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Group Activity 3 N3200 Group 4, Week 2: Focused Review of System…
Group Activity 3 N3200
Group 4
Week 2: Focused Review of System Questions (patient centered & relevant) Should not repeat Qs asked in HPI or History
How often do you smoke cigars? How much on average, do you drink? After the accident, how long did it take for you to get your breath back and stop coughing? Before the accident, did you experience any coughing like you are now? Have you experienced extreme sweating in the past like you are now? Have you had a fever, chills, and/or shortness of breath? - Theo
Does your shortness of breath occur at rest or with activity? Does the shortness of breath impact your daily living, such as being able to carry groceries from a car, or being able to clean floors or do laundry.
NOTE: Normal sputum is thin, clear to white in color, and tasteless and odorless. Yellow-green colored sputum may indicate a bacterial infection and rust-colored sputum is characteristic of pneumonia.
NOTE: Aspiration pneumonia is an infection of the lungs caused by inhaling saliva, food, liquid, vomit and even small foreign objects. Pt could have experienced intake of foreign materials or bacteria from falling in lake.
When you stand up from sitting and then walk across the room, do you have shortness of breath? chest pain?
You said that you have been exposed to asbestos. Has your cough been getting worse? Do you constantly feel tired? -Lexi
Do you use any over the counter medications or supplements on a regular basis? If so, which ones and how often?
Have you found that these medications work the way they are intended to provide comfort care for you condition? In what dosage are you taking them? - Miranda
Have you noticed any swelling that is not normal, specifically in your legs or arms?
Any spots that are red, hot to the touch, or cause pain when touched? -Sara
Do you experience any dizziness upon standing up? If so, can you describe a time where this has occurred? - Miranda
Have you had any chest pain? Have you noticed a pounding pulse? Have you noticed swelling anywhere? -Lexi
If so, How frequent are these symptoms? Can you describe the three most recent occasions where they have ocurred? What were you doing at the time? - Miranda
when did your headache begin?-Sara
Have you had any changes or problems with your vision? - Sara
NOTE: I have so many questions about results of his physical exam and testing. VItals? What do his lungs sound like? Does listening to his lungs suggest pneumothorax, or pneumonia? Does he have bruising of his torso from the accident? CBC with differential would tell us about infection. A chest x-ray would help. Sara
Step 2:
Seeking Information
This is the data gathering portion of your concept map.
Include:
HPI
Past Medical/Surgical History
Family History
Social History
Allergies
Medications
Allergies
Patient is allergic to Penicillin, and also has seasonal allergies
What type of symptoms occur when you experience an allergic reaction. - Miranda
HPI
Do you have a fever higher than 100 degrees? A high fever is a common symptom of pneumonia. -Lexi
Have you noticed blood in your mucus after you've coughed? -Lexi
How long have you had these symptoms? If you've had the cough for longer than a few weeks, it is most likely pneumonia. -Lexi
Have you noticed any recent unintended change in weight: Any change in the way your pants fit? Have you noticed any swelling, especially in your legs, feet, or abdomen? --Sara
Did your cough and breathing difficulties begin with your boating accident?--Sara
In the past week, have you been anywhere out of the ordinary? Or have you encountered anything you think would irritate your lungs?
Social history
Does your wife or anyone who has been around you recently have symptoms? -Lexi
How often do you smoke? Do you only smoke when in a social setting or do you smoke often? Smoking is a common cause of COPD. -Lexi
Family history
Mom has asthma. Is she on medication for it?
Does father have any known allergies or other health conditions?
Do any close relatives have any kind of heart disease?--Sara
Is your father still living? If not, how did he die and at what age? --Sara
Does anyone in your family have hypertension or have heart problems that you know of? -Lexi
Medication
What is the dosage of Lisinopril for your hypertension? Has this number changed at all? Lisinopril can cause headaches and a dry cough. -Lexi
How closely do you follow your low sodium dietary restriction? How often and in what capacity do you stray from it? - Miranda
Past Medical/Surgical History
Have you ever encountered symptoms like these before? Do you typically have headaches?--Sara
How often do you check or monitor your blood pressure? -Lexi
Are you prone to recurring respiratory illnesses? Such as frequent cold or flu - Miranda
Are you a person prone to repeated bouts of bronchitis? -Sara
Step 1: Initial Thoughts (Hypothesis)
Each group member list as many Differential Diagnoses (DDx) as possible
Provide a brief statement about WHY you suspect each diagnosis.
Does the patient exhibit hallmark symptoms? Have certain risk factors? Is it a common illness? Or is it a rare but serious condition that needs to be considered?
Theo
Step 1: Initial findings that stood out to me were Hypertension, Sleep Apnea, and a Family history of the mother's Asthma. The patient has not been vaccinated for pneumococcal bacteria and had tonsils removed.
Additional questions: When did your issues/symptoms begin? How long do the symptoms last? How often do they occur? Does something bring on the issue? What makes it better or worse? Can you describe how it makes you feel? On a scale of 1-10 (1 being none and 10 being the worst what is your pain right now; when is it at its worse and best, on average? Do you have any additional symptoms you have not started yet or maybe forgot to mention? Do you use your CPAP regularly? What medications are you currently taking, including things like aspirin and vitamins? Do any of the medications you currently take have any side effects? What medications have you used in the past? What do you believe may have been the cause of the symptoms? What is important that you want us to know about the symptoms?
66-year-old man white male presents to ED with Dyspnea, well nourished, toxic appearance, pallor, and diaphoretic.
Pt has chest discomfort that is exacerbated with deep breaths and at night. Pt states sleeping in a recliner helps him, possibly orthopneic. Pt claims hyperhidrosis when waking at night. Pt claims coughing relaxes the pain. The cough produces thick yellow phlegm with a foul smell. Pt also complains of indigestion. The patient complains of deep chest pains that are on both sides of the lungs.
Lexi
INITIAL THOUGHTS: Some things that stood out to me were a medical history of hypertension, sleep apnea, dyspnea, diaphoresis, a pallor appearance, and his mother having asthma.
DDx: I think the patient most likely has pneumonia. He's never received the Pneumovax vaccination, so he's at a higher risk for diseases caused by Pneumococcal bacteria. Without this vaccination, the patient's immune system cannot effectively fight the infection. The patient is over the age of 65 as well, making him more susceptible to pneumonia than younger people. Excessive sweating, dyspnea, chest pain, and coughing with green/yellow phlegm are symptoms the patient has that are commonly seen in pneumonia.
A CT scan or an X-ray should be done to view the lungs. In pneumonia, the alveoli in the lungs are inflamed and can be filled with fluid.
Amy
The patient is diaphoretic (sweating heavily) and of toxic appearance. This is the first way I can tell that something is wrong, without even asking questions or running any tests. Difficulty breathing is also an immediate concern
Differential Diagnoses: pneumonia due to symptoms of difficulty breathing and possible exposure to bacteria from lake water.
Dry drowning could also be a possibility.. left over water in lungs from when patient fell into water and was not able to expel it from lungs
Pulmonary edema, due to shortness of breath and smoking?
Sara
My initial thought was he might be having a HEART ATTACK. His physical appearance and history of hypertension were what stood out to me
When I listened to his remarks, I became concerned about ASPIRATION and INFECTION
His report that he has started sleeping in a recliner makes me wonder about HEART FAILURE b/c dyspnea can be worse while lying flat with heart failure.
Dyspnea, a lot of phlegm, and purulent sputum make me think BRONCHITIS. In this case, I think it would be secondary to water in his lungs (or some other irritant). He also indicated it hurts to inhale ("breath") and exhale ("cough").
Miranda
Initian Thoughts: What stood out at first to me was the toxic appearance, sweat, and paleness. This led me to believe there was something immediately wrong with his respiratory of circulatory system. The next tngs that caught my attention were the past tonsil removal, hypertension, and lack of flu shot of pneumonia vaccination.
These lead me to believe thatthe patient is most likely suffering from an pneumonia. However, his hypertention could also play a role due to his inconsistency with his low sodium diet. Cardiac Arrrest may be a risk st this point.
week 3: Group Reflection Q's:
Group Dynamics Reflection: Discuss areas of group strengths and weakness with regard to knowledge, problem solving, and team work. How can this be modified for next time?
I think one challenge is that we are working from different locations as this is an online course. But I felt that our use of text messaging and Zoom, helped greatly on this assignment. - Theo
It was hard to work on the respiratory subject and know what questions to ask/what to hypothesize when I was still working my way through the respiratory material and unfamiliar with it.
I think that we did a good job of building off of each other's questions. I agree that it was difficult to work on the respiratory subject because it's difficult for me to distinguish between respiratory disorders. -Lexi
Working remotely is always difficult, especially with intricate content such as this. I think our group did well with communication and time management all around. - Miranda
Working remotely is more challenging than face-to-face, but I wouldn't be able to attend this class in person so that's the trade off. We reached out to one another for clarification or to discuss revisions. I think we lack knowledge about some diagnoses to consider. I felt like I was a medical student with this assignment. I do think we all tried to be logical in our questions in order to gain important information. -Sara
Learning Experience Reflection:
How did our proposed solutions compare with the actual solution to the case?
I feel we were close with the Dx as Aspiration Pneumonia was a possible Hypothesis. The fact that the Pt inhaled water as a result of falling in the water and the boat crash. This would have exposed him to waterborne bacteria. -Theo
I agree and definitely feel like we were on the right track. If we had more experience with the different kinds of bacterial pneumonias, I do think we would have gotten around to the actual solution
I also would say that we were on the right track. We just didn't specify a specific type of pneumonia. We could have also looked into the different types of pneumonia. -Lexi
I also think that we were on the right track. This is my first exposure to diagnosis, personally, and I wold say that given that, we did fairly well. - Miranda
I agree with the group that we noted the possible aspiration of lake water (with all its microbes) as possible etiology. Given our current level of knowledge, I think our hypotheses were good. We knew that some sort of pneumonia was very possible. -Sara
Where in the process did stumble?
Did we make assumptions that led us down a wrong path?
I think our review of initial data collection and RoS questioning was the correct direction, I feel that the results of the CBC would have narrowed it down to Legionella bacteria. - Theo
I think that we were on the right track. I agree with Theo that the results would have helped us. -Lexi
I believe we went in the correct direction. - Miranda
I think we did a good job of hypothesizing and then trying to follow the evidence. -Sara
Did we not ask the right questions (or ask questions in the wrong way)?
I do not feel that our questions were the wrong, as the did point to a form of Pneumonia.-Theo
I don't think that our questions were wrong, but I do think that we could have asked questions specific to different types of pneumonia. -Lexi
I agree that we asked the correct questions, and we improved our patient appropriate vocabulary for asking questions after feedback from Final Product 2
I think we were asking correct questions based on what we knew at the time. However I do think that we could have asked more specific ones based on more potential diagnosis. - Miranda
With all of us entering questions independently, we had a lot of overlap. It also felt a little random to me because it's difficult to narrow our questions to get us to a specific diagnosis when we are just learning about these conditions, and don't know the differential diagnoses. It was a really good beginning, though. We corrected our vocabulary after being marked down for using words that were too big. -Sara
Were we led astray by focusing on unimportant details?
There was extra information that was unnecessary toward a Dx. But I feel our questioning narrowed the possible issues. - Theo
I feel like there were some points where we were asking questions that weren't aimed at the diagnosis or that were focusing on extra information. -Lexi
There were a few times where we focused on irrelevant information, but overall I think we did good. - Miranda
I think we started broad and then tried to narrow things down. I also think with this type of assignment (not actually seeing a patient in person) we had to ask a lot of questions that we would be able to observe for ouselves in a real-life scenario. -Sara
Did we misread or misunderstand information or feedback?
Not that I noticed. Miranda
Agreed, I think we spotted the key points.
I think we did ok. I also think that the actor who did the recording of the patient was difficult to understand. After listening multiple times, I changed what I thought he was saying in two different instances. -Sara
Did we not think creatively enough
I think that we were thinking creatively, we just didn't think to explore the different kinds of pneumonia. -Lexi
Agreed, I think we should have explored other pneumonia types.
I agree with Lexi. I was just thinking about viral vs. bacterial when it came to pneumonia. -Sara
We difinately could have broadened or horizons and done better, but this was still a great attempt. - Miranda
Case Reflection
Did you miss assessments or do any that were unnecessary? Or is there any other information you would want
I would have liked to have results from the labs that we recommended. - Theo
We did not miss any assessments that I am aware of
It would have been helpful to our Dx to get the results from our recommended tests. -Lexi
I do not believe that we missed any assessments. - Miranda
It's difficult to say because, in real time, we would have had more information and the knowledge to "order" specific tests and obtain the results from those tests. We didn't always get feedback from our assessment questions. -Sara
Continuing Care: What would you want to continue monitoring for this patient?
The Pt will need to start antibiotic treatment and continued to be monitored for any type of Lung Failure. Legionnaires' disease is known to kill 1-10 people due to complications from the illness. - Theo
Treatment with antibiotics should be started as soon as possible. I would also monitor the patient for dehydration as vomiting and diarrhea may occur.
I agree that the patient should recieve immediate antibiotics, as well as be monitored for complications. - Miranda
I'm assuming he would be treated parenterally with antibiotics and fluids. Monitoring of vitals. Monitoring of heart and lung function. If they don't improve, further investigation for complications would be needed. Treat symptoms like fever and headache. - Sara
I agree that the patient should receive antibiotics and be monitored for any changes -Lexi
Possible diagnosis: Pneumonia brought on by pneumococcal bacteria from his exposure to lake water. Pt's complaint of dyspnea as well as the location of pain, indicates a form of pneumonia. The illness is believed to be brought on by a bacterial infection due to yellow phlegm and foul smells produced during coughs. Pt also complains of headaches and hyperhidrosis which are results of the bodies immune system fighting an infection..
Recommend testing: X-rays, ABGs, Blood culture, Sputum culture, CBC, CT Scan, Bronchoscopy, Thoracentesis. Additionally, conduct a nasopharyngeal swab to asses for viruses.
Do you have any problems breathing at night? If so, do you use pillows to help you get in a position to breathe easier?