Assignment: Chronic Disease Essay

Assignment: Chronic Disease Essay

Assignment Chronic Disease Essay

In the case scenario, a 60-year old female patient presents with complaints of increased shortness of breath (SOB) and a non-productive cough in the last month. She reports that fatigue limits her daily activities and also has SOB when in a recumbent position. She has a medical history of coronary artery disease and high blood pressure. On physical examination, she is in no acute distress, BP of 160/100, a pulse of 100, and the respiratory rate is 16.  On auscultation, there are distant air sounds and crackles in the lower lobes on late inspiration.  Cardiac examination reveals distant SI and S2 and S3 perceived over the apex.

Chief Complaint

The chief complaints are shortness of breath, non-productive cough, and limitation of activity.

Differential Diagnosis

Left-Sided Heart Failure: The typical symptoms of heart failure include breathlessness, orthopnea, paroxysmal nocturnal dyspnea, reduced exercise tolerance, fatigue, prolonged time to recover after exercise, and ankle swelling (Redfield, 2016). Less typical symptoms include nocturnal cough, wheezing, confusion, palpitations, syncope, and bendopnea (dyspnea on bending over). Physical findings in heart failure include third heart sound, lateral displaced apical impulse, hepato jugular reflex, and tachycardia, dullness on percussion at the lung bases, pulmonary crackles and elevated jugular venous pressure (Ziaeian & Fonarow, 2016).

Heart failure is the most likely diagnosis as per the patient’s symptoms of SOB, cough, fatigue, and limitation of activity and a history of coronary artery disease. Besides, positive physical findings of tachycardia, distant air sounds, and crackles in the lower lobes make heart failure the most probable diagnosis.

Hypertensive heart disease: It is caused by a chronic high BP and presents with symptoms of chest pain, chest tightness, SOB, persistent cough, fatigue, ankle swelling and loss of appetite (Dawber, Moore & Mann, 2015). On physical examination, there is an elevated BP, high pulse, distended jugular veins, decreased breath sounds, ankle edema but with a normal S. Hypertensive heart disease is a possible diagnosis as per the symptoms of SOB, cough, fatigue, history of hypertension and physical findings of distant air sounds, high BP and an elevated pulse.

Cardiogenic Pulmonary Edema (CPE): Patients with CPE present with extreme SOB on exertion that has a sudden onset. Other

symptoms include cough, profuse diaphoresis, orthopnea, and paroxysmal nocturnal dyspnea (Dawber, Moore, & Mann, 2015). Physical findings in CPE include tachycardia, tachypnea, hypertension, and fine rales at lung bases, and S gallop on auscultation (Ziaeian & Fonarow, 2016). CPE is a probable diagnosis based on the patient’s history of hypertension, cough, SOB on exertion, orthopnea, as well as physical findings of tachycardia, high BP, and S3.

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Treatment Plan

Diagnostic tests: Investigations will include chest x-ray, electrocardiogram, echocardiography, and Natriuretic peptides level to assist in diagnoses of heart failure and to rule out differential diagnoses (Redfield, 2016).

Medications: Pharmacotherapy will aim at lowering BP and reducing morbidity.

1. Carvedilol 25 mg BD; to improve left ventricular ejection fraction.
2. Furosemide 40 mg BD; to control fluid status.

• Enalapril 10 mg BD; for vasodilatation and neurohormonal modification.

Health education: I will encourage the patient to adhere to the drug regimen, report adverse effects, and avoid NSAIDs. Nutritional counseling will be offered, the patient will be advised to avoid high sodium foods, alcohol, and have a balanced diet rich in vegetables, whole grains, and fruits (Redfield, 2016). Lastly, I will advise her to avoid strenuous exercises and take rests when experiencing breathlessness.

Follow-up: A follow-up visit will be scheduled after two weeks to monitor BP and evaluate progress. The patient will be advised to seek emergency care if her symptoms worsen.

A sixty-year-old baker presents to your clinic, complaining of increasing shortness of breath and nonproductive cough over the last month. She feels like she can\’t do as much activity as she used to do without becoming tired. She even has to sleep upright in her recliner at night to be able to breathe comfortably. She denies any chest pain, nausea, or sweating. Her past medical history is significant for high blood pressure and coronary artery disease. She had a hysterectomy in her 40s for heavy vaginal bleeding. She is married and is retiring from the local bakery soon. She denies any tobacco, alcohol, or drug use. Her mother died of a stroke, and her father died from prostate cancer. She denies any recent upper respiratory illness, and she has had no other symptoms. On examination, she is in no acute distress. Her blood pressure is 160/100, and her pulse is 100. She is afebrile, and her respiratory rate is 16. With auscultation, she has distant air sounds and she has late inspiratory crackles in both lower lobes. On cardiac examination, the S1 and S2 are distant and an S3 is heard over the apex.
What is the chief complaint?
Based on the subjective and objective information provided what are your 3 top differential diagnosis listing the presumptive final diagnosis first?
What treatment plan would you consider utilizing current evidence based practice guidelines?

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The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies.

Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances.

If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect.

I do not accept assignments that are two or more weeks late unless we have worked out an extension.

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Communication is so very important. There are multiple ways to communicate with me:

Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class.

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Important information for writing discussion questions and participation

Welcome to class

Hello class and welcome to the class and I will be your instructor for this course. This is a -week course and requires a lot of time commitment, organization, and a high level of dedication. Please use the class syllabus to guide you through all the assignments required for the course. I have also attached the classroom policies to this announcement to know your expectations for this course. Please review this document carefully and ask me any questions if you do. You could email me at any time or send me a message via the “message” icon in halo if you need to contact me. I check my email regularly, so you should get a response within 24 hours. If you have not heard from me within 24 hours and need to contact me urgently, please send a follow up text to

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Please, be advised I do NOT accept any assignments by email. If you are having technical issues with uploading an assignment, contact the technical department and inform me of the issue. If you have any issues that would prevent you from getting your assignments to me by the deadline, please inform me to request a possible extension. Note that working fulltime or overtime is no excuse for late assignments. There is a 5%-point deduction for every day your assignment is late. This only applies to approved extensions. Late assignments will not be accepted.

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Plagiarism is highly prohibited. Please ensure you are citing your sources correctly using APA 7th edition. All assignments including discussion posts should be formatted in APA with the appropriate spacing, font, margin, and indents. Any papers not well formatted would be returned back to you, hence, I advise you review APA formatting style. I have attached a sample paper in APA format and will also post sample discussion responses in subsequent announcements.

Your initial discussion post should be a minimum of 200 words and response posts should be a minimum of 150 words. Be advised that I grade based on quality and not necessarily the number of words you post. A minimum of TWO references should be used for your initial post. For your response post, you do not need references as personal experiences would count as response posts. If you however cite anything from the literature for your response post, it is required that you cite your reference. You should include a minimum of THREE references for papers in this course. Please note that references should be no more than 5 years old except recommended as a resource for the class. Furthermore, for each discussion board question, you need ONE initial substantive response and TWO substantive responses to either your classmates or your instructor for a total of THREE responses. There are TWO discussion questions each week, hence, you need a total minimum of SIX discussion posts for each week. I usually post a discussion question each week. You could also respond to these as it would count towards your required SIX discussion posts for the week.

I understand this is a lot of information to cover in 5 weeks, however, the Bible says in Philippians 4:13 that we can do all things through Christ that strengthens us. Even in times like this, we are encouraged by God’s word that we have that ability in us to succeed with His strength. I pray that each and every one of you receives strength for this course and life generally as we navigate through this pandemic that is shaking our world today. Relax and enjoy the course!

Hi Class,

Please read through the following information on writing a Discussion question response and participation posts.

Contact me if you have any questions.

Important information on Writing a Discussion Question

• Your response needs to be a minimum of 150 words (not including your list of references)
• There needs to be at least TWO references with ONE being a peer reviewed professional journal article.
• Include in-text citations in your response
• Do not include quotes—instead summarize and paraphrase the information
• Follow APA-7th edition
• Points will be deducted if the above is not followed

Participation –replies to your classmates or instructor

• A minimum of 6 responses per week, on at least 3 days of the week.
• Each response needs at least ONE reference with citations—best if it is a peer reviewed journal article
• Each response needs to be at least 75 words in length (does not include your list of references)
• Responses need to be substantive by bringing information to the discussion or further enhance the discussion. Responses of “I agree” or “great post” does not count for the word count.
• Follow APA 7th edition
• Points will be deducted if the above is not followed
• Remember to use and follow APA-7th edition for all weekly assignments, discussion questions, and participation points.
• Here are some helpful links
• Student paper example
• Citing Sources
• The Writing Center is a great resource