iHuman case: Rand Hall V3 PC

Just do the History, Physical Exam, and Assessment parts for the iHuman case named Rand Hall V3 PC.

Discussion Question 1: Think about your performance and the expert feedback in the HISTORY section. Share two questions you missed and explain why they were important for this case. Use examples from your textbook to clarify. Do you feel any pain or have other symptoms along with your cough? The patient said they have a cough and it hurts when they breathe in. It’s crucial to ask about any pain linked to the cough to find out potential causes. According to Goolsby & Grubbs (2014), coughs can be acute (lasting up to 3 weeks), subacute (lasting 3-8 weeks), or chronic (lasting 8 weeks or more). iHuman case: Rand Hall V3 PC Have you experienced this chest pain before? It’s important to know if the chest discomfort is something new or if it’s happened before. The healthcare provider needs to ask the patient about the pain’s severity and whether it feels sharp, aching, or dull (Goolsby et al., 2017). If the patient coughs and feels chest pain or discomfort, it’s essential to figure out exactly where it hurts and check if it spreads anywhere, especially concerning their breathing (Goolsby et al, 2014).
Discussion Question 2 Reflecting on your performance and the expert feedback in your PHYSICAL EXAM section, highlight two mistakes in your examination or documentation. Support your explanation with specific references from your text, emphasizing the significance of these findings in accurately assessing this client. Administered a pain stimulus to a conscious patient. Giving a pain stimulus to a verbally conscious patient is unnecessary because they can express their pain verbally. Various pain scales, like the numeric rating scale (NRS), visual analog scale (VAS), and the verbal rating scale (VRS), can be used for assessment (Goolsby et al., 2014). Regardless of the scale chosen, it’s crucial to evaluate each patient’s pain using the PQRST mnemonic, which stands for Palliative/Provoking, Quality, Radiation, Severity, and Timing (Goolsby et al., 2014). Skipped inspecting the eyes during the HEENT exam. Examining the eyes primarily involves visual inspection (Goolsby et al., 2014). It’s vital to observe the lids, checking for any drooping, and ensuring their position relative to other eye structures, like the pupil and iris (Goolsby et al., 2014). Additionally, as per Goolsby et al. (2014), it is equally crucial to examine the conjunctiva and sclera for any signs of redness or discharge.
Discussion Question 3: Considering my performance in the PHYSICAL EXAM collection, one vital finding I noted was bronchial breath sounds. To further assess this, a specific physical exam can be performed at the point-of-care. During the exam, lung sounds are auscultated starting from the posterior side and then moving anteriorly in a ladder motion (Bickley, 2017). Bronchial breath sounds are distinctive—they’re harsher, louder, and have a higher pitch compared to bronchovesicular or vesicular breath sounds (Bickley, 2017). A short silence exists between inspiration and expiration, and expiratory sounds last longer than inspiratory ones (Bickley, 2017). Typically, these sounds should be heard over the manubrim, which covers the larger proximal airways. However, if bronchial breath sounds are detected in a location distant from this area, it may indicate replacement of air-filled lungs by air or consolidated tissue, prompting further investigation (Bickley, 2017).
Discussion Question 4: Analyzing my performance and the expert feedback in identifying problem categories during the ASSESSMENT phase, I overlooked the orthostatic blood pressure drop. Understanding the significance of this category is crucial for arriving at correct differential diagnoses for the client. Orthostatic blood pressure is defined as a drop of at least 20 mm Hg in systolic pressure or a 10 mm Hg drop in diastolic pressure within 3 minutes of standing (Bickley, 2017). This is particularly common in older adults and should be considered if a patient’s current blood pressure is notably lower than their historical higher readings. The assessment involves measuring blood pressure and heart rate in both supine and standing positions (Bickley, 2017). Normally, as a patient moves from lying down to standing, the systolic pressure should remain unchanged or drop slightly, while the diastolic pressure rises slightly (Bickley, 2017). Recognizing and assessing orthostatic blood pressure is essential for a comprehensive understanding of the patient’s condition and contributes to forming accurate differential diagnoses.
Discussion Question 5: Reflecting on my performance and expert feedback in assessing differential diagnoses, one missed diagnosis was listing pneumocystis instead of the accurate diagnosis, community-acquired pneumonia. I listed pneumonia, pneumocystis as a diagnosis. However, this was not correct.  The correct differential diagnosis should have been community-acquired pneumonia. Community-acquired pneumonia happens outside the hospital and is mainly caused by Streptococcus pneumoniae, Staphylococcus aureus, and Haemophilus influenzae (Goolsby et al., 2014). Symptoms include cough, fever, malaise, chills, rigors, and/or chest discomfort (Goolsby et al., 2014). Often, patients with community-acquired pneumonia appear visibly unwell at the clinic. Signs may include abnormal vital signs, uneven fremitus, and a dull sound when percussing the area over the consolidation (Goolsby et al., 2014). When listening to the lungs, bronchial breath sounds and crackles can be present (Goolsby et al., 2014). The CURB-65 tool assesses confusion, BUN, respiratory rate, blood pressure, and age, assigning one point for each present factor (Goolsby et al., 2014). If the total score is 3 to 5, hospitalization is usually needed for treatment (Goolsby et al., 2014).

References

Goolsby, J. M., & Grubbs, L. (2014). Advanced Assessment: Interpreting Findings and Formulating Differential Diagnoses (3rd ed.). [South University]. Retrieved from https://digitalbookshelf.southuniversity.edu/#/books/9780803645011/

Bickley, L. S. (2017). Bates’ Guide to Physical Examination and History Taking (12th ed.). [South University]. Retrieved from https://digitalbookshelf.southuniversity.edu/#/books/9781496354709/

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