How to Answer Sandy Year Female Questions (Complete Guide)

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Original Question

Sandy is a 64-year-old female who presents to your primary care clinic today complaining of “cold” with symptoms that started last week including cough and “runny nose”. She is upset she is still coughing. She has been taking pseudo-ephedrine for the past 48 hours with little relief of her nasal congestion, but she is mainly concerned about her cough. She told the MA she needs a Z- Pak, and has to be at work to open her business at 10 am. Past Medical History •Type 2 DM (diet controlled) •Osteoarthritis, •Seasonal allergies •Hypertension Medication list •Lisinopril 10 mg one tab PO Q Day, C •Calcium supplement and MVI daily •Loratadine 10mg one tab PO Q Day prn •NSAID PRN Her vital signs are •BP: 138/88 mmHg •Pulse: 78 bpm and regular •Respiratory rate: 20 b/min, non-labored •Her temp taken at the clinic is 99.6°F. Michael Michael is a 27-day-old infant who arrives at the office with complaints of “breathing fast” and congestion since yesterday. He is accompanied by both parents. At home his rectal temperature was 37.2 degrees this morning. The parents tried using a humidifier to alleviate the symptoms, but they do not feel this helped. They also used a bulb syringe with nasal saline to help relieve nasal congestion. Michael has had several visitors at his home during the first few weeks of life, including small children who attend day-care centers. Diagnostic tests •DFA test was positive for RSV Vital information •Weight: 4050 grams •Temperature: 37.2C •HR: 120 regular rhythm without murmur •Respiratory rate: 42 bbm, expiratory wheezing in all lobes, intercostal retractions present John John is a 66 year-old man brought in by after his daughter, Karen. John was in the yard playing with his grandsons when he suddenly fell down in a faint. His grandsons reported that John had complained of chest tightness and then fainted. He was transported to the hospital where he was noted to be hypotensive secondary to a urosepsis. The hypotensive episode precipitated a small myocardial infarction, and he ruled in with an elevated troponin. He was hospitalized and stabilized. He has rarely ever seen a doctor. You are told that he does not trust or believe in the medical system after his wife Marie died 5 years ago due to metastatic colon cancer. Past Medical History He has always hated hospitals. His dislike for hospitals and physicians was further reinforced by the sudden and unexpected death of his wife. He was told that he had high blood pressure and high cholesterol at a health fair many years ago, but refused to “let quacks mess with my body.” His diet is heavy on red meat, potatoes and fatty foods, and low in fruits, vegetables and whole grains. He had a CT scan of his chest when he had a bout of pneumonia 5 years ago and was found to have a lung lesion, for which he underwent a right lower lobectomy. He refused further follow-up. Current Illness The cardiac echo revealed decreased LV function with an estimated ejection fraction of 20% and severely thickened and or calcified, and severely stenotic Aortic Valve (is 0.4 cm squared with a mean gradient of 35 mm Hg) Cardiologists want to do a catheterization for further evaluation but the patient refused. Pulmonary repeated a CT scan of thorax and several mediastinal lesions were visible and consistent with metastatic disease. This morning he awoke and could not get dressed himself, or walk the stairs due to shortness of breath. His pulse ox is 85% on room air. He is crying and says he is afraid to die In the above module you will find 3 scenarios, each dealing with an unscheduled patient in the waiting room of your office at 9am today. Examine the scenarios, and then answer the questions that follow. What is your priority for evaluating and treating the three patients, today, as an NP? You are the sole provider in the office, have a full schedule, and in addition you have these three unscheduled, urgent care patients. Your practice follows their own patients and does not refer to Urgent Care Centers. Are there ethical forces conflicting, in terms of your decision making, as to who gets priority? If so, describe. What are the medical priorities to consider? Administrative priorities? What does your scope of practice say about your professional obligations in this instance? The ANA Code of Ethics?

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