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Hi, I am taking a class called Advanced Primary Care of Family and we have to write Discussion Posts every week. I would like to please have this Post be written by you. I am providing PDF copy of what the question is As well as what the Specifications are for writing the Post. DISCUSSION POSTS: MUST HAVE A MINIMUM of 2 References dated within last 5 years, which must be peer reviewed journal articles. Posts MUST include the required elements of an APA in-text citation and list of references.All responses must be in a narrative format and each paragraph must have at least 4 sentences. ********PLEASE NO PLAGIARISM/ SELF-PLAGIARISM IS ACCEPTABLE; ALL WRITINGS ARE RUN THROUGH TURN-IT IN FOR VERIFICATION!****
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Discussion Homework: COPD
The patient is a 60-year-old white female presenting to the emergency department with acute
onset shortness of breath. Symptoms began approximately 2 days before and had
progressively worsened with no associated, aggravating, or relieving factors noted. She had
similar symptoms approximately 1 year ago with an acute, chronic obstructive pulmonary
disease (COPD) exacerbation requiring hospitalization. She uses BiPAP ventilatory support at
night when sleeping and has requested to use this in the emergency department due to
shortness of breath and wanting to sleep.
She denies fever, chills, cough, wheezing, sputum production, chest pain, palpitations, pressure,
abdominal pain, abdominal distension, nausea, vomiting, and diarrhea.
She reports difficulty breathing at rest, forgetfulness, mild fatigue, feeling chilled, requiring
blankets, increased urinary frequency, incontinence, and swelling in her bilateral lower
extremities that are new-onset and worsening. Subsequently, she has not ambulated from bed
for several days except to use the restroom due to feeling weak, fatigued, and short of breath.
There are no known ill contacts at home. Her family history includes significant heart disease
and prostate malignancy in her father. Social history is positive for smoking tobacco use at 30
pack years. She quit smoking 2 years ago due to increasing shortness of breath. She denies all
alcohol and illegal drug use. There are no known foods, drugs, or environmental allergies.
Past medical history is significant for coronary artery disease, myocardial infarction, COPD,
hypertension, hyperlipidemia, hypothyroidism, diabetes mellitus, peripheral vascular disease,
tobacco usage, and obesity. Past surgical history is significant for an appendectomy, cardiac
catheterization with stent placement, hysterectomy, and nephrectomy.
Her current medications include fluticasone-vilanterol 100-25 mcg inhaled daily, hydralazine 50
mg by mouth, 3 times per day, hydrochlorothiazide 25 mg by mouth daily, albuterolipratropium inhaled every 4 hours PRN, levothyroxine 175 mcg by mouth daily, metformin 500
mg by mouth twice per day, nebivolol 5 mg by mouth daily, aspirin 81 mg by mouth daily,
vitamin D3 1000 units by mouth daily, clopidogrel 75 mg by mouth daily, isosorbide
mononitrate 60 mg by mouth daily, and rosuvastatin 40 mg by mouth daily.
Physical Exam
Initial physical exam reveals temperature 97.3 F, heart rate 74 bpm, respiratory rate 24, BP
104/54, HT 160 cm, WT 100 kg, BMI 39.1, and O2 saturation 90% on room air.
Constitutional: Extremely obese, acutely ill-appearing female. Well-developed and wellnourished with BiPAP in place. Lying on a hospital stretcher under 3 blankets.
HEENT: (Head, Ears, Eye, Nose , Throat)
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Head: Normocephalic and atraumatic
Mouth: Moist mucous membranes
Macroglossia
Eyes: Conjunctiva and EOM are normal. Pupils are equal, round, and reactive to light. No
scleral icterus. Bilateral periorbital edema present.
Neck: Neck supple. No JVD present. No masses or surgical scarring.
Throat: Patent and moist
Cardiovascular: Normal rate, regular rhythm, and normal heart sound with no murmur. 2+
pitting edema bilateral lower extremities and strong pulses in all four extremities.
Pulmonary/Chest: No respiratory status distress at this time, tachypnea present, (+) wheezing
noted, bilateral rhonchi, decreased air movement bilaterally. The patient was barely able to
finish a full sentence due to shortness of breath.
Abdominal: Soft. Obese. Bowel sounds are normal. No distension and no tenderness
Skin: Skin is very dry
Neurologic: Alert, awake, able to protect her airway. Moving all extremities. No sensation
losses
Questions
1. What pertinent labs and diagnostics are ordered for this patient?
2. What are your differential diagnosis?
3. What is your treatment plan?
NOTE IMPORTANT:
➢ Use APA 7th Edition Format and support your work with at least 2 different peerreviewed references within 5 years of publication for each post.
➢ All paragraphs need to be cited properly.
➢ All responses must be in a narrative format and each paragraph must have at least 4
sentences.
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