Purpose
Problem-based learning is a methodology designed to help students develop the reasoning process used in clinical practice through problem solving actual patient problems in the same manner as they occur in practice. The purpose of this activity is to develop students’ clinical reasoning skills using a case-based learning exercise. Through participation in an online discussion forum, students identify learning issues in a self-directed manner which facilitates learning for the entire group.
Activity Learning Outcomes
Through this discussion, the student will demonstrate the ability to:
- Demonstrate competence in the evaluation and management of common respiratory problems (WO 2.1) (CO 2,3,4,5)
- Distinguish between obstructive and restrictive lung disease (CO 2, 4) Develop a management plan for the case study patient based on identified primary, secondary and differential diagnoses. (WO 2.2) (CO 2,4)
- Interpret pulmonary function test results. (WO 2.3) (CO 2, 4)
Due Date:
Student enters initial post to part one by 11:59 p.m. MT on Thursday; responds substantively to at least one topic-related post of a peer including evidence from appropriate sources AND all direct faculty questions in parts one by Sunday, 11:59 p.m. MT.
A 10% late penalty will be imposed for discussions posted after the deadline on Thursday 11:59pm MT, regardless of the number of days late. NOTHING will be accepted after 11:59pm MT on Sunday (i.e. student will receive an automatic 0). Week 8 discussion closes on Saturday at 11:59pm MT.
Total Points Possible: 50
Case Study – Part 2
You ordered a CXR and spirometry at the previous visit and he returns today to review the results. Physical exam and symptoms are unchanged since last visit. Vital signs at this visit are: Temp-98.3, P-68, RR-20, BP 152/90, Height 68.9in., Weight 258 pounds, O2sat 94% on RA
CXR Result:
No acute infiltrates or consolidations are seen. Cardiac and mediastinal silhouettes are normal. No hilar enlargement is evident. Osseous thorax is intact.
Spirometry Results:
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Requirements/Questions:
- What is your primary (one) diagnosis for this patient at this time? (support the decision for your diagnosis with pertinent positives and negatives from the case)
- Identify the corresponding ICD-10 code.
- Provide a treatment plan for this patient’s primary diagnosis which includes:
- Medication*
- Any additional testing necessary for this particular diagnosis*
- Patient education
- Referral
- Follow up
- Provide an active problem list for this patient based on the information given in the case.
- Are there any changes that you would also make to this patient’s overall treatment plan at this time? Must provide an EBP argument for each treatment or testing decision.
*If part of the plan does not warrant an action, you must explain why. ALL medication and testing decisions (or decisions not to treat with medication or additional testing) MUST be supported with an evidence-based practice (EBP) argument. Over-the-counter (OTC) and RXs must be written in full as if handing a script to the patient in the office.
Over-the-counter (OTC) and RXs must be written in full as if handing a prescription to the patient in the office.
Example:
Amoxicillin 500 mg capsule
1 tab po BID q 10 days
Disp #20 no refills
Solution:
Final Diagnosis
Following the spirometer test, the most probable diagnosis is Chronic Obstructive Pulmonary Disorder (COPD) J44.9 ICD-10. The spirometer test shows that the FEVI value is less than 80% of the FVC. That alone indicates the possibility of pneumonia. However, both FEV1 and FVC have decreased proportionally, indicating a more restrictive lung disorder (COPD). Considering the earlier observations, the client experiences the inability to hold his breath and lack of energy to walk around. Also, the chronic cough and the former pulmonary hypertension indicate a possibility of COPD. Necessarily, the only symptom that justifies COPD over pneumonia, and heart disease is that the patient is not able to perform some everyday activities without excessive resting (Postma, & Rabe, 2015). The shortage of oxygen among COPD patients prevents them from completing regular events such as walking, working, and other physical activities.
Treatment Plan
The patient needs medications that will help him manage his pulmonary disorder to improving the tidal volume of lungs.
Medical Treatment
First-Line treatment drugs include 5-HT reuptake inhibitors. According to Horita and Kaneko, (2015), these drugs are recommended for COPD treatments due to their high efficacy.
- Fluvoxamine oral tablets
Initial immediate-release tablet dose: 50 mg orally once a day at bedtime
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