Please see attachment for Case study information and instructions. I will also leave a copy here. Any source used needs to be within 5 years.
CASE INFORMATION
Patients Chief Complaint:
“My voice has been hoarse for 2 weeks”
History of Present Illness:
54 yo female hx of osteoarthritis of the left knee, anxiety, depression, tobacco use with complaints of voice hoarseness for 2 weeks. She has tried gargling with warm salt water, but it is not helping. Has not been sick with fever or chills. No sick contacts. No rhinorrhea or viral symptoms. Admits to current tobacco use and notes that her usual morning smokers cough has recently been worse. Denies hemoptysis but did note bloody sputum approximately three months ago which resolved. She is concerned that her voice change may be due to her tobacco use. Last saw a doctor 10 years ago since she is normally healthy.
Past Medical History:
Osteoarthritis of the left knee
Anxiety
Depression
Current Medications:
Ibuprofen 600mg every 6 hrs as needed for pain
Allergies: NKDA
Family History:
Mother alive hx of HTN, DM, colon cancer
Father deceased 2/2 MI
One daughter alive & well
Social History:
Married for 33 years, lives with husband
Has one daughter
1 ½ pack per day smoker since age 17 years
Alcohol use daily 3 glasses of wine
Denies drug use, no hx of IV drug use
Employed at a plastics factory for the past 15 years, prior to that stay at home mom
Review of Systems:
General: Denies fever, sweats or chills. Denies weakness, fatigue. Recent weight loss.
Skin: denies rashes, lumps, sores, itching, dryness, changes in color, changes in hair or nails,
changes in sizes or color of moles
HEENT: No use of glasses. Denies use of contact lenses, denies eye pain, redness, excessive tearing, double or blurred vision, spots, specks or flashing lights. Endorses good hearing. Denies tinnitus, vertigo, frequent ear infections. Denies frequent colds, nasal stuffiness, discharge or itching. Denies hay fever, nose bleeds. Endorses good dentition. Denies bleeding gums. Denies sore tongue, dry mouth. C/O voice hoarseness
Neck: denies swollen glands, goiter, lumps, pain or stiffness
Breast: denies lumps, pain, discomfort, or nipple discharge
Respiratory: C/O cough productive of tan sputum, C/O shortness of breath worse with exertion such as going up stairs. Denies wheezing, pleuritic pain.
CVS: No high blood pressure. No hx of heart murmur. Denies chest pain, PND, Orthopnea & edema. No syncope. No orthopnea
GI: No abd pain. No diarrhea. Denies dysphagia, heartburn. C/O poor appetite. Denies nausea. Denies changes in bowel habits, rectal bleeding or black or tarry stools, hemorrhoids, constipation.
Peripheral Vascular: Denies claudication, leg cramps, varicose veins. Denies history of DVT. Denies swelling in calves, legs or feet
Urinary: Denies increase frequency of urination, polyuria, nocturia, urgency, burning or pain during urination, hematuria.
Msk: No back pain. No joint pain. C/O intermittent left knee pain.
Psych: Denies nervousness, tension, depression, memory change, suicidal ideation, plans or attempts.
Neuro: Denies headache, dizziness, vertigo, weakness, paralysis, numbness, tingling, tremors or other involuntary movements, denies seizures.
Hematology: denies anemia, easy bruising, or bleeding
Endocrine: Denies heat/cold intolerance, excessive sweating, excessive thirst
Psych: Denies changes in mood, attention, or speech; denies changes in orientation, memory, insight or judgement.
Physical Exam:
Vital Signs: 37.0, 85, 16 unlabored, 120/80, 94% RA
Ht 5 ft 5 inches Wt 120 lbs BMI 20.0
General: Alert, oriented, ambulatory, appears older than stated age. Well-groomed and dressed appropriately.
Skin: warm, dry, no petechiae, no ecchymoses, no rash, no bruising or discoloration.
HEENT: Head: NCAT, no facial swelling. Eyes: PERRLA, EOMI, no scleral icterus. Ears: external ear, no tragus tenderness, TM gray, intact. Nose: mucous membranes are moist, no polyps. Mouth: mucous membranes moist, tongue midline, tonsils are +2, no exudates noted.
Neck/Lymph Nodes: Neck supple, trachea is midline. Thyroid is without masses or goiter. There is mild, nontender enlargement of the anterior cervical lymph nodes in the neck. No neck masses.
Heart: Regular, normal S1 & S2, no S3 or S4 noted. No peripheral edema.
Lungs: Respirations are regular, easy. Lungs inspiratory wheeze right upper lobe, diminished right base.
Abdomen: No rashes or lesions noted. Bowel sounds are positive. No tenderness. No rebound or guarding.
Musculoskeletal/Extremities: Pulses +2 Left knee pain with ROM, crepitus noted.
Neuro: A&O X’s3. CN II-XII intact. Memory intact. Gait normal. Muscle tone and strength 5/5 extremities X’s 4. Sensation is intact.
Additional case information:
After the initial visit at your office the patient was sent for diagnostic testing: CBC, CMP, CXR & then a CT Scan. Results are as follows:
CBC
WBC 2.5 (low)
RBC 4.0 (normal)
Hbg 11.7 (normal)
Hct 35.9 (normal)
Plt 220 (normal
CMP
Na + 142 (normal)
K+ 3.9 (normal)
Cl 102 (normal)
HCO3 28 (normal)
BUN 20 (normal)
Cr 1.2 (normal)
Glu 94 (normal)
Chest X-ray
AP and lateral views show a 3.5 cm mass located centrally in the right upper lobe
Left lung is clear
No pleural effusions
CT Chest with IV contrast
Confirms the mass in addition to mediastinal widening & enlargement of the right sided hilar nodes.
Based on the case information you were given, reading from your text please answer the following 8 questions:
Describe the pathophysiology of the lung cancer.
Briefly (3-4 sentences each) describe the different types of lung cancer.
Explain why this patient had hemoptysis.
Identify the incidence and prevalence of lung cancer in the US and Canada.
Discuss the importance of early diagnosis of lung cancer.
Identify four risk factors in this patient’s case for the development of lung cancer.
After reviewing your text and any reference articles list the history and physical findings in this case that relate to the diagnosis of lung cancer.
Discuss the role of APRN in the diagnosis, treatment, and the importance of referral in this patient’s case.
For each question answered please use a heading prior to answering the question so that it is clear what question you are answering. Your paper should have a total of eight (8) headings as there are eight (8) questions noted above.
Papers should be 4-8 pages maximum.
Late Policy: 5 points will be deducted each day an assignment is late. If greater than 5 days late you will receive a grade of zero (0) for that assignment.
