Caring Dialogue

Patient: Jane is a 78-year-old woman who presents to your office from home Presentation: 5-day history of nasal congestion, sore throat, dry cough, low-grade fevers, malaise; over 24 hours developed productive cough with yellow sputum, worsening dyspnea on exertion, orthopnea, and ankle swelling. In clinic: T 37.9C, HR 96 bpm, BP 138/76 mmHg, RR 20/min, SpO2 92% on room air. Past medical history: Hypertension, chronic systolic heart failure (LVEF 35%), chronic kidney disease stage 3, COPD (GOLD 2), prior ischemic stroke with mild residual left weakness. Up to date on influenza and pneumococcal vaccines. Medications: ACE inhibitor, beta-blocker, furosemide, inhaled tiotropium and albuterol, low-dose aspirin, statin. Social: Lives with spouse, she is a smoker (35 pack-years). Her husband is upset because she will not stop smoking. She states “I want to stop but I just can’t do it”. General: alert, mildly dyspneic with talking. HEENT: nasal mucosal erythema, clear postnasal drip. Lungs: diffuse wheezes bilaterally, fine bibasilar crackles greater on right. Cardiovascular: regular rhythm, S3 present, jugular venous pressure mildly elevated. Extremities: 1+ pitting edema ankles. Key Initial findings Pulse oximetry: 92% on room air 94% with 2 L/min nasal cannula CBC: WBC 10.8 x10^9/L (neutrophils 78%), Hgb 13.0 g/dL, platelets 210 x10^9/L BMP: Na 137, K 4.7, Cl 102, HCO3 23, BUN 28 mg/dL, creatinine 1.6 mg/dL (baseline 1.3) BNP: 520 pg/mL (elevated from prior baseline 250) CRP mildly elevated 18 mg/L Chest X-ray (AP upright): cardiomegaly, mild interstitial congestion, small right lower-lobe patchy airspace opacity Rapid influenza antigen: negative SARS-CoV-2 PCR: negative Diagnosis: Likely viral upper respiratory infection with secondary bacterial bronchitis or small focal consolidation (early community-acquired pneumonia) and concurrent decompensated heart failure (volume overload) precipitated by infection. Advanced Pathophysiology Analysis (discuss) 1. Initial viral URTI and mucosal defense 2. Predisposition to bacterial superinfection 3. Interaction between chronic heart failure and pulmonary physiology (infection and inflammation) 4. Provide a summary of your caring approach to Jane and her husband related to her acute illness and smoking. You will be asked to post an original submission to the discussion board and reply to at least 2 other students posts with a substantive response. A substantive response adds value to the discussion by bringing new ideas, research, evidence, etc. to the conversation. I agree, Ditto and the like are not acceptable replies. Rules of Netiquette are followed. Replies are not texts with your friends. Full sentences and proper spelling are expected. Ensure that postings are detailed responses to each question and that course and chapter content are applied in your discussion responses. For example, consider taking a new approach in presenting chapter content, cite new examples, present external research (paraphrase, avoid unnecessary and/or lengthy quotations; do not plagiarize, cite references. For maximum points, please reference external research or examples. All original posts and responses to peers must be submitted by 11:59PM on Sunday for the week in which they are due. (1 point will be deducted for each day late). Please note: You must first post your original response in order to access your peers posts. Points 150 Provide evidence-based information of the pathophysiology of her URTI, what differential would you consider, immune system pathophysiology, why is an older person at risk for infections (50 points) Link symptoms to disease process (50 points) Explore the person’s experience, beliefs, and wishes; what matters most and grounded in caring (40 points) Substantial post and respond to at least two peers no Please include Advanced Physiology and Pathophysiology essentials for clinical practice by Nancy c. Tkacs and Linda L. Hermans 2nd edition as the ne of the references