Healthy People 2020 Objectives Essay Assignment
Additional subjective data the patient will share.
Subjective data allows the nurse practitioner to get more information on the patients complains. It allows the nurse to ask probing questions in order to distinguish symptoms of certain diseases from others. For this patient the additional subjective data to be obtained includes; the onset of the chest pain, the site or location, the duration of the pain, its character , areas of chest pain radiation and its timing(Johnson & Ghassemzadeh, 2022). Inquire if the patient has other accompanying symptoms such as a cough, fever, nausea, vomiting or edema. This will help to eliminate some systems. Evaluate the patient for any prior cardiac illnesses and family history of cardiac diseases, pulmonary embolisms, DVT, cancers, recent surgeries, recent gastrointestinal procedures and any history of drug abuse. I will inquire if the patient smokes, takes alcohol or has any other lifestyle disease such as diabetes mellitus. Healthy People 2020 Objectives Essay Assignment
Since the patient also exhibits gastrointestinal symptoms.
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I will probe him to find out if he has any additional gastrointestinal symptoms such as abdominal pain, vomiting, nausea, diarrhea or changes in bowel movements. I will also try to establish the onset of the GI symptoms i.e. whether they developed suddenly or gradually, the relieving factors of the symptoms and the exacerbating factors. I will ask the patient if he usually gets a feeling of incomplete evacuation, if he strains with defecation. I will also get a thorough nutritional history which will be of help while counselling the patient and giving the plan of management. I will ask on more information about his surgery(cholecystectomy) and find out when it was done, the indications of the surgery and if his symptoms reduced after that surgery. I will inquire if he is on any medication for the anxiety and if it’s affecting his day to day life. To find out if his anxiety is being controlled properly, I will ask him the symptoms that he is currently experiencing and how he feels about his condition and having to take care of his wife who has MS. Healthy People 2020 Objectives Essay Assignment
Additional objective data I will be assessing for?
Objective data and assessment usually provides practical information on patients state thus enabling early detection of diseases and proper planning of patient care to achieve optimal health. When conducting a physical examination on the patient a nurse practitioner should make sure to note the following; vital signs which include a blood pressure in both arm’s, a pulse rate, respiratory rate and oxygen saturation. These vital signs usually give a rough idea on the stability of a patient. Get a thorough general examination of the patient noting if he appears to be in any distress and diaphoresis. Check for any signs of pallor, jaundice, cyanosis, finger clubbing, lymphadenopathy, edema and dehydration. I will examine the skin for the presence of any lesions which might be indicative of a diseases process and xanthomas which are skin lesions indicative of inherited lipid metabolism disorders. I will examine the eye for corneal ancus which presents as a ring of fatty deposits around the colored part of the eye. When examining the cardiovascular system I will check for any neck vein distention, a hyperactive precordium and auscultate for any carotid and femoral bruits to rule out stenosis(Hill & Bordoni, 2022). I will also auscultate the heart for any additional heart sounds and palpate for all the peripheral pulses an examination that can be helpful in making a diagnosis of hyperlipidemia.
I will examine the abdomen for any signs of distension, visible masses or distended vessels. I will palpate for any superficial or deep masses, organomegally and auscultate for bowel sounds. As highlighted by(Mealie et al., 2022) all abdominal examinations end with a digital rectal examination where I will carefully explain the procedure to the patient, get his consent and check for any hemorrhoids, fissures or masses. I will palpate the prostate gland and the anal tone. After I will be done I will check for any blood on the examining finger. I should also conduct a thorough central nervous system to rule out any possibilities of a stroke which is one of the complications of hyperlipidemia. Healthy People 2020 Objectives Essay Assignment
National Guidelines that are Appropriate to Consider. What Level of Evidence Supports these Guidelines.
The 2018 AHA/ACC guidelines should be considered in the management of this patient. This guideline is used in the control of blood cholesterol levels and recommends that the LDL levels in adults should be maintained below 100mg/dl(Su et al., 2021). Literature evidence globally shows that this level of LDL reduces the likelihood of one having heart diseases and strokes. It recommends that in the management of patients with high cholesterol, lifestyle modifications such as the intake of proper nutrition i.e. taking foods with less saturated fats and regular physical activities for at least a half an hour are a major step in treatment
What Tests Will I order?
Some of the tests that I will order for in this patient will include; a complete blood count, troponin levels and a basic metabolic panel. Radiological and imaging modalities to be considered will include an electrocardiogram (EEG), a chest radiograph to check for any signs of cardiomegaly and to rule out other causes of chest pain such as infections and trauma(Gillen & Goyal, 2022), a computed tomography pulmonary angiography and an ultrasound to rule out accumulation of fluids around the heart. A thyroid function test and glucose level tests will also be of great help to this patient. An abdominal ultrasound will also be of importance in trying to evaluate the gastrointestinal system. According to (Wilkinson et al., 2019) Healthy People 2020 Objectives Essay Assignment
A 48 year old male patient who is an electrician whom you haven’t seen in several years presents with chronic fatigue and mild chest pain frequently relieved by taking a break from working overhead. He’s married to a 47-year-old woman with MS and has two married children and one grandchild living nearby. He also complains of frequent eructation, flatulence, and indigestion after eating. He was told when he was 30 lbs. lighter that he could control his hyperlipidemia by diet.
CC: “I’m always tired, and I have this annoying chest pain when I climb a ladder.”
Past medical history: Anxiety, cholecystectomy, vasectomy
Vital signs: Blood pressure: 146/88; height, 6΄΄; weight, 242 lbs.
Lab results:
- TC 230
- LDL 180
- HDL 32
- Glucose: 178
- Hgb 12
- Hct 36
- MCV 78 Healthy People 2020 Objectives Essay Assignment
Questions:
- What additional subjective data do you think the patient will share?
- What additional objective data will you be assessing for?
- What National Guidelines are appropriate to consider? What level of evidence supports these guidelines?
- What tests will you order?
- Will you be looking for a consult?
- What are the medical and nursing diagnoses?
- Are there any legal/ethical considerations?
- What is your plan of care?
- medical
- nursing
- complementary therapies
- Are there any Healthy People 2020 objectives that you should consider?
- Using the Circle of Caring, what or who else should be involved to truly hear the patient’s voice, getting him and the family involved in the care to reach optimal health?
- What additional patient teaching is needed?
- What billing codes would you recommend? Healthy People 2020 Objectives Essay Assignment
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Grading criteria:
Assessment: Develops and demonstrates a clear & precise assessment plan supported with professional literature and includes objective and subjective data.
Guidelines/evidence: Thoroughly describes all relevant practice guidelines. Clearly defines and delineates the levels of evidence that support the guidelines.
Diagnostics: Clearly describes all appropriate diagnostics (including sensitivity and specificity). Clearly differentiates the difference between a positive and a negative finding and APN considerations
Treatment plan: Develops and provides a clearly written set of orders inclusive of all essential elements in a treatment plan.
Evaluation: Develops and demonstrates a clear & precise evaluation plan for the next office visit inclusive of data that will indicate no change necessary in plan or changes necessary in the plan.
Healthy people 2020/health promotion: Develops and demonstrates a clear & precise description of the Healthy People 2020 goals and specifically relates one goal to current case.
Patient/family teaching: Develops and demonstrates a clear & precise educational plan for the patient and family.
Billing: Discusses all levels of billing that apply to the case and most likely appropriate level for first visit and one follow up visit.
Follow up: Develops a follow up plan that specifically identifies the data that will need to be reviewed during the follow up visit. (This may function as communication to the team…i.e. check BP, cholesterol, and EKG next visit).
APA format Healthy People 2020 Objectives Essay Assignment