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Give an overview of Pharmacologic management, include rationale for prescribing and cost of medications

This is a three-part assignment the first part was done last week and below is my instructors notation that I need to go back and write up the H&P and the bates format which the book were supposed to use his Bikley Bates guided to physical examination and history taking 11th edition. I need to have the first part of this assignment corrected attached for your review is a copy of the eight-page assessment/assignment I would like to have this corrected and then we’ll start working on part two that is due next week

Unit 3 Assignment 1 (U3A1) – Geriatric Case Study Part I

Good start. Write up the H & P in the Bates format. Then, add the discussion part separately.

Dr. White

Please take part two review it and continue on with my current case study and then at the end you will see that part three will also be due.

This part here is a continuation of part one now part two has to follow the assignment instructions as outlined below:

Assignment: Geriatric case study Part II

Directions:

The student will receive feedback from faculty on Part I, which will allow for editing, updating of the diagnosis. Contact faculty with any questions regarding your diagnosis. If you do not have a correct diagnosis, the rest of your case study will be off base, or incorrect.

A. Reflection on faculty feedback, and correctness of diagnosis. Update your diagnosis, based on any faculty feedback to your part I paper. Define the current diagnosis.

B. Pathogenesis of the diagnosed condition. Include the pathophysiology of the condition, along with the possible etiology. Utilize research based articles, as well as any current text.

C. Compare your client case with the “classic” presentation of the disease state. What is similar or different regarding your client, as presented in the literature. Include a discussion on how the co-morbidities may influence the case comparison.

The third part listed below will be due in two weeks attached for your review is how it needs to be put together

Geriatric case study final project (Summative)

Purpose: The purpose of this assignment is to present a comprehensive case study of a geriatric client which uses the information and faculty feedback from two previously completed parts of the case study. Include all updated information from part 1 and part 2 in the case study.

Directions: Include all updated information from part 1 and part 2 in the case study. Reproduce both part 1 and part 2 in this final project, with corrections and suggestions by faculty integrated into your paper.

A. In addition, include the following concluding plan for management regarding your patient:

1. A comprehensive plan of prevention and intervention management which addresses the primary diagnosis and related co-morbidities.

a. Counseling and education: Provide a one page health counseling/education plan that is included in the appendix.

b.Discuss Lifespan/developmental caregiving and family considerations

c. Give overview of Pharmacologic management, include rationale for prescribing and cost of medications

d.Identify any cultural considerations with this clients management

There are three parts to this assignment part one is already done but needs to be corrected part two and part three need to be finished with a detailed explanation any questions please for free to call.

Unit 3 Assignment 1 (U3A1)

MSN-627 Geriatric Case Study Part I

Vaughn Brozek

Herzing University

Geriatric Case Study Part I

A geriatric patient with the chief complain of prostatitis is selected for this assignment. This part of assignment discusses the different parameters of patient`s condition in order to list the differential diagnosis on the basis of observed signs and symptoms. This assignment highlights the chief complaint, present illness, past history, family history, personal and social history of the patient. The diagnostic tests to be ordered along with review of the systems and physical examination. Lastly, three diagnosed health conditions are discussed after assessing the collected data.

Clinical Decision Making Based on Client Data

F.K. is an 82 year old Hispanic male patient who visited the hospital with the chief complain of fever, chill, low back pain, narrow urinary stream, urinary frequency and difficulty in urination. Patient`s medical history includes prostatitis as the major medical diagnosis. His medical history includes hypertension since the last 10 years and arthritis since the last 16 years. With respect to his present illness and past diagnosed diseases, it is essential to focus on the following elements as the part of his health assessment.

Chief Complaint

Patient came to hospital for his check-up with the chief complaints encompassing fever, chill, low back pain, narrow urinary stream, urinary frequency and difficulty in urination.

Present Illness

Patient told that he had been suffering from the mentioned signs and symptoms for three days. He is suffering from increased nocturia, decreased strength of urinary flow and slight terminal dysuria. Consequently, he possesses difficulty in instigating the flow of urine which is also eventually influencing his activities in daily routine. The patient has to pass urine 4 to 5 times daily in night as the frequency of urination has been increased. Patient is also suffering from the fever and chills for three days. He also did not take medical treatment or medication. He further told that he has recently diagnosed with the prostatitis one week ago. He denied for the blood in the stool, gross hematuria, nausea or vomiting and abdominal pain.

Past History

This patient possesses the medical history of hypertension and arthritis since 10 and 16 years respectively. His arthritis condition indicates progressive deterioration and points out towards restricted mobility allied to various concerns encompassing risk of falls, and preventable morbidity and mortality.

Any History of Surgery or Hospitalizations: Recently, he has no record of hospitalization and surgeries.

Allergies: The patient did not report any allergic reaction to medicine.

Current Medications: He takes two medicines; Tylenol 500 mg twice a day for pain allied to arthritis and Capoten 25 mg once daily for hypertension. He also takes calcium supplement and multivitamin.

Family History

Parents of patient are not alive. His father was died due to prostate cancer. He was also the patient of hypertension. On the other hand, his mother was died due to Tuberculosis. She was patient of osteoporosis as well. Patient is elder brother of two brothers and one younger sister. All are alive and living with different health conditions. His brothers are 75 and 60 years old with the major disease of arthritis and respectively hypertension. On the other hand, his 68 years old sister has diagnosed with osteoarthritis and hypertension. Genogram is in Appendix.

Personal and Social History

He is living alone after the death of his wife; and although his son and daughter in-law lives nearby he is reluctant to move in with them. The patient has been living in the same house since his marriage and has sentimental and emotional attachment to the place due to which he is not willing to move out. The patient displays signs of social isolation and risk of depression. Patient appears well aware and conformable about his surroundings. Although the patient does not express any difficulties in performing daily activities, it was noted during patient assessment that he is unable to perform several daily chores. He has several other family members around the country; and his two brothers live at a distance of 6 hour drive from his place. Patient does not have financial issues, he receives the health care expense or health coverage from Medicaid program and

Occupation: The patient is well qualified and an engineer by profession.

Lifestyle (diet and exercise): The patient takes home made meal. However, most of the food contains the ready to eat meal. He also goes for walk as he cannot exercise due to pain associated to arthritis.

Substance use: The patient is a non-smoker and does not take substance abuse nor he drinks alcohol.

Physical Exam and Review of Systems

Vital Signs: HR 80, RR 20, BP 120/78, T 101, Wt 188lbs

Musculoskeletal: + low back pain

Extremities, Including Pulses: 2 + pulse throughout and no edema in the lower legs

Genital/Pelvic: Never feels emptied, Urinary stream narrow, no tenderness or masses, testes are descended bilaterally, no penial discharge, masses, or lesions, circumcised.

Rectum: Prostate enlarged, boggy and tender to palpation, stool light brown

GI: + rebound, + TTP all quadrants, – masses/ hernia /organomegaly, +bowel sounds

Carotids: No bruits

Heart: RRR with Grade II/VI systolic murmur heard at the right border of sternum

Lungs: Clear, CTA bilaterally, good effort

Lymph Nodes: cervical lymphadenopathy

HEENT: unremarkable

Psych: decreased mood/affect, + judgment/insight

Lab Tests and Results: PSA: 8.6, CBC: elevated level of WBCs

Diagnostic Tests to be Ordered

Further tests will include urine culture in order to diagnose the chronic bacterial prostatitis as previously the patient was diagnosed with prostatitis only on the basis of PSA test report and elevated WBCs in CBC report. Patient will also be recommended for further PSA test following one week of medication treatment in order to evaluate the inflammation of prostate and further management of disease (Park et al., 2013). Histological test of prostate will also be recommended as he possesses the high risk of prostate cancer respecting his family history (Edlin et al., 2012).

Differential Diagnosis

On the basis of gathered data and signs patient illness, the main diagnosis is prostatitis (Park et al., 2013). The differential diagnosis based on data includes chronic bacterial prostatitis, urinary tract infection, urethritis and acute urinary retention. Concerning the prostatitis, there is a high risk of chronic bacterial prostatitis as the patient has been suffering from the discussed sign and symptoms for many days (Croswell, Kramer & Crawford, 2011). The co morbidities other than the chief complaints include hypertension, pain in legs and joints due to arthritis, and depression due to social isolation. The hypertension is allied to depression, social isolation and inadequate diet containing ready to eat meal. The patient’s prostatitis condition and problems with urination are also a risk towards social isolation and restricted home chores and intake of inadequate diet.

References

Park, D. S., Oh, J. J., Hong, J. Y., Hong, Y. K., Choi, D. K., Gong, I. H., & Kwon, S. W. (2013). Serum prostate-specific antigen as a predictor of prostate volume and lower urinary tract symptoms in a community-based cohort: a large-scale Korean screening study. Asian Journal of Andrology, 15(2), 249-253, doi: 10.1038/aja.2012.132

Edlin, R. S., Heyns, C. F., van Vuuren, S. P., & Zarrabi, A. D. (2012). Prevalence of histological prostatitis in men with benign prostatic hyperplasia or adenocarcinoma of the prostate presenting without urinary retention. South African Journal of Surgery, 50(4), 127-130, Retrieved from https://www.sajs.org.za/index.php/sajs/article/view/1095/539

Croswell, J. M, Kramer, B. S, & Crawford, E. D. (2011). Screening for prostate cancer with PSA testing: Current status and future directions. Oncology, 25(6), 452-60.

Appendix


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