NSG 323-811 Shadow Health_INFORMATION PROCESSING {UPDATED} | NSG323-811 Shadow Health_INFORMATION PROCESSING {UPDATED}

NSG 323-811 Shadow Health_INFORMATION PROCESSING {UPDATED} Each relevant diagnosis is scored on a four-point scale: • Priority (1 point): the correct priority of the diagnosis was chosen • Evidence (up to 2 points): the strength of the patient cue(s) selected as evidence for the identified diagnosis o Required Evidence: selecting at least one cue that directly indicates the presence of a problem or risk is worth 2 points o Supporting Evidence: selecting at least one cue that is a contributing factor or cause of a problem or risk, without the presence of Required Evidence, is worth 1 point • Planning (1 point): the plan proposed to address the diagnosis includes at least one correct component Relevant Diagnoses  1. Acute pain of the foot 4 of 4 points Priority 1 / 1 Student Response:  High Correct Priority: High  Priority Pro Tip: Managing acute pain is an immediate high priority, because other health concerns cannot be effectively addressed while a patient experiences severe pain. Evidence 2 / 2 Relevant "Yeah, it got a lot worse two days ago. It was noticeably more painful." Required Evidence "I'd say a 7. It hurts a lot, and the pain pills haven't kicked in yet." Required Evidence "It's throbbing and like, sharp if I try to put weight on it." Required Evidence "No, I can't. I can't put any weight on it without like, shooting pain." Required Evidence Irrelevant "It's called tramadol."  Evidence Pro Tip: Tina reports intense pain and rates her pain on a numerical scale. She also reports characteristics of the pain, including its duration of one week; this timespan defines her pain as acute. Planning 1 / 1 Relevant Intervene - Prescribe: Prescribe medications to treat pain. Irrelevant Intervene - Labs: Obtain a wound culture. Intervene - Labs: Order a 24 hour urine test for free cortisol and creatinine. Intervene - Labs: Order a basic metabolic panel to assess renal function. Intervene - Labs: Order a complete blood count test (CBC). Intervene - Labs: Order a fasting lipid panel to evaluate for dyslipidemia. Intervene - Labs: Order a hemoglobin A1C test to establish baseline. Intervene - Labs: Order a test of serum IGF-1 (insulin like growth factor). Intervene - Prescribe: Prescribe a first-line drug for blood glucose control, such as metformin. Intervene - Other: Refer to ob/gyn for further evaluation and management. Educate - Medication: Educate the patient on diabetes medication action, dose, and schedule. Educate - Health Maintenance: Educate the patient on the impact of diet, exercise, and weight loss on glycemic control. Educate - Health Maintenance: Educate the patient on the role of lifestyle changes, including diet and exercise, in improving health outcomes. Educate - Health Maintenance: Educate the patient on wound care procedure. Educate - Disease Process: Educate the patient on associated risks of hypertension with diabetes. Educate - Disease Process: Educate the patient on relation of genetic and lifestyle factors, including diet, with hypertension. Educate - Disease Process: Educate the patient on the risks of morbidity and mortality due to obesity and comorbidities. Educate - Disease Process: Educate the patient on the signs and symptoms of hyper- and hypoglycemia. Educate - Disease Process: Educate the patient on the signs and symptoms of worsening infection. Educate - Disease Process: Educate the patient regarding the relationship of diabetes mellitus and peripheral vascular disease.  Planning Pro Tip: Intervene to reduce the pain by prescribing an appropriate analgesic and educating the patient on its effective use and potential side effects. Provide the patient with options for non-pharmacological pain relief, such as RICE (rest, ice, compression, elevation). - - - - - - - - - - - - - - - - - - - - - - - Student Response:  (No Priority Selected) Correct Priority: Low  Priority Pro Tip: Oligomenorrhea is a secondary issue caused by Tina's endocrine and metabolic disorders and thus is a lower priority diagnosis. Evidence 0 / 2 Relevant (None provided) Irrelevant (None provided)  Evidence Pro Tip: Tina reports having about 6 periods per year, meeting the criteria for oligomenorrhea, which are periods more than 35 days apart or 9 per year. Her periods occur fewer than 90 days apart, making oligomenorrhea the correct diagnosis rather than amenorrhea. Planning 0 / 1 Relevant (None provided) Irrelevant (None provided)  Planning Pro Tip: Endocrine disorders are the cause of Tina's irregular menstruation, so order labs to evaluate for poly-cystic ovarian syndrome and thyroid disease. Inspect for both hair growth indicative of excessive androgen production and that indicative of deficient production, and inspect for acanthosis nigricans. Educate your patient on keeping a menstrual calendar to more precisely identify irregularities in her cycle.  10. Polycystic ovarian syndrome 0 of 4 points Priority 0 / 1 Student Response:  (No Priority Selected) Correct Priority: Low  Priority Pro Tip: PCOS is the root cause of several of Tina's symptoms and should be addressed. However it is lower priority than Tina's acute problems; addressing her pain and hyperglycemia are more immediate needs to improve her status. Evidence 0 / 2 Relevant (None provided) Irrelevant (None provided)  Evidence Pro Tip: The Rotterdam criteria should be used to establish a diagnosis of PCOS. At least two of the following must be present: ovulatory dysfunction (Tina reports infrequent menstruation), androgen excess (Tina reports excess hair in a male pattern), or poly-cystic ovaries. Diabetes, obesity, and acanthosis nigricans - all reported by Tina - are common signs and symptoms of PCOS. Planning 0 / 1 Relevant (None provided) Irrelevant (None provided)  Planning Pro Tip: A pelvic exam should be performed in order to assess for palpable enlargement of the ovaries. An ultrasound may be needed to evaluate for cysts of the ovaries. Educate Tina regarding PCOS and its relationship to diabetes. Work with Tina to assist her in establishing GYN care. Further assessment and lab work may be performed to evaluate for androgen excess. Other Diagnoses Identified (No other diagnoses were identified)