NRNP 6540 Assessing Cardiovascular and Pulmonary Disorders Assignment Example
NRNP 6540 Week 4 Assignment: A 67-Year-Old with Tachycardia and Coughing
NRNP 6540 Assessing Cardiovascular and Pulmonary Disorders Assignment Brief
Assignment Instructions Overview
This assignment is centered on the assessment, diagnosis, and management of cardiovascular and pulmonary disorders. It requires students to analyze a case study involving a patient with complex health issues, including respiratory and cardiovascular symptoms. Through this case, students must demonstrate an ability to integrate subjective and objective findings, interpret diagnostic results, and develop a treatment plan based on current evidence-based guidelines.
The assignment involves answering 10 specific questions about a hypothetical patient’s symptoms, diagnosis, and potential treatments. Students are expected to identify relevant assessment tools, evaluate differential diagnoses, propose treatment regimens, and provide patient education. The goal is to develop a comprehensive understanding of the patient’s condition, including the appropriate steps to assess, diagnose, and manage her symptoms effectively.
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Understanding Assignment Objectives
The primary objectives of this assignment are to enhance students’ clinical reasoning, diagnostic skills, and treatment planning abilities in managing cardiovascular and pulmonary conditions. Students are expected to:
- Assess and interpret clinical signs and symptoms within the context of cardiovascular and respiratory disorders.
- Utilize assessment tools and clinical guidelines to establish diagnoses and determine the severity of conditions.
- Identify appropriate diagnostic tests to further evaluate symptoms and rule out differential diagnoses.
- Propose evidence-based interventions, including pharmacological and non-pharmacological treatments, tailored to the patient’s condition and history.
- Educate patients and families on managing symptoms, medication adherence, and follow-up care to prevent complications.
The Student’s Role
In this assignment, students take on the role of a healthcare provider, responsible for analyzing a patient’s health history, conducting a thorough assessment, interpreting laboratory and diagnostic data, and creating a comprehensive care plan. Students must:
- Apply clinical guidelines and professional standards to ensure appropriate decision-making.
- Think critically about the patient’s symptoms, using tools like the CURB-65 to assess pneumonia severity or an Ankle-Brachial Index (ABI) to evaluate vascular health.
- Integrate knowledge of the patient’s existing chronic conditions, such as COPD, into the treatment plan to address both acute and chronic aspects of the case.
- Develop patient-centered care strategies, considering the patient’s daily living needs, family dynamics, and health education requirements.
Competencies Measured
This assignment measures a range of essential competencies for advanced practice nursing, including:
- Clinical Decision-Making: Students are evaluated on their ability to assess a patient’s condition accurately, differentiate between possible diagnoses, and select appropriate treatment options.
- Evidence-Based Practice: This competency is demonstrated through the use of current guidelines, research-based assessment tools, and validated interventions for managing cardiovascular and pulmonary diseases.
- Patient Education and Advocacy: Students must show proficiency in educating patients and caregivers about their health, potential risk factors, and steps for disease management. This includes communicating complex information clearly and providing actionable follow-up instructions.
- Professional and Ethical Responsibility: Students are expected to approach each question with a patient-centered, ethical perspective, ensuring that care recommendations respect the patient’s preferences, lifestyle, and health goals.
You can also read these assignment examples for the NRNP 6540 – Advanced Practice Care of Older Adults Course:
NRNP 6540 Assessment of Older Adults Evaluation Plan Discussion Example
NRNP 6540 Assessing Cardiovascular and Pulmonary Disorders Assignment Example
Introduction
Ms. Baker, a 68-year-old woman, presents with a rapid heart rate and frequent coughing. With a medical history including chronic obstructive pulmonary disease (COPD), hypertension, hyperlipidemia, and vitamin D deficiency, she also experiences intermittent leg pain while walking, which subsides with rest. Given her recent symptoms, vital signs, and laboratory results, the following assessment and management plan will explore her diagnosis, treatment options, and education needs.
Question 1: Expected Chest X-ray Findings for Pneumonia
For a patient like Ms. Baker, who is diagnosed with pneumonia, common radiographic findings on her chest X-ray would likely include areas of consolidation, which represent fluid and pus-filled alveolar spaces due to infection (Marrie, 2018). Given her diagnosis of left lower lobe pneumonia, we would anticipate localized opacities or infiltrates within the left lower lobe. Additional signs may include air bronchograms or increased vascular markings due to inflammation in the affected lung tissue.
Question 2: Classification of Pneumonia – CAP vs. HAP
Ms. Baker’s pneumonia is best classified as community-acquired pneumonia (CAP). CAP is an infection acquired outside of a hospital or healthcare facility, typically diagnosed in patients presenting from the community with no recent healthcare exposure (Metlay et al., 2019). In contrast, hospital-acquired pneumonia (HAP) occurs 48 hours or more after admission to a healthcare setting (Mandell, 2020). Since Ms. Baker’s symptoms developed at home, her pneumonia aligns with CAP criteria.
Question 3: Assessment Tool and Application (CURB-65)
3A) The CURB-65 score is a widely used tool to assess pneumonia severity and guide treatment. It assigns points based on five factors: confusion, urea >7 mmol/L, respiratory rate ≥30, blood pressure <90/60 mmHg, and age ≥65 (Lim et al., 2010).
3B) In Ms. Baker’s case:
Confusion: Not present
Urea: Not elevated (BUN is 17 mg/dL)
Respiratory rate: Elevated at 22 breaths per minute but does not meet the ≥30 criterion
Blood pressure: Normal at 126/78 mmHg
Age: She is 68, scoring 1 point for age alone.
Based on her CURB-65 score of 1, Ms. Baker could likely be managed as an outpatient with oral antibiotics and close monitoring (Lim et al., 2010).
Question 4: Treatment Plan Based on CAP Guidelines
For Ms. Baker’s CAP, recommended treatment aligns with amoxicillin/clavulanate combined with a macrolide like azithromycin. The combination covers common CAP pathogens, including Streptococcus pneumoniae and Haemophilus influenzae (Metlay et al., 2019). Given her COPD history, this regimen is optimal as it addresses potential bacterial pathogens in COPD patients, who are at higher risk of secondary infections. Ms. Baker should also use bronchodilators, such as her ProAir HFA inhaler, to manage respiratory symptoms related to her COPD exacerbation (GOLD, 2023).
Question 5: Gold Standard for Measuring COPD Airflow Limitation
The gold standard for assessing airflow limitation in COPD patients is spirometry. Specifically, FEV1 (Forced Expiratory Volume in 1 second) measures airflow limitation severity (GOLD, 2023). Regular spirometry assessments will help monitor Ms. Baker’s disease progression and adjust her COPD management plan accordingly.
Question 6: Most Likely Diagnosis for Intermittent Leg Pain
The best diagnosis for Ms. Baker’s intermittent leg pain is intermittent claudication. Intermittent claudication is commonly associated with peripheral artery disease (PAD) and is characterized by leg pain or cramping during activity that subsides with rest (Criqui & Aboyans, 2015). Ms. Baker’s smoking history and hypertension further increase her PAD risk, making this diagnosis more likely than other options, such as DVT, cellulitis, or electrolyte imbalance, which have different symptom profiles.
Question 7: Diagnostic Test for Intermittent Claudication
To evaluate Ms. Baker’s suspected intermittent claudication, an Ankle-Brachial Index (ABI) test is appropriate. The ABI measures blood flow by comparing blood pressure in the ankle and arm, with abnormal values indicating PAD (Aboyans et al., 2018). Positive findings would prompt further vascular assessment and guide treatment to improve her walking tolerance.
Question 8: Differential Diagnoses for Initial Presentation
- COPD Exacerbation: Her increased cough and reliance on her inhaler suggest a potential COPD exacerbation, especially with a history of smoking and COPD (GOLD, 2023).
- Community-Acquired Pneumonia (CAP): Symptoms like cough, sputum production, and tachycardia align with pneumonia, a confirmed diagnosis through assessment.
- Heart Failure: Given her history of hypertension, heart failure should be considered as a differential, as it can manifest with fatigue, cough, and peripheral symptoms (McDonagh et al., 2021).
Question 9: Patient Education and Follow-Up
Education: Ms. Baker should be advised on the importance of medication adherence, including using her inhaler correctly and consistently taking her prescribed antibiotics. She should also receive education on recognizing symptoms of worsening COPD or pneumonia, such as increased shortness of breath or high fever, and on avoiding respiratory infections by practicing good hygiene and considering pneumococcal and influenza vaccinations (GOLD, 2023).
Follow-Up: Ms. Baker should be scheduled for a follow-up within 1–2 weeks to reassess her respiratory symptoms, confirm pneumonia resolution, and adjust her COPD treatment if necessary.
Question 10: Suitability of Amoxicillin/Clavulanate + Macrolide
Yes, amoxicillin/clavulanate plus a macrolide would be an appropriate choice for Ms. Baker’s CAP treatment. This combination targets both typical and atypical CAP pathogens and is recommended for patients with COPD due to their higher risk of infection by gram-negative and atypical bacteria (Metlay et al., 2019). However, given her penicillin allergy, alternative options should be considered, such as doxycycline or a quinolone, based on her allergy severity and response history.
Conclusion
Ms. Baker’s case highlights the need for comprehensive assessment and individualized care to address her respiratory and cardiovascular health needs. By following evidence-based guidelines and carefully considering her COPD and smoking history, her CAP can be effectively managed, and additional cardiovascular concerns, such as intermittent claudication, can be evaluated to improve her overall quality of life.
References
Aboyans, V., Ricco, J. B., Bartelink, M. L. E. L., et al. (2018). ESC Guidelines on the diagnosis and treatment of peripheral artery diseases. European Heart Journal, 39(9), 763-816.
Criqui, M. H., & Aboyans, V. (2015). Epidemiology of peripheral artery disease. Circulation Research, 116(9), 1509–1526.
GOLD. (2023). Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. Global Initiative for Chronic Obstructive Lung Disease.
Lim, W. S., van der Eerden, M. M., Laing, R., et al. (2010). Defining community-acquired pneumonia severity on presentation to hospital: An international derivation and validation study. Thorax, 58(5), 377–382.
Mandell, L. A. (2020). The treatment of community-acquired pneumonia: A year in the life of a clinician. Clinical Infectious Diseases, 71(6), 1294-1301.
Marrie, T. J. (2018). Pneumonia: Symptoms, types, and treatment. American Family Physician, 97(7), 433-440.
McDonagh, T. A., Metra, M., Adamo, M., et al. (2021). 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. European Heart Journal, 42(36), 3599-3726.
Metlay, J. P., Waterer, G. W., Long, A. C., et al. (2019). Diagnosis and treatment of adults with community-acquired pneumonia. American Journal of Respiratory and Critical Care Medicine, 200(7), e45-e67.
Detailed Assessment Instructions for the NRNP 6540 Assessing Cardiovascular and Pulmonary Disorders Assignment Example
NRNP 6540 Week 5 Case Assignment
Case Title: A 67-year-old With Tachycardia and Coughing
Ms. Baker is a 68-year-old female who is brought to your office today by her daughter Rebecca. Ms. Baker lives with her daughter and is able to perform all activities of daily living (ADLs) independently. Her daughter reports that her mother’s heart rate has been quite elevated, and she has been coughing a lot over the last 2 days. Ms. Baker has a 30-pack per year history of smoking cigarettes but quit smoking 3 years ago. Other known history includes chronic obstructive pulmonary disease (COPD), hypertension, vitamin D deficiency, and hyperlipidemia. She also reports some complaints of intermittent pain/cramping in her bilateral lower extremities when walking and has to stop walking at times for the pain to subside. She also reports some pain to the left side of her back, and some pain with aspiration.
Ms. Baker reports she has been coughing a lot lately, and notices some thick, brown-tinged sputum. She states she has COPD and has been using her albuterol inhaler more than usual. She says it helps her “get the cold up.” Her legs feel tired but denies any worsening shortness of breath. She admits that she has some weakness and fatigue but is still able to carry out her daily routine.
Vital Signs: 99.2, 126/78, 90, RR 22
Labs: Complete Metabolic Panel and CBC done and were within normal limits
| CMP Component | Value | CBC Component | Value |
| Glucose, Serum | 86 mg/dL | White blood cell count | 5.0 x 10E3/uL |
| BUN | 17 mg/dL | RBC | 4.71 x10E6/uL |
| Creatinine, Serum | 0.63 mg/dL | Hemoglobin | 10.9 g/dL |
| EGFR | 120 mL/min | Hematocrit | 36.4% |
| Sodium, Serum | 141 mmol/L | Mean Corpuscular Volume | 79 fL |
| Potassium, Serum | 4.0 mmol/L | Mean Corpus HgB | 28.9 pg |
| Chloride, Serum | 100 mmol/L | Mean Corpus HgB Conc | 32.5 g/dL |
| Carbon Dioxide | 26 mmol/L | RBC Distribution Width | 12.3% |
| Calcium | 8.7 mg/dL | Platelet Count | 178 x 10E3/uL |
| Protein, Total, Serum | 6.0 g/dL | ||
| Albumin | 4.8 g/dL | ||
| Globulin | 2.4 g/dL | ||
| Bilirubin | 1.0 mg/dL | ||
| AST | 17 IU/L | ||
| ALT | 15 IU/L |
Allergies: Penicillin
Current Medications:
- Atorvastatin 40mg p.o. daily
- Multivitamin 1 tablet p.o. daily
- Losartan 50mg p.o. daily
- ProAir HFA 90mcg 2 puffs q4–6 hrs. prn
- Caltrate 600mg+ D3 1 tablet p.o. daily
Diagnosis: Pneumonia
Directions: Answer the following 10 questions and upload your document to Canvas site by due date.
Question 1: What findings would you expect to be reported or seen on her chest x-ray results, given the diagnosis of pneumonia?
Question 2: Define further what type of pneumonia Ms. Baker has, HAP (hospital-acquired pneumonia) or CAP (community-acquired pneumonia)? What’s the difference/criteria?
Question 3:
- 3A) What assessment tool should be used to determine the severity of pneumonia and treatment options?
- 3B) Based on Ms. Baker’s subjective and objective findings, apply that tool and elaborate on each clinical factor for this patient.
Question 4: Ms. Baker was diagnosed with left lower lobe pneumonia. What would your treatment be for her based on her diagnosis, case scenario, and evidence-based guidelines?
Question 5: Ms. Baker has a known history of COPD. What is the gold standard for measuring airflow limitation?
Question 6: Ms. Baker mentions intermittent pain in her bilateral legs when walking and having to rest to stop the leg pain/cramps. Which choice below would be the best choice for a potential diagnosis for this? Explain your reasoning.
- DVT (Deep Vein Thrombosis)
- Intermittent Claudication
- Cellulitis
- Electrolyte Imbalance
Question 7: Ms. Baker mentions intermittent pain in her bilateral legs when walking and having to rest to stop the leg pain. What test could be ordered to further evaluate this?
Question 8: Name three (3) differentials for Ms. Baker’s initial presentation.
Question 9: What patient education would you give Ms. Baker and her daughter? What would be your follow-up instructions?
Question 10: Would amoxicillin/clavulanate plus a macrolide have been an option to treat Ms. Baker’s Pneumonia? Explain why or why not.
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