N512-19A Module 3 Assignment 2 Respiratory Disease Across the Life Span

N512-19A Module 3 Assignment 2 Respiratory Disease Across the Life Span

N512-19A Module 3 Assignment 2 Respiratory Disease Across the Life Span

Discussion 3

Darla Thomas, a 25 y.o. African-American previously well woman, presents to her primary care Nurse Practitioner’s office with complaints of episodic shortness of breath and chest tightness. She has had the symptoms on and off for about 2 years but states that they have worsened lately, occurring two or three times a month. She notes that the symptoms are worse during the spring months. She has no exercise-induced or nocturnal symptoms.

The family history is notable for a father with asthma. She is single and works as a secretary in a high-tech firm. She lives with a roommate, who moved in approximately 2 months ago. The roommate has a cat. The patient smokes occasionally when out with friends, drinks socially, and has no history of drug use. Examination is notable for mild end-expiratory wheezing. Pulmonary function tests are ordered to confirm the diagnosis. N512-19A Module 3 Assignment 2 Respiratory Disease Across the Life Span

In this discussion:

  1. Discuss what you think this patient’s likely diagnosis is. Why do you support this “likely” diagnosis?
  2. Identify the pathogenetic mechanisms that are responsible for this patient’s symptoms of wheezing, shortness of breath, and chest tightness.
  3. What might you expect the results of her pulmonary function tests to be? Why?
  4. Provide and discuss a plan of care for her. What would be your priority patient education outcomes? How would you achieve these outcomes?

Include citations from the text or the external literature in your discussions.

Remember to respond to at least two of your peers. Please refer to the Course Syllabus for Participation Guidelines & Grading Criteria.

N512-19A Module 3 Assignment 2 Respiratory Disease Across the Life Span Example Discussion Approach

Ms. Thomas’s likely diagnosis is asthma. According to Hammer and McPhee (2019), asthma is an airway disease characterized by intermittent symptoms including shortness of breath, chest tightness, and wheezing; These symptoms can be triggered from exposure to an allergen that causes airway inflammation and reactivity in sensitive individuals (Hammer, 2019).

Ms. Thomas states her symptoms are worse during spring months, allergens in the air such as pollen could be a contributing factor. Exposure to cat dander and occasional smoking could also be a contributing factor (Hammer, 2019). Asthma is also known to be an inheritable disease (Rebar, 2019). Ms. Thomas’s father has asthma, which could be another contributing factor for her diagnosis.

Ms. Thomas’s wheezing is caused by airway caliber reduction and prolonged turbulent airflow from hyper-secretion and retention of mucus along with smooth muscle contraction (Hammer, 2019). According to Hammer and McPhee (2019), shortness of breath and chest tightness is caused from an increased muscle effort to overcome increased airway resistance detected by spindle stretch receptors in intercostal muscles and a chest wall. N512-19A Module 3 Assignment 2 Respiratory Disease Across the Life Span

Sensory nerves in a chest wall also detect an increased work of breathing as lung compliance falls resulting in shortness of breath and chest tightness. As an airway obstruction increases, hypoxemia and CO2 retention occur stimulating respiratory drive through peripheral and central chemoreceptors; this causes respiratory muscle fatigue in turn resulting in increased shortness of breath (Hammer, N512-19A Module 3 Assignment 2 Respiratory Disease Across the Life Span 2019).

Ms. Thomas’s symptoms appear to be mild, therefore I would expect her pulmonary function test to be normal between attacks. During an active asthma attack I would expect to see according to Hammer and McPhee (2019), forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), and the ratio of FEV1 to FVC (FEV1%), along with peak expiratory flow rate will be diminished. A reduced FVC occurs from air trapping due to premature airway closure before full expiration – a consequence of incomplete emptying of lungs at end expiration. There may also be an increased Pulmonary diffusing capacity for carbon monoxide (DLCO) from increased lung and capillary blood volume (Hammer, 2019).

The best treatment for asthma is preventing and avoiding precipitating factors, such as environmental allergens or irritants (Rebar, 2019). My priority education outcomes for Ms. Thomas would be her understanding of what and how to avoid precipitating factors. Some precipitating factors such as pollen, an environmental allergen, may not be avoidable. Another unavoidable factor is genetics. N512-19A Module 3 Assignment 2 Respiratory Disease Across the Life Span

However, Ms. Thomas has a roommate with a cat which could be a factor. I would encourage Ms. Thomas to speak with her roommate about finding a different home for the cat. Ms. Thomas is not an everyday smoker however; I would encourage her to not smoke at all as smoking is another precipitating factor.

I may also consider prescribing Ms. Thomas a short-acting beta-agonist such as Albuterol in which she can take during an asthma attack to relieve symptoms of wheezing and shortness of breath (U.S National Library of Medicine, 2020). As Ms. Thomas’s nurse practitioner, I may refer her to a pulmonologist if her frequency of symptoms become worse or intensify. N512-19A Module 3 Assignment 2 Respiratory Disease Across the Life Span

Hammer, G., & McPhee, S. (2019). Pathophysiology of disease: An introduction to clinical medicine (8th ed). McGraw-Hill

Rebar, C., Heimgartner, N., & Gersch, C. (2019). Pathophysiology made incredibly easy (6th ed). Wolters Kluwer

U.S National Library of Medicine. (13 January 2020). Asthma quick relief drugs. Medline Plus. https://medlineplus.gov/ency/patientinstructions/000008.htm

566 words

In reply to Amanda Rusch

Re: AR-Discussion 3 – N512-19A Module 3 Assignment 2 Respiratory Disease Across the Life Span

by LR- 

Hi Amanda,

I really enjoyed reading your post. I had considered prescribing the short acting beta agonist, but then I read the Global Initiative for Asthma guidelines [GINA] (2019), which recommends no longer treating with a SABA alone, but to treat with a low dose ICS and a long acting beta agonist (LABA) such as budesonide-formoterol (HFA 160 mcg-4.5 mcg/inhalation or dry powder inhaler [DPI] 200 mcg-6 mcg/inhalation) 1 inhalation, as needed for symptom relief. N512-19A Module 3 Assignment 2 Respiratory Disease Across the Life Span

Formoterol has a rapid onset of action similar to albuterol (three to five minutes), in addition to its long-acting effects (12 hours of bronchodilation), and while conventionally used as maintenance therapy for asthma in conjunction with an inhaled glucocorticoid, its rapid onset of action makes it practical for quick relief (GINA, 2019). I would also prescribe prednisone 40mg x1 in case of emergency.

That was a good call on the pulmonology referral. I might also refer her to an allergist. I would probably run some labs as well like a CBC to check for anemia, eosinophilia, or infection, and a ferritin to check iron storage. Anemia may contribute to shortness of breath. According to Fanta (2019), it’s important that the patient keep an asthma diary.

In a diary, she can keep track of when she’s having symptoms (such as coughing, wheezing or shortness of breath), emergency red flag symptoms, and which medications she has taken and when; as well as her peak expiratory flow (PEF).

Thank you for posting! It was really informative. N512-19A Module 3 Assignment 2 Respiratory Disease Across the Life Span
Lorri

Fanta, C. (2020). Acute exacerbations of asthma in adults: Emergency department and inpatient management. In B. S. Bochner (Ed.) UpToDate. https://www.uptodate.com/contents/acute-exacerbations-of-asthma-in-adults-emergency-department-and-inpatient-management

Global Initiative for Asthma. (2019). Pocket Guide for Asthma Management and Prevention. Retrieved 31 July 2020, from https://ginasthma.org/wp-content/uploads/2019/04/GINA-2019-main-Pocket-Guide-wms.pdf

303 words

N512-19A Module 3 Assignment 2 Respiratory Disease Across the Life Span Assignment 2

Emil Mowry is a 62 y.o., single, Latino rancher who did not complete high school. He remembers rolling his first cigarette when he was 11 years old. He does not remember ever wanting to quit smoking. For the last five years he has had increasing difficulty breathing. Emil was diagnosed by his Family Nurse Practitioner as having emphysema.

He was told that he has Chronic Obstructive Pulmonary Disease (COPD). He did not ask his Nurse Practitioner what this means, but he plans to look it up on the Internet. N512-19A Module 3 Assignment 2 Respiratory Disease Across the Life Span

The purpose of this assignment is to create an evidence-based patient-centered educational brochure on the pathophysiology and clinical manifestations of, and common treatment options for, COPD that could be used by Nurse Practitioners or Nurse Educators with their patients newly-diagnosed with this disorder. The proposed brochure should include graphics and citations from your textbook and the external, scholarly-practice literature. N512-19A Module 3 Assignment 2 Respiratory Disease Across the Life Span

You may present the content in the electronic format of your choice: single sheet, folded, tri-fold. In other words, you may use MS Word Document, MS Publisher, or any other software to develop your educational brochure. Since your audience are patients, please keep in mind the literacy and numeracy level (some literature suggests no more than 8th grade level literacy and numeracy). Also, please refer to the Assignment Rubric below for grading criteria and to help you complete this assignment.

In regards to APA format, please use the following as a guide:

  • Include transitions in your brochure, if needed (i.e. headings or subheadings)
  • Use in-text references throughout the brochure
  • Spelling, grammar, and organization are appropriate
  • Include a reference list (this could be at the end of the brochure or you may submit a separate document listing your references)
  • Attempt to use primary sources only. That said, you may cite reliable electronic sources (i.e. ANA)

Assignment 2 Rubric N512-19A Module 3 Assignment 2 Respiratory Disease Across the Life Span

Assignment 2 Rubric

Criteria

Earned Points

Content: Application & Analysis

Responds correctly and/or appropriately to all questions and criteria. Content is excellent.

Demonstrates a high level of critical thinking, shows significant insight or creative thought about the topic, and does not merely recite the text/resources. Uses concepts and terminology correctly. Detail rich and specific. N512-19A Module 3 Assignment 2 Respiratory Disease Across the Life Span

Responds correctly and/or appropriately to all questions and criteria. Content is good. N512-19A Module 3 Assignment 2 Respiratory Disease Across the Life Span

Demonstrates some critical thinking throughout the paper and may also show some insight or creative thinking about the topic. Mostly uses concepts and terminology correctly (1-2 issues). Minor detail inconsistencies (1-2).

Responds correctly and/or appropriately to at least one question OR if only one question, partially responds to question. Does not address all criteria. Content is minimal.

Demonstrates at least one critical thinking skill in the paper. Attempts to use concepts and terminology correctly. Several detail inconsistencies (3-5).

Paper is unclear and does not address the questions and/or criteria. Content does not meet requirements. Many inconsistencies and conflicting information (6+). N512-19A Module 3 Assignment 2 Respiratory Disease Across the Life Span

/60

Criteria

20 Points

16 Points

14 Points

12 Points

Earned Points

Quality: Supporting Research & Sources

All work is accurately cited (where applicable) and appropriately supports content with research, text, multimedia, and/or other resources. References are relevant and enhance the topic. N512-19A Module 3 Assignment 2 Respiratory Disease Across the Life Span

Most of the work is accurately cited (where applicable) and adequately supports content with research, text, and/or resources. One issue with reference or use of one inappropriate reference. References are relevant to the topic.

2-3 issues with references, including the use of inappropriate references to support content. May fail to provide references to support content. 1-2 references are not relevant to the topic and/or distract from the topic at hand.

4 or more issues with references, including the use of inappropriate references to support content OR failure to include references (where applicable). No supporting references are used OR they are used but 3+ references are not relevant to the topic.

/20

Criteria

10 Points

8 Points

7 Points

6 Points

Earned Points

Organization

Paper is well-organized. Ideas are clear and arranged logically. Transitions are smooth, no flaws in logic.

Paper is organized. Ideas are usually clear and arranged in an acceptable sequence (1-2 issues). Transitions are usually smooth (1-2 issues), good support.

Paper lacks organization. There are many problems with the approach (3-5 issues with organization). Some difficulty understanding ideas. Issues with support and transitions (3-5). N512-19A Module 3 Assignment 2 Respiratory Disease Across the Life Span

Paper is poorly organized and difficult to understand. Many issues with support and transitions (6+). Ideas are arranged illogically and do not make sense.

/10

Accuracy & Basic Writing Mechanics

Error-free, including APA formatting, reflecting clear understanding of various forms of expression and careful editing.

Very few (less than 3) errors in spelling, grammar, syntax, and/or punctuation. Very few (less than 3) issues with APA formatting. Occasional poor choice of word. N512-19A Module 3 Assignment 2 Respiratory Disease Across the Life Span

4-5 errors in spelling, grammar, syntax, and/or punctuation. 4-5 issues with APA Formatting. Writing may be difficult to understand at times.

More than 5 errors in spelling, grammar, syntax, and/or punctuation. Many (6+ issues with APA formatting. Writing is difficult to understand in many instances. N512-19A Module 3 Assignment 2 Respiratory Disease Across the Life Span

/10

Criteria

60 Points

55 Points

50  Points

40 Points

Earned Points

Content: Application & Analysis

Responds correctly and/or appropriately to all questions and criteria. Content is excellent.

Demonstrates a high level of critical thinking, shows significant insight or creative thought about the topic, and does not merely recite the text/resources. Uses concepts and terminology correctly.  Detail rich and specific. N512-19A Module 3 Assignment 2 Respiratory Disease Across the Life Span

Responds correctly and/or appropriately to all questions and criteria. Content is good.

Demonstrates some critical thinking throughout the paper and may also show some insight or creative thinking about the topic. Mostly uses concepts and terminology correctly (1-2 issues). Minor detail inconsistencies (1-2).

Responds correctly and/or appropriately to at least one question OR if only one question, partially responds to question. Does not address all criteria. Content is minimal.

Demonstrates at least one critical thinking skill in the paper.  Attempts to use concepts and terminology correctly.  Several detail inconsistencies (3-5).

Paper is unclear and does not address the questions and/or criteria. Content does not meet requirements. Many inconsistencies and conflicting information (6+).

 

 

 

 

 

 

/60 N512-19A Module 3 Assignment 2 Respiratory Disease Across the Life Span

Criteria

20 Points

16 Points

14 Points

12 Points

Earned Points

Quality: Supporting Research & Sources

All work is accurately cited (where applicable) and appropriately supports content with research, text, multimedia, and/or other resources.  References are relevant and enhance the topic. Most of the work is accurately cited (where applicable) and adequately supports content with research, text, and/or resources.  One issue with reference or use of one inappropriate reference.  References are relevant to the topic. 2-3 issues with references, including the use of inappropriate references to support content. May fail to provide references to support content.  1-2 references are not relevant to the topic and/or distract from the topic at hand. 4 or more issues with references, including the use of inappropriate references to support content OR failure to include references (where applicable).  No supporting references are used OR they are used but 3+ references are not relevant to the topic. /20 N512-19A Module 3 Assignment 2 Respiratory Disease Across the Life Span

Criteria

10 Points

8 Points

7 Points

6 Points

Earned Points

Organization

 

Paper is well-organized. Ideas are clear and arranged logically. Transitions are smooth, no flaws in logic. Paper is organized. Ideas are usually clear and arranged in an acceptable sequence (1-2 issues). Transitions are usually smooth (1-2 issues), good support. Paper lacks organization. There are many problems with the approach (3-5 issues with organization). Some difficulty understanding ideas.  Issues with support and transitions (3-5). Paper is poorly organized and difficult to understand. Many issues with support and transitions (6+). Ideas are arranged illogically and do not make sense. /10 N512-19A Module 3 Assignment 2 Respiratory Disease Across the Life Span

Accuracy & Basic Writing Mechanics

Error-free, including APA formatting, reflecting clear understanding of various forms of expression and careful editing. Very few (less than 3) errors in spelling, grammar, syntax, and/or punctuation. Very few (less than 3) issues with APA formatting. Occasional poor choice of word. 4-5 errors in spelling, grammar, syntax, and/or punctuation. 4-5 issues with APA Formatting. Writing may be difficult to understand at times. More than 5 errors in spelling, grammar, syntax, and/or punctuation.  Many (6+ issues with APA formatting.  Writing is difficult to understand in many instances. /10 N512-19A Module 3 Assignment 2 Respiratory Disease Across the Life Span

Submission status N512-19A Module 3 Assignment 2 Respiratory Disease Across the Life Span

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