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Acute Pulmоnаry Plаn оf Cаre Review the pulmоnary infection cases to determine whether the diagnosis is infectious rhinitis, influenza, acute bronchitis, acute bronchiolitis, or pneumonia. Then, you will begin the plan of care. J.M. is a 21-year-old male. Subjective Data (condensed) CC: “I feel awful. I couldn’t go to class this morning.” HPI/ROS Sudden onset of myalgia with his body aching all over and headache for the past day. He feels tired and has the chills, and his temperature was 100°F. He has a mild nonproductive cough. He denies rhinorrhea, sinus pain, nausea, otalgia, or shortness of breath. Denies nausea, abdominal pain, or vomiting. He reports exposure to sick contacts in his dorm, stating, “Everyone seems to be coughing and catching a cold or the flu.” Medications: none Allergies: penicillin Past medical history: healthy Social history: college student, lives in a dormitory. Nonsmoker and drinks alcohol once a week, about two or three beers. Objective Data Physical exam: Vital signs: temperature 100°F; pulse 98 beats per minute; respiratory rate18 per minute; blood pressure 110/70 mmHg; pulse oximeter 98% General: ill and tired appearance Head, Eyes, Ears, Neck, Throat (HEENT): unremarkable Neck: no lymphadenopathy; negative Kernig sign, negative Brudzinski sign Cardiovascular lungs, abdomen: unremarkable What other subjective or objective data would you determine? (10 points) Clinical manifestations occur because of the immune response. Signs and Symptoms include fever, chills, headache, myalgia, malaise, exhaustion, and non-productive cough with chest discomfort. Other clinical manifestations are similar to those found in viral rhinitis and can include watery rhinitis, sore throat, and nasal congestion. Vomiting and diarrhea may occur but this is more common in children than adults. On exam, you would expect to find warmth to the skin, flushing of cheeks, possible abnormal respiratory sounds, redness to nares, and overall appearance of the patient to be that they appear ill, cervical lymphadenopathy may be present as well. Keep in mind that the subjective findings are what the patient tells you their symptoms are and you would document them how the patient describes them to you: fever, chills, body aches, tiredness, runny nose, sore throat, dry cough, chest feels tight, nose is congested, vomiting, nausea or upset stomach, diarrhea Objective findings are what you find on your exam, this is what you as the provider can see, feel, and hear on examination. What diagnostic tests (if any) would you advise for this client? Provide rationale. (10 points) Viral cultures may take 2-10 days to result, rapid tests in the office can provide results within 10 minutes and can determine the type of flu, whether it is A or B. The reason this testing is important is to determine the diagnosis especially due to the fact the patient will need to isolate at home and ensure proper treatment. Viral infections do not require antibiotics and treatment would be supportive. Also, knowing the diagnosis will allow the patient to notify anyone they have been in contact with to watch for symptoms due to the contagious nature of this condition. What is the most likely primary diagnosis (select one) and pathogen causing this disorder? (10 points) – Assessment Jack most likely has influenza type A. Influenza A is unique because of the continual antigen changes of H and N. The type of virus is an orthomyxovirus which binds the sialic acid receptor on respiratory epithelial cells. This attachment is what initiates infection. Discuss the mode of transmission and discuss the data that supports your decision. (10 points) The virus is transmitted through the inhalation of or contact with respiratory droplets. The typical season for influenza infection is October -March. Children are two to three more times likely to contract the flu and will frequently spread the virus to others. Once a person is infected by the virus replication occurs quickly as the virus shuts down the host cell protein synthesis for three hours which allows viral proliferation. In incubation period is 1-4 days with peak transmission 1 day before onset of symptoms and lasts 4-7 days afterward. Children can be infectious for more than 10 days and young children can spread the virus for 6 days before the onset of symptoms with severely immunocompromised people can spread the virus for weeks to months. (Dlugash & Story, 2024) What are the differential diagnoses (other possibilities) that Jack may have? (10 points) infectious rhinitis, influenza, acute bronchitis, acute bronchiolitis, pneumonia, COVID, RSV, Lower respiratory tract infection 6.Develop a treatment plan for this client with rationales for each: A.Prescription pharmacological therapy (if indicated) (10 points) Antiviral medications: M2 Inhibitors: amantadine or rimantadine Neuraminidase Inhibitors: Zanamivir, oseltamivir (Tamiflu) and peramivir Baloxavir marboxil (Xofluza) is a newer category of medication for the flu that inhibits polymerase acidic endonuclease, which is necessary for viral reproduction. (Note these meds must be taken within 48 hours of onset of symptoms) B. Non-prescription (OTC) pharmacological therapy (10 points) Antipyretics an analgesics: Acetaminophen, NSAIDS Cough medications increased fluid intake, adequate rest, isolation, good hand hygiene C.Thorough patient education. (Remember this is a college student living away from home who may be caring for himself for the first time.) (20 points) Symptoms will be present for several days even with treatment. This is a viral illness and some symptoms may continue for weeks. Need to stay home/in dorm until afebrile for 24 hours or longer without medication. Ensure to follow a healthy diet and increase fluid intake Take all medications as prescribed Ensure good hand hygiene If fever remains >100.4 and does not improve with antipyretics or if symptoms worsen to include shortness of breath, inability to perform daily activities or unable to intake food or water return to clinic or report to nearest ER. 10 points for APA-formatted References Dlugasch, L. & Story, L. (2024). Applied Pathophysiology for the Advanced Practice Nurse. (2nd ed). Jones & Bartlett Learning.
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Cаrоl Gilligаn’s criticism оf Lаwrence Kоhlberg’s development theory is based on the argument that Kohlberg’s
Clinicаl reseаrchers аre interested in gaining insight intо the causes оf abnоrmal behavior. One way that they do this is to delve deeply into the histories of patients with a common diagnosis, interviewing family, friends, teachers, therapists, physicians, babysitters, and others who can provide rich details about the patients’ lives. Then, researchers try to see if there are any common themes in the information gathered. What research method does this strategy represent?