Chief Complaint Just Question & Answer Guide (With Explanation)
This type of question evaluates analytical and critical thinking skills.
What This Question Is About
This question relates to chief complaint just and requires a structured academic response.
How to Approach This Question
Use appropriate theories and support your answer with clear reasoning.
Key Explanation
This topic involves chief complaint just. A strong answer should include explanation, application, and examples.
Original Question
CHIEF COMPLAINT: “just not feeling right” HISTORY OF PRESENT ILLNESS T.K., a 70-year-old white male who lives alone, presents to the family practice with a chief complaint of “just not feeling right for 2-3 days.” Last week he had lunch with his daughter and granddaughter, who had an upper respiratory infection. He developed a cold last week that was treated with Mucinex DM. He did not seek health care, since the medication was helpful; and he thought that it was resolved. He admits to increasing fatigue and found it difficult to “get started with his usual routine this morning.” The fatigue initially started with a lack of energy; he has been unable to take his daily short walk and did not want to get out of bed this morning. Yesterday, he forgot a lunch scheduled with his daughter and forgot to take his medications. PAST MEDICAL & SURGICAL HISTORY: Hypertension: 10 years; osteoarthritis: 5 years; hearing aid and glasses: 5 years. Influenza, and COVID-19 vaccinations this year. Pneumovax 4 years ago. PPD 2 years ago was negative. Dental and eye exams 1.5 years ago. Appendectomy 30 years ago. CURRENT OUTPATIENT MEDICATIONS Zestoretic 10/25mg Aleve PRN ALLERGIES: Penicillin; Latex. FAMILY HISTORY: Father died at age 66 years from a myocardial infarction (MI), and mother died at age 75 from an MI. One sibling age 72 with hypertension and type 2 diabetes mellitus; a 45-year-old daughter divorced with hypertension; one 5-year-old healthy grandchild; and a 40-year-old married son, alive and well. SOCIAL HISTORY: Retired accountant who continues to live in a one-level home that he and his wife resided in for 40 years. He has a weekly housekeeper who cooks some meals; otherwise, he eats many pre-packaged foods. He has good retirement benefits and adequate savings with health insurance. Difficult transition without wife; usually refuses socialization with friends. Drives car. Spends day watching television; reading history; and interacting with Eddie, his 9-year-old dachshund. BEHAVIORAL: Smoked cigarettes for 15 years, has smoked none for the last 20 years. Drinks 4-6 oz wine daily, for 30+ years REVIEW OF SYSTEMS: He denies changes in vision or hearing. He denies headaches and myalgias. He denies fever, but admits to “some” shortness of breath with exertion. He denies cough, chest pain, or palpitations, but admits to feeling congested and having tightness in his chest at intervals, especially with exertion. He denies rhinorrhea, dysphagia, otalgia, sputum production, fever, or chills. He denies anorexia, abdominal pain, and changes in his bowel habits. He denies changes in urinary habits. He has had no falls. He admits to being lonely but verbalizes no suicidal ideations. PHYSICAL EXAMINATION Vital signs: Temperature 99.2°F oral, heart rate 70 beats per minute, blood pressure 130/80 mm Hg, respiratory rate 24 breaths per minute, O2 saturation 95% on room air. Exam: General: Well nourished; appropriately dressed for season and setting; in no apparent distress. Skin: healthy color, with elastic recoil. HEENT: Normocephalic; no dentures, mild plaque noted on teeth; mild AV nicking, sinuses non- tender; TMs pearly gray; nares patent with small amount of yellow drainage; pharynx pink, no lymphadenopathy, thyroid nontender. Cardiovascular: No JVD or anterior chest pulsations noted; carotids palpable and without bruits; S1 and S2 noted with regular rhythm; 2/6 systolic ejection murmur. No edema, 2+ pulses of upper extremities. Pedal pulses are 1+. Respiratory: AP/transverse diameter is 1â„2; equal and symmetrical chest expansion; no fremitus; mild dullness to percussion in right lower lobe; basilar crackles and expiratory wheezes in right lung; no extra lung sounds. Abdomen: No pulsations noted; bowel sounds noted in all quadrants; nontender to palpation; no organomegaly. Neurologic: Alert and oriented x4; follows commands appropriately; thought processes intact but somewhat slow in responses; gait steady, but slightly unsteady on feet. DIAGNOSTICS Laboratory Findings: Complete blood count: WBC count of 12,700/mm3 with 74% neutrophils and 12% bands; Hgb 14; HCT 45. Complete Metabolic Panel: Na: 140; K: 4.2; glucose: 86; BUN: 10; creatinine: 1.2; albumin: 4.1. Sputum specimen obtained following Albuterol nebulizer treatment: Streptococcus pneumoniae, greater than 25 WBCs, and fewer than 10 epithelial cells per high-power field on gram stain with encapsulated gram-positive diplococci. CXR anterior/posterior and lateral: minor emphysematous changes and an almost complete right lower lobe infiltrate. Based on the main diagnosis of this patient you, the nurse practitioner identify, you will submit your case study completed in the sections identified below: 1. Definition of diagnosis you suspect in this patient 2. Epidemiology 3. Etiology/Classification 4. Risk Factors of the diagnosis – concentrating on the ones specifially for Immunity/Inflammation/Infection focus of this weeks content 5. Pathophysiology- with emphasis on Immunity/Inflammation/Infection focus of this weeks content 6. Clinical Presentation (including History and Physical Exam pertinent findings of the typical presentation of this diagnosis) 7. Diagnosis (including criteria, laboratory findings, imaging) 8. Management of the disease 9. Prevention of recurrence 10. Complications and Prognosis Bonus- Differential Diagnoses. If you accurately list the pertinent differential diagnoses for this patient, you will be awarded bonus points per the rubric. Note: Use 3 or more references. List your content in sections denoting the headings 1-10 and in the order listed above. Bonus differential diagnoses can be included at the end of your submitted case study. Rubric Case Study Rubric Week 3 Criteria Ratings Pts This criterion is linked to a Learning OutcomeEpidemiology, Etiology/Classification & Risk Factors 16 pts Excellent Complete inclusion of epidemiology, etiology/classification data, and pertient risk factors 12.45 pts Good Incomplete inclusion of epidemiology, etiology/classification data, and pertient risk factors. Missing 1-4 data points. 8.89 pts Fair Incomplete inclusion of epidemiology, etiology/classification data, and pertient risk factors. Missing 5 or more data points. 0 pts No Marks No inclusion of content for this topic 16 pts This criterion is linked to a Learning OutcomePathophysiolgy 21 pts Excellent Complete inclusion of pathophysiology content 16.5 pts Very Good Incomplete inclusion of pathophysiology content. Missing 1-2 data points. 10.5 pts Good Incomplete inclusion of pathophysiology content. Missing 3-4 data points. 6 pts Fair Incomplete inclusion of pathophysiology content. Missing 5 or more data points. 0 pts No Marks No inclusion of content for this topic 21 pts This criterion is linked to a Learning OutcomeClinical Presentation & Diagnosis Clinical Presentation (including History and Physical Exam pertinent findings), Diagnosis (including criteria, laboratory findings, imaging) 19 pts Excellent Complete inclusion of clinical presentation & diagnosis criteria. Missing no more than 1 data points. 15.83 pts Good Incomplete inclusion of clinical presentation & diagnosis criteria. Missing 2-4 data points. 11.08 pts Fair Incomplete inclusion of clinical presentation & diagnosis criteria. Missing 5 or more data points. 0 pts No Marks No inclusion of content for this topic. 19 pts This criterion is linked to a Learning OutcomeManagement of the Disease, Prevention of Recurrence & Complications and Prognosis 16 pts Excellent Complete inclusion of management of the disease, prevention of recurrence & complications and prognosis data points. Missing no more than 1 data points. 12.45 pts Good Incomplete inclusion of management of the disease, prevention of recurrence & complications and prognosis data points. Missing 2-4 data points. 8.89 pts Fair Incomplete inclusion of management of the disease, prevention of recurrence & complications and prognosis data points. Missing 5 or more data points. 0 pts No Marks No inclusion of content for this topic. 16 pts This criterion is linked to a Learning OutcomeBonus: Differential Diagnosis 0 pts Full Marks 6 (Optional) Points Possible: Accurately list the 3-4 most PERTINENT differential diagnoses for this patient in order to receive points. 0 pts No Marks No partial points will be awarded. 0 pts This criterion is linked to a Learning OutcomeReferences 3 or more references listed in APA format. 4 to >0.8 pts Excellent 3 references. Correctly cited. Appropriate quality resources. 0.8 to >0 pts No Marks 4 pts Total Points: 76
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