You are seeing S.F., a 74-year-old. Hispanic male in the office this morning for difficulty breathing.
Background:
S.F. presents with increased dyspnea on exertion that has become progressively worse over the last 3 days. You observe that he is using pursed lip breathing as he explains his chief complaint. He reports that he has been coughing up a moderate amount of thick, green sputum for approximately one week that was accompanied by a fever of 100.6 and chills. He took Ibuprofen 400 mg every 4 hours and increased his fluid intake for the last week. Two days ago he noticed that the sputum is now yellow rather than green and that he has not experienced any more fever. Overall, he feels like he is getting better. However, the dyspnea on exertion developed three days ago without relief despite the use of his Spiriva HandiHaler. He reports that he lost his rescue inhaler and has not had it to use in over 2 months.
PMH:
COPD
Hypertension
Osteoarthritis
Current medications:
Asprin-81 daily
Cyclobenzaprine 10 mg prn
Meloxicam 15 mg daily
Metoprolol 25 mg daily
Spiriva HandiHaler daily as directed
Tramadol 50 mg daily prn
Surgeries:
Appendectomy as a child (date unknown)
2004-Left cataract extraction with intraocular lens placement
2008-Right cataract extraction with intraocular lens placement
Allergies: NKA
Vaccination History:
Influenza vaccine- October 2013
Pneumovax-2010
His last TD-can’t remember
Has not a TDAP/TD in 20 years
Screening History:
Last Colonoscopy was 2012-normal
Last dilated retinal and glaucoma exam was 2013
Social history:
Retired roofer-stopped working in 2004 due to arthritis and pain in his rotator cuff. Is married and lives with spouse. They have 4 grown children who live within a 10 mile radius of them. Currently smokes-is down to ½ pack cigarettes daily. Has smoked for 45 years total.
Family history:
Father is deceased and had a history of hypertension and diabetes; Mother is deceased and had a history of CAD/MI; Sister-history of colon cancer.
Discussion Part One:
Provide differential diagnoses (DD)with rationale.
Further ROS questions needed to develop DD.
Based on the patient data provided, choose geriatric assessment tools that would be appropriate to use in conducting a thorough geriatric assessment. Provide a rationale on why you are choosing these particular tools.
NR 601 Week 4 Case Study Discussions Physical Examination (Part-1) Provide differential diagnoses (DD)with rationale
NR 601 Week 4 Case Study Discussions Physical Examination (Part-1) Provide differential diagnoses (DD)with rationale Grading Rubric Guidelines
Performance Category
10
9
8
4
0
Scholarliness
Demonstrates achievement of scholarly inquiry for professional and academic decisions.
Provides relevant evidence of scholarly inquiry clearly stating how the evidence informed or changed professional or academic decisions
Evaluates literature resources to develop a comprehensive analysis or synthesis.
Uses valid, relevant, and reliable outside sources to contribute to the threaded discussion
Provides relevant evidence of scholarly inquiry but does not clearly state how the evidence informed or changed professional or academic decisions.
Evaluates information from source(s) to develop a coherent analysis or synthesis.
Uses some valid, relevant, reliable outside sources to contribute to the threaded discussion.
Discusses using scholarly inquiry but does not state how scholarly inquiry informed or changed professional or academic decisions.
Information is taken from source(s) with some interpretation/evaluation, but not enough to develop a coherent analysis or synthesis.
Little valid, relevant, or reliable outside sources are used to contribute to the threaded discussion.
Demonstrates little or no understanding of the topic.
Discusses using scholarly inquiry but does not state how scholarly inquiry informed or changed professional or academic decisions.
Information is taken from source(s) without any interpretation/evaluation.
The posting uses information that is not valid, relevant, or reliable
No evidence of the use of scholarly inquiry to inform or change professional or academic decisions.
Information is not valid, relevant, or reliable
Performance Category
10
9
8
4
0
Application of Course Knowledge –
Demonstrate the ability to analyze, synthesize, and/or apply principles and concepts learned in the course lesson and outside readings and relate them to real-life professional situations
Posts make direct reference to concepts discussed in the lesson or drawn from relevant outside sources;
Applies concepts to personal experience in the professional setting and or relevant application to real life.
Posts make direct reference to concepts discussed in the lesson or drawn from relevant outside sources.
Applies concepts to personal experience in their professional setting and or relevant application to real life
Interactions with classmates are relevant to the discussion topic but do not make direct reference to lesson content
Posts are generally on topic but do not build knowledge by incorporating concepts and principles from the lesson.
Does not attempt to apply lesson concepts to personal experience in their professional setting and or relevant application to real life
Does not demonstrate a solid understanding of the principles and concepts presented in the lesson
Posts do not adequately address the question posed either by the discussion prompt or the instructor’s launch post.
Posts are superficial and do not reflect an understanding of the lesson content
Does not attempt to apply lesson concepts to personal experience in their professional setting and or relevant application to real life
Posts are not related to the topics provided by the discussion prompt or by the instructor; attempts by the instructor to redirect the student are ignored
No discussion of lesson concepts to personal experience in the professional setting and or relevant application to real life
Performance Category
5
4
3
2
0
Interactive Dialogue
Replies to each graded thread topic posted by the course instructor, by Wednesday, 11:59 p.m. MT, of each week, and posts a minimum of two times in each graded thread, on separate days.
(5 points possible per graded thread)
Exceeds minimum post requirements
Replies to each graded thread topic posted by the course instructor, by Wednesday, 11:59 p.m. MT, of each week, and posts three or more times in each graded thread, over three separate days.
Replies to a post posed by faculty and to a peer
Summarizes what was learned from the lesson, readings, and other student posts for the week.
Replies to each graded thread topic posted by the course instructor, by Wednesday, 11:59 p.m. MT, of each week, and posts a minimum of two times in each graded thread, on separate days
Replies to a question posed by a peer
Summarizes what was learned from the lesson, readings, and other student posts for the week.
Meets expectations of 2 posts on 2 different days.
The main post is not made by the Wednesday deadline
Does not reply to a question posed by a peer or faculty
Has only one post for the week
Discussion posts contain few, if any, new ideas or applications; often are a rehashing or summary of other students’ comments
Does not post to the thread
No connections are made to the topic
Minus 1 Point
Minus 2 Point
Minus 3 Point
Minus 4 Point
Minus 5 Point
Grammar, Syntax, APA
Note: if there are only a few errors in these criteria, please note this for the student in as an area for improvement. If the student does not make the needed corrections in upcoming weeks, then points should be deducted.
Points deducted for improper grammar, syntax and APA style of writing.
The source of information is the APA Manual 6th Edition
2-3 errors in APA format.
Written responses have 2-3 grammatical, spelling, and punctuation errors.
Writing style is generally clear, focused, and facilitates communication.
4-5 errors in APA format.
Writing responses have 4-5 grammatical, spelling and punctuation errors.
Writing style is somewhat focused.
6-7 errors in APA format.
Writing responses have 6-7 grammatical, spelling and punctuation errors.
Writing style is slightly focused making discussion difficult to understand.
8-10 errors in APA format.
Writing responses have 8-10 grammatical, spelling and punctuation errors.
Writing style is not focused, making discussion difficult to understand.
Post contains greater than 10 errors in APA format.
Written responses have more than 10 grammatical, spelling and punctuation errors.
Writing style does not facilitate communication.
The student continues to make repeated mistakes in any of the above areas after written correction by the instructor
0 points lost
-5 points lost
Total Participation Requirements
per discussion thread
The student answers the threaded discussion question or topic on one day and posts a second response on another day.
The student does not meet the minimum requirement of two postings on two different days
Early Participation Requirement
per discussion thread
The student must provide a substantive answer to the graded discussion question(s) or topic(s), posted by the course instructor (not a response to a peer), by Wednesday, 11:59 p.m. MT of each week.
The student does not meet the requirement of a substantive response to the stated question or topic by Wednesday at 11:59 pm MT.
