Discussion #1
Scenario 1
Jackie Johnson, a 35-year-old African-American, married female, advertising executive, presents to the emergency department with complaints of chest pain. The pain is described as 8 on a scale ranging from 1 to 10, retrosternal, and sharp in nature. It radiates to the back, is worse with taking a deep breath, and is improved by leaning forward. On review of systems, she has noted a “flulike illness” over the last several days, including fever, rhinorrhea, and cough. She has no medical history and is taking no medications. She denies tobacco, alcohol, or drug use. On physical examination, she appears in moderate distress from pain, with a blood pressure of 125/85 mm Hg, heart rate 105 bpm, respiratory rate 18/min, and oxygen saturation of 98% on room air. She is currently afebrile. Her head and neck examination is notable for clear mucus in the nasal passages and a mildly erythematous oropharynx. The neck is supple, with shotty anterior cervical lymphadenopathy. The chest is clear to auscultation. Jugular veins are not distended. Cardiac examination is tachycardic with a three-component high-pitched squeaking sound. Abdominal and extremity examinations are normal.
Responses must answer for Scenario 1 Discussion:
1. Provide and discuss your list of differential diagnoses with your clinical reasoning for each one. Support your choices with relevant & current research.
2. Provide and discuss this patient’s likely diagnosis with your colleagues. Support your choice of diagnosis with current research and literature.
3. Provide and discuss what the most common causes of this disease are, and which is most likely in this patient?
4. Identify the pathophysiologic mechanism for her chest pain.
5. Develop a plan of care post-discharge based upon your recommendations living arrangements and social supports.
Support your discussion with citations from the external literature, the Shadow Health simulation assignment, and your textbook.
Discussion #2
Scenario 2
Eight-year-old Elise arrives at the clinic with severe epistaxis. On examination, a generalized purple petechial rash and hemorrhage bullae on her gums and lips are detected. She and her parents cannot recall any recent injuries, and the epistaxis began spontaneously that morning. Her only recent health issue was an upper respiratory infection 2 weeks ago. Her blood analyses indicate thrombocytopenia, and the few platelets are large. The Ivy bleeding time is prolonged, and bone marrow aspiration demonstrates increased megakaryocytes and normal erythrocytes and granulocytes. Her hemoglobin and hematocrit are in the low normal range.
Responses must answer for Scenario 2 Discussion:
1. Provide your list of differential diagnoses after studying the case study. Share your clinical reasoning for your choices with your colleagues using research and literature support.
2. What diagnosis would you finally choose from your list of diagnoses? Describe the pathophysiology behind the disorder. What causes it? Share your clinical reasoning for your choice with your colleagues using research and literature support.
3. Describe this child’s short and long term prognosis.
4. What teaching would you provide to this family as a registered nurse?
