The treatment plan for the client will involve recommendation of proper nutrition. This will help build up energy for activity and immunity to fight infections. A medical prescription of first line of treatment, short-acting bronchodilator inhalers, will be conducted to improve the client’s breathing by widening and relaxing the airways. The client will inhale two puffs for up to 4 times daily. Consequently, smoking abstinence is a critical approach in treating lung cancer patients with COPD. A lung resection would be effective even though it is undermined by the poor physical condition of the patient(Dai, Yang, Cox, & Jiang, 2017). Meditation helps calm the patients mind by focusing on their breathing. Massages and physical activities will also help him with relaxing. Provision of social support through family and group therapies will be essential in reducing stress.N582-19A_20Nov Advanced Practice Nursing II Essay.

Evaluation

Health People 2020 objectives

Patient/Family Teaching

Billing

Follow-up plan

N582-19A_20Nov Advanced Practice Nursing II Essay.

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