Concerning Pathophysiology related to admitting diagnosis and/or current problem, what would be the etiology, hypothetical progression, pathophysiology, and impact of age and gender on incidence and prevalence for the patient below?

 

Patient information:  presented to the ED with multiple complaints of pain and generalized malaise. Since Monday he has had multiple problems including chest pain, and shortness of breath. His abdomen and back have an achey pain (10/10), though he says if his sugar is under control its better but he can’t stand up. L side chest pain started Monday too, sharp in nature, deep breath make it worse. No recent trauma. Last BM daily. Headache frontal times 3 days. Chronic blurry vision from cataracts. He is lightheaded on standing up but otherwise no dizziness. No nausea, vomiting, dysuria, cough, pain with chewing or coughing. Walks with a cane. No heart attacks or stents. Takes meds as prescribed. Has urinary frequency sometimes with urgency. Has history of diabetes, hypertension, cataracts, and anemia.

Age: 60s

Gender: Male

Marital Status: Single

Support system: Children and family members.

Reason for for seeking care from patient’s own words: “Pain all over”

Admitting Medical Diagnosis: Acute Pericarditis

Vital Signs: 

BP is 168/86 on left arm while patient was sitting. Pulse is 75 bpm, Respirations is 18bpm, Height is 5’9″, Weight is 306 pounds, SPO2 94% ; BMI is 45.19 kg/m^2

Cardiovascular: regular rhythm, tachycardia present, no murmurs heard during heart sounds, no friction rub, no gallop

Peripheral Vascular:  warm/ well-perfused, no edema, no joint warmth or erythema.

Respiratory:  thorax was symmetric and equal in rage during chest expansion. Lungs are clear bilaterally. No adventitious sounds.

Pain: patient with acute onset left sided sharp chest pain with diffuse ST elevations. No stemi, troponin negative. Pain worsens w/deep inspiration and sharp all more consistent with pericarditis than ischemia.

Abdominal: Bowel sounds are normal. Abdomen is soft and there is no mass during palpations. Abdominal tenderness (mild discomfort to palpation diffusely). There is no guarding.

Skin: is dry and warm, normal turgor. Findings: rash (macular, erythematous rash to the LLQ of the abdomen with in punctuate skin break at right border. No tenderness, purulence, or fluctuance present.

Neuro:  no acute motor or sensory deficits, alert and oriented to person , place, time, CNII-XII grossly intact. Transxemic attack- occlusion caused symptoms

GU:  positive for difficulty urinating. Negative for dysuria.

Abdomen/GI:   positive for abdominal pain and constipation, negative for nauseas and vomiting.

Lines:   Left peripheral IV on AC 2g

Lab values during admission:  WBC 10.3, HGB: 9.5, Platelet 115, Sodium 138, Potassium 3.6, Chloride 104, CO2 26, BUN 33, Creatinine 1.39, Calcium 8.8, Glucose 209, Hematocrit 31.1

Electrocardiogram during admission:  reveals abnormal sinus rhythm rate 101 with diffuse ST elevations in all leads. No ST depressions or t-wave inversions.

Lab values day after admission:  WBC 10.4, HGB 9.3, Platelet 115, Sodium, 136, Potassium 3.6, Chloride 104, CO2 24,  BUN 33, Creatinine 1.35, Calcium 8.6, Glucose 224, Hematocrit 30.1

Radiology during admission:  XR Chest 1 VW. Findings: There is no evidence for consolidative infiltrate, pneumothorax, or pleural effusion. Cardiomegaly is demonstrated with a stable residual prominence of the central pulmonary vasculature. No acute abnormalities are seen. Impressions: no acute cardiopulmonary process demonstrated.

Transthoracic Echo (TTE) day after admission:  Findings were normal

 

Medications: 

albuterol 2.5 mg, inhalation, TID

allopurinol, 100 mg, oral, BID

aspirin delayed release, 81 mg, oral, daily with breakfast

Atorvastatin, 20 mg, oral, bedtime

carvedilol, 3.125 mg, oral, BID with meals

colchicine, 0.6 mg, oral, BID

enoxaparin, 40 mg, subcutaneous, q12h SCH

ferrous sulfate, 1 tablet, oral, Daily with breakfast

hydrochlorothiazide, 12.5mg, oral daily

Indomethacin, 50 mg, oral, TID with meals

insulin regular, 3 units, subcutaneous, TID

losartan, 100mg, oral, daily

nifedipine XL, 30 mg, oral , daily

polyethylene glycol, 17 g, oral, daily

Living conditions promoting the spread of the COVID-19 infection (i.e.- distance from essential services, medical facilities, and grocery stores. Effect on multi-generational households and congregate living such as jails, prisons, and detention centers)

What dietary changes will help in preventing constipation? List three (3) nutrients including their food source.

How does working with care plans/ concept maps foster critical thinking in nursing? Describe how critical thinking, the nursing process, and evidence-based practice "fit" together in caring for clients

Discuss the value of professional career portfolios, including teaching philosophy, a curriculum vitae, samples of publications and writings, proof of competencies, etc. Describe how you plan to organize your portfolio, how you plan to distribute it to potential employers, what you plan to include it, and what type of educator role you would seek

 

-Consider the NLN scope of practice; what practice standards do you already feel comfortable /competent at performing, and which ones do you need to work towards accomplishing? How and why?