NR603 Week 3 Case Study

NR603 Week 3 Case Study: A Comprehensive Analysis

The NR603 Week 3 Case Study delves into the intricate clinical scenario of Joseph Camella, a 66-year-old male presenting with progressive dyspnea. This case offers a profound exploration of diagnostic methodologies, therapeutic interventions, and patient management strategies pertinent to advanced clinical practice.

Patient Profile

Joseph Camella, a 66-year-old male, reports a decade-long history of dyspnea, with a notable exacerbation over the past five years. His medical history includes hypertension, type 2 diabetes mellitus, and sleep apnea. He is currently on Lisinopril 10 mg daily, Hydrochlorothiazide 25 mg daily, Glipizide 5 mg daily, and utilizes a CPAP machine for sleep apnea management. He also reports an allergy to sulfa drugs and a smoking history of 40 pack-years, having ceased smoking a decade ago.

Clinical Presentation

Joseph presents with progressive shortness of breath, particularly during exertion, and a persistent cough with white sputum production. He experiences wheezing, especially at night, and reports fatigue and occasional ankle edema. Physical examination reveals bilateral expiratory wheezes, possible crackles, and bilateral lower extremity edema.

Differential Diagnosis

The differential diagnosis for Joseph includes:

• Chronic Obstructive Pulmonary Disease (COPD): Given his smoking history and symptoms of dyspnea and cough, COPD is a primary consideration.

• Congestive Heart Failure (CHF): The presence of bilateral lower extremity edema and fatigue raises suspicion for CHF.

• Asthma: The episodic nature of wheezing and cough, along with nocturnal symptoms, suggests asthma.

• Pulmonary Embolism (PE): Although less likely, PE should be considered due to the acute onset of symptoms.

Diagnostic Workup

To elucidate the underlying etiology, the following diagnostic tests are recommended:

• Pulmonary Function Tests (PFTs): To assess for obstructive lung diseases such as COPD.

• Chest X-ray: To evaluate for signs of heart failure, lung masses, or other pulmonary conditions.

• Echocardiogram: To assess cardiac function and rule out heart failure.

• Complete Blood Count (CBC): To check for anemia or infection.

• B-type Natriuretic Peptide (BNP): To evaluate for heart failure.

• D-dimer: To assess for the possibility of a pulmonary embolism.

Management Plan

The management plan for Joseph should be multifaceted, addressing both pharmacological and non-pharmacological aspects:

• Pharmacological Interventions:

  • Bronchodilators: Short-acting beta-agonists (e.g., Albuterol) for acute relief of bronchospasm.

  • Inhaled Corticosteroids: To reduce airway inflammation in COPD or asthma.

  • Diuretics: If heart failure is diagnosed, to manage fluid retention.

  • Antihypertensives: To control blood pressure, considering his history of hypertension.

• Non-Pharmacological Interventions:

  • Smoking Cessation Support: Although he quit smoking a decade ago, reinforcing the importance of avoiding exposure to environmental pollutants is crucial.

  • Pulmonary Rehabilitation: To improve exercise tolerance and quality of life.

  • Diabetes Management: Tight glycemic control to prevent complications.

  • Weight Management: To alleviate symptoms and improve overall health.

  • Patient Education: Educate on proper inhaler technique, medication adherence, and recognition of symptom exacerbation.

Follow-Up and Monitoring

Regular follow-up is essential to monitor treatment efficacy and adjust the management plan as needed:

• Short-Term Follow-Up: Within 2-4 weeks to assess response to initial interventions.

• Long-Term Follow-Up: Every 3-6 months, including repeat PFTs, echocardiogram, and assessment of comorbid conditions.

Conclusion

The NR603 Week 3 Case Study of Joseph Camella underscores the complexity of diagnosing and managing patients with multifaceted presentations. A comprehensive, patient-centered approach, integrating diagnostic precision with individualized therapeutic strategies, is paramount in optimizing patient outcomes.

Below are sample Questions and Answers:

AIC 6.4%
Fasting glucose 135mgs/dl
Total Cholesterol: 230 (200-239; borderline high) >240 very high
Triglycerides 180mgs/dl (less than 150) 150-199 is borderline high
Ldl 180 (<100 is normal) 130-159 is borderline high; 160-189 is very high
Hdl 38 (40-59 is normal but higher is better) <40 is at increased risk of
cardiac disease
5'8" weight: 220 pounds; BMI 33.5 vital signs: BP 146/90 P 70 Sao2 97%
Random glucose finger stick in office: 130mgs/dl
Less than 70 for LDL
There’s no abnormal physical findings in the respiratory system to suggest
early heart failure. But mild JVD present with trace edema in lower
extremities.
Eats out a lot - processed food, social drinking, occasional cigarette
weekly; stopped Lisinopril one month ago, refuses HLD medication, will
control with diet and exercise, allergy to METFORMIN
1. What Leads Demonstrate the ST Depression?
2. Is Lorene Hypertensive per ACA 2017 Guidelines? Compare the ACA
guidelines to JNC 8 guidelines and discuss what treatment you
recommend for her BP and why.
3. What is the Primary diagnosis causing Lorene's chest pain?
Include ICD 10 codes (no differentials)
4. What other secondary diagnoses does Lorene have that should be
addressed? (Include the rationale and a reference for your
diagnoses)