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NR603 - Week 3 iHuman ( Joseph camella 66 years, Dyspnea), Study Guides, Projects, Research of Nursing

NR603 - Week 3 iHuman ( Joseph camella 66 years, Dyspnea)

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NR603 - Week 3 iHuman ( Joseph camella 66
years, Dyspnea)
Good Questions:
1. How can i help you today
Im having trouble breathing. My wife made me come in. She’s
worried about me.
2. Do you have any other symptoms or concerns we should discuss
An allergic cough and runny nose. I get the cough every year
during this season.
3. Do you wheeze?
Normally just when my allergies act up. Lately ive sort of
noticed wheezing at night. Thats fairly new I guess.
4. Are you short of breath when lying down?
Im always SOB
5. Do you sleep with pillows to help you breathe?
Just 1 pillows
6. Does anything make your cough better or worse?
My coughing is worse when the trees shed pollen
7. Are you taking any prescription medications?
Yes indeed. I brought my list with me here. Lisonopril 10mg daily,
HCTZ 25mg daily, glipizide 5mg daily. Also use a CPAP machine,
though it’s not really a medicine.
8. Are you taking any OTC or herbal medications?
Aleve for shoulder pain and Allergra for the allergies
9. Do you have any allergies?
Sulfa drugs, I am pretty sure im allergic to tree and grass pollen
and ragweed
10. Do you now or have you ever smoked or chewed tobacco
I was a big time smoker in the past. Started when I was 16. A pack a
day, but i stopped 10 years ago. That was hard to do.
11. Do you have a problem with fatigue/tiredness
I sure do. I get tired when i exert. I think im really out of shape, but
i also dont sleep great due to sleep apnea, and this makes me tired
during the day too
12. Have you been having fevers?
no
13. Is there any swelling in your ankles?
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NR603 - Week 3 iHuman ( Joseph camella 66

years, Dyspnea)

Good Questions:

  1. How can i help you today ● Im having trouble breathing. My wife made me come in. She’s worried about me.
  2. Do you have any other symptoms or concerns we should discuss ● An allergic cough and runny nose. I get the cough every year during this season.
  3. Do you wheeze? ● Normally just when my allergies act up. Lately ive sort of noticed wheezing at night. Thats fairly new I guess.
  4. Are you short of breath when lying down? ● Im always SOB
  5. Do you sleep with pillows to help you breathe? ● Just 1 pillows
  6. Does anything make your cough better or worse? ● My coughing is worse when the trees shed pollen
  7. Are you taking any prescription medications? ● Yes indeed. I brought my list with me here. Lisonopril 10mg daily, HCTZ 25mg daily, glipizide 5mg daily. Also use a CPAP machine, though it’s not really a medicine.
  8. Are you taking any OTC or herbal medications? ● Aleve for shoulder pain and Allergra for the allergies
  9. Do you have any allergies? ● Sulfa drugs, I am pretty sure im allergic to tree and grass pollen and ragweed
  10. Do you now or have you ever smoked or chewed tobacco ● I was a big time smoker in the past. Started when I was 16. A pack a day, but i stopped 10 years ago. That was hard to do.
  11. Do you have a problem with fatigue/tiredness ● I sure do. I get tired when i exert. I think im really out of shape, but i also dont sleep great due to sleep apnea, and this makes me tired during the day too
  12. Have you been having fevers? ● no
  13. Is there any swelling in your ankles?

● Sometimes. Not bad though

  1. Do you have a problem with generalized weakness? ● Weakness? No, I dont think i’d call it that really
  2. Do you have a cough? ● Not normally, but i have been coughing for the last couple of months

and was a smoker. My brother had HTN and heart disease too but passed from cancer

  1. Do you drink alcohol?

● A beer with my supper sometimes a couple more when im watching a game

  1. Tell me about your work ● Construction… master carpenter, then rose to foreman. I retired at 59. Too tough to continue
  2. Does your chest feel tight or heavy? ● No.
  3. How severe is your difficulty breathing? ● It seems pretty bad to me. I mean, its affecting my life too much
  4. Does anyone in your family have difficulty breathing? ● Not that ive noticed
  5. Are you coughing up blood? ● No thank god
  6. Do you have a history of lung disease? ● Never evaluated for it, though probably should be. I was exposed to asbestos years ago - and we now know thats bad stuff. Of course there were the usual fumes from stuff around you on the job site, like welding and stuff like that
  7. Do you now or have you ever had cancer? ● No thank god
  8. Have you had TB? ● Not that ive been told
  9. Do you have asthma? ● Not been diagnosed but im starting to think maybe thats whats wrong with me now.
  10. Do you have a family history of blood clots in your legs or lungs? ● no
  11. Do you have a history of deep vein thrombosis or pulmonary embolism? ● I do have ugly varicose veins. Is that the same thing?
  12. Do you have heart disease and/or have you ever had a heart attack? ● Never had a heart attack, but sometimes i worry about it a bit
  13. Is there any swelling in your legs? ● Havent noticed that at all
  14. Have you ever been diagnosed with thyroid problems? ● no
  15. Do you awaken at night short of breath? ● Not so far
  16. Do you recently travelDo ● no
  17. Is there any swelling in your feet? ● Yeah, and my shoes dont fit

● No one has ever told me that. Is that different than a heart attack

50. Do you have high cholesterol?

● I dont think so. No one has ever told me that one

51. Do you have chills?

● no

52. Do you have a history of cystic fibrosis?

● no

53. Do you have a history of valvular heart disease?

● no

54. Have you been diagnosed with a bleeding disorder?

● No

55. Have you had chicken pox, measles mumps or rheumatic fever?

● Not that I recall

56. Are you eating alot of salty

food? Not really

57. Do you have muscle pain or cramping?

● No

58. Do you have a sensation of a pounding heart in your chest?

● No

59. Do you have difficulty chewing?

● no

60. Do you have a problem with movement?

● nope

61. Did you ever have involuntary strange dance like movements?

● No i have not

62. Did you have strep throat as a child?

● Not that I remember

63. Have you recently had surgery?

● no

64. Have you eaten anything out of the ordinary lately?

● No nothing out of the ordinary

65. Do you have arthritis?

● no

66. Do you feel faint or like you might faint?

● Nope, never have passed out

67. Have you noticed any trouble with your speech?

● nope

68. Do you have a problem swallowing?

● nope

  1. Pneumonia - community acquired
  1. Heart failure
  2. Asbestosis
  3. Lung cancer
  4. Mitral regurgitation?( I would not put that one, I can not find any resources that states it as a differential)
  5. Bronchiectasis? ( I agree)
  6. Pulmonary embolism?
  7. Asthma? ( i agree)
  8. Tuberculosis
  9. Pulmonary HTN
  10. Myasthenia gravis
  11. Lou Gehrig disease? I put the ones below and got 67% (I got 80% by taking out MG, Pneumo Asbestosis, lung cancer, and TB, i think they were ruled out w/ testing) Must Not Miss
  12. Emphysema
  13. Lung cancer u
  14. Heart failure
  1. PPD( statesIt is in not needed at this time )
  1. Stress echocardiogram
  2. Cardiac stress test
  3. Troponin I
  4. Acetylcholine receptor antigen More? I did these tests below and got 89% - i didn’t get any that said they were not necessary — idk if maybe they don’t give that feedback anymore? 12-Lead ECG · Normal rhythm and axis · Mild LVH · No ischemic changes Alpha 1 antitrypsi n, blood · Normal · 1.6 (1.5-3.5) ABGs · Arterial pH 7.40 (7.35-7.45) · PaCO2 42 (35-48) · Pao2 53 (83-108) LOW · Bicarbonate 26 (22-26) · Carbon dioxide 23 (17-20) · Oxygen saturation 87% (95-99) LOW · Ba

T

· Severe upper lobe and mid lung zone centrilobular emphysema, sparing the lung bases · No interstitial infiltrates or pleural plaques d-Dimer, blood · 44 (0-300) · N o r m a l E c h o c a r d i o g

200 feet with patient complaining of moderate dyspnea Stress echocardiogram · Normal

Troponin I · N o r m a l T r o p o n i n T · N or ma l