NRNP 6540 Assessing, Diagnosing, and Treating Cardiovascular and Pulmonary Disorders

NRNP 6540 Assessing, Diagnosing, and Treating Cardiovascular and Pulmonary Disorders

Assessing, Diagnosing, and Treating Cardiovascular and Pulmonary Disorders

Heart and lung diseases are still the leading causes of illnesses and deaths in the elderly, especially those who have long-term illnesses like COPD and high blood pressure. This paper explores the assessment, diagnosis, and treatment of Ms. Baker, a 68-year-old with a recent pneumonia diagnosis. Using case-based evidence, this paper will examine expected imaging findings, pneumonia classification, severity assessment tools, appropriate treatment options, and considerations for managing COPD. The discussion will integrate evidence-based guidelines to ensure optimal outcomes in complex patients with overlapping cardiopulmonary issues.

Don't use plagiarized sources. Get Your Custom Essay on
NRNP 6540 Assessing, Diagnosing, and Treating Cardiovascular and Pulmonary Disorders
Just from $7/Page
Order Essay

Case Title: A 68-year-old With Tachycardia and Coughing

Ms. Baker, a 68-year-old female, is brought to your office today by her daughter, Rebecca. Ms. Baker lives with her daughter and can perform all activities of daily living (ADLs) independently. Her daughter reports that her mother’s heart rate has been occasionally elevated at home, reaching 110 beats per minute. She has also been coughing a lot over the last 2 days. Ms. Baker has a 30-pack per year history of smoking cigarettes, but quit smoking 3 years ago. Other known histories include chronic obstructive pulmonary disease (COPD), hypertension, vitamin D deficiency, and hyperlipidemia. She also reports some complaints of intermittent pain/cramping in her bilateral lower extremities when walking and has to stop walking at times for the pain to subside. She also reports some pain in the left side of her back and some pain with aspiration.

Ms. Baker reports that she has been experiencing frequent coughing and has noticed some thick, brown-tinged sputum. She states she has COPD and has been using her albuterol inhaler more than usual. She says it helps her “get the cold up.” Her legs feel tired, but she denies any worsening of shortness of breath. She admits that she has some weakness and fatigue, but is still able to carry out her daily routine. Vital Signs: Temp 99.2, BP 126/78, Pulse 90, RR 22, 02 Sat 98%

Labs: Complete Metabolic Panel and CBC were done and were within normal limits

CMP Component Value CBC Component Value
Glucose, Serum 86 mg/dL White blood cell count 5.0 x 10E3/uL
BUN 17 mg/dL RBC 4.71 x10E6/uL
Creatinine, Serum 0.63 mg/dL Hemoglobin 10.9 g/dL
EGFR 120 mL/min Hematocrit 36.4%
Sodium, Serum 141 mmol/L Mean Corpuscular Volume 79 fL
Potassium, Serum 4.0 mmol/L Mean Corpus HgB 28.9 pg
Chloride, Serum 100 mmol/L Mean Corpus HgB Conc 32.5 g/dL
Carbon Dioxide 26 mmol/L RBC Distribution Width 12.3%
Calcium 8.7 mg/dL Platelet Count 178 x 10E3/uL
Protein, Total, Serum 6.0 g/dL    
Albumin 4.8 g/dL    
Globulin 2.4 g/dL    
Bilirubin 1.0 mg/dL    
AST 17 IU/L    
ALT 15 IU/L    

Allergies: Penicillin

Current Medications:

  • Atorvastatin 40mg o. daily
  • Multivitamin 1 tablet p.o. daily
  • Losartán 50 mg p.o. daily
  • Albuterol inhaled 90mcg 2 puffs q4–6 hrs. prn
  • Caltrate 600mg+ D3 1 tablet p.o. daily

Diagnosis: Pneumonia

Question 1: What findings would you expect to be reported or seen on her chest x-ray results, given the diagnosis of pneumonia?

In pneumonia, chest x-ray findings typically reveal areas of infiltration or consolidation in the impacted lobe. Ms. Baker, diagnosed with left lower lobe pneumonia, would likely have a patchy or dense opacity in the left lower lung area on the x-ray, perhaps accompanied by air bronchograms (Kanwal et al., 2024). Depending on the severity, further findings might include atelectasis or pleural effusion. Since she has a productive cough and sputum that has a brown tint, the radiograph would correlate these symptoms by showing localized infection in the parenchyma, confirming pneumonia as the diagnosis.

Question 2: Define further what type of pneumonia Ms. Baker has, HAP (hospital-acquired pneumonia) or CAP (community-acquired pneumonia)? What is the difference/criteria?

Since her symptoms started outside of a medical facility, Ms. Baker has had community-acquired pneumonia (CAP), and she has not recently been admitted to the hospital. Pathogens, including Haemophilus influenzae and Streptococcus pneumoniae, are often blamed for CAP (Miyashita, 2022). Forty-eight hours or more after admission, hospital-acquired pneumonia (HAP) is often brought on by germs that are resistant to many drugs, such as MRSA and Pseudomonas. Because of Ms. Baker’s home environment, stable vitals, and outpatient presentation, CAP is the appropriate categorization for her diagnosis.

 

Question 3:

  • 3A) What assessment tool should be used to determine the severity of pneumonia and treatment options?

The primary tool for assessing the severity of pneumonia and guiding treatment decisions is the CURB-65 test. According to Kanwal et al. (2024), the following conditions must be met: confusion; urea levels more than 19 mg/dL; a respiratory rate of 30 bpm or higher; a systolic blood pressure of less than 90 mmHg or a diastolic blood pressure of at least 60 mmHg; and age 65 years or older. Each factor is assigned one point, with higher scores indicating a greater mortality risk and a higher likelihood of hospitalization. This tool helps clinicians standardize decisions, ensuring that patients with mild disease receive safe outpatient care while those with severe cases receive timely inpatient management.

  • 3B) Based on Ms. Baker’s subjective and objective findings, apply that tool and elaborate on each clinical factor for this patient.

Ms. Baker earns one point for being older than 65 according to the CURB-65 evaluation. She is alert and shows no signs of confusion; her blood pressure is steady at 126/78 mmHg, her respiratory rate is 22 (below the ≥30 criterion), and her BUN is within normal ranges at 17 mg/dL (Kanwal et al., 2024). Outpatient treatment is a safe choice if the score is 1, which indicates a low mortality risk. With stable vitals, routine labs, and mild symptoms, Ms. Baker qualifies for community-based treatment while ensuring close monitoring due to her COPD comorbidity.

 

Question 4: Ms. Baker was diagnosed with pneumonia in the left lower lobe. What would your treatment be for her based on her diagnosis, case scenario, and evidence-based guidelines?

The management of Ms. Baker’s left lower lobe CAP should adhere to IDSA/ATS recommendations for outpatients with concomitant conditions. Recommended treatment consists of a beta-lactam (such as amoxicillin-clavulanate or cefuroxime) in conjunction with either a macrolide (like azithromycin) or doxycycline (Miyashita, 2022). An alternative is to utilize a respiratory fluoroquinolone as monotherapy, such as levofloxacin. Hydration, relaxation, and the administration of antipyretics when necessary are all components of supportive care. Given her COPD history, close monitoring is essential to detect potential exacerbations. Smoking cessation reinforcement and inhaler optimization also support her pulmonary recovery.

Question 5: Ms. Baker has a known history of COPD. What is the gold standard for measuring airflow limitation?

Spirometry is the gold standard for assessing airflow restriction in COPD. This test objectively assesses lung function, particularly FEV₁ and FVC (Song et al., 2021). Chronic airflow limitation is indicated, and the diagnosis of COPD is confirmed when the post-bronchodilator FEV₁/FVC ratio is less than 0.70. Spirometry is essential for diagnosis, determining the severity of the condition, guiding therapy, and monitoring development over time. For Ms. Baker, spirometry helps differentiate acute infection from chronic COPD impairment.

Question 6: Ms. Baker mentions intermittent pain in her bilateral legs when walking and having to rest to stop the leg pain/cramps. Which choice below would be the best potential diagnosis for this? Explain your reasoning.

  1. DVT (Deep Vein Thrombosis)
  2. Intermittent Claudication
  3. Cellulitis
  4. Electrolyte Imbalance

The most probable diagnosis for Ms. Baker’s bilateral leg discomfort is intermittent claudication. This disorder results from peripheral artery disease (PAD), characterized by diminished circulation to the legs, which leads to cramping or pain that alleviates with rest (Pymer et al., 2021). DVT is unlikely since her pain is bilateral and not associated with swelling, redness, or warmth. Usually, cellulitis manifests as localized skin abnormalities, whereas electrolyte imbalance usually causes generalized cramps rather than exertional leg discomfort—her risk factors, such as hyperlipidemia and smoking, further support PAD.

Question 7: Ms. Baker mentions intermittent pain in her bilateral legs when walking and having to rest to stop the leg pain. What test could be ordered to evaluate this further?

The optimal first assessment for Ms. Baker’s intermittent leg discomfort is the ankle-brachial index (ABI). This non-invasive test determines whether peripheral artery disease is present and its severity by contrasting the ankle and arm blood pressure (Pymer et al., 2021). An ABI below 0.9 indicates arterial occlusion. Should the findings be abnormal, further examinations, including duplex ultrasonography, may be requested, such as MR or CT angiography. Given her history of smoking, hyperlipidemia, and symptoms that are compatible with intermittent claudication, this test is reasonable.

Question 8: Name three (3) differentials for Ms. Baker’s initial presentation.

  1. Acute COPD exacerbation – because of her cough, sputum production, and increasing usage of Albuterol (Song et al., 2021).
  2. Bronchitis – productive cough and sputum without severe systemic signs could indicate acute bronchitis (Jarhyan et al., 2022).
  3. Pneumonia – confirmed in this case, with localized chest pain, brown sputum, and radiologic evidence (Kanwal et al., 2024). These differentials reflect her pulmonary history and symptoms. Each requires careful evaluation to distinguish between infection, airway inflammation, or exacerbation of chronic disease for appropriate treatment.

Question 9: What patient education would you give Ms. Baker and her daughter? What would be your follow-up instructions?

Patient education should focus on taking antibiotics as directed, using an inhaler correctly, staying hydrated, getting enough sleep, and recognizing when symptoms are worsening, such as heightened dyspnea, chest discomfort, or fever. Ms. Baker and her daughter need to be told to keep an eye on oxygen saturation and report persistent tachycardia or respiratory distress (Kahnert et al., 2023). To evaluate the course of symptoms and the effectiveness of therapy, follow-up should take place within 48 to 72 hours. Long-term education should address smoking cessation reinforcement, techniques for managing COPD, and lowering cardiovascular risk via dietary, pharmacological, and lifestyle modifications.

Question 10: Would amoxicillin/clavulanate plus a macrolide have been an option to treat Ms. Baker’s Pneumonia? Explain why or why not.

Indeed, a macrolide and amoxicillin/clavulanate would be a suitable combination for treating Ms. Baker’s pneumonia. Current IDSA/ATS guidelines support this regimen for outpatients with comorbid diseases such as COPD, high blood pressure, and hyperlipidemia (Song et al., 2021).. The beta-lactam covers a wide range of bacteria, including Streptococcus pneumoniae and H. influenzae. The macrolide adds coverage against less common bacteria, such as Mycoplasma pneumoniae. This mix is both practical and safe. However, if allergies, intolerance, or contraindications arise, other options, such as respiratory fluoroquinolones, may also be considered.

Conclusion

To sum up, Ms. Baker’s case shows how hard it is to treat pneumonia in people who already have long-term heart and lung problems. Evidence-based methods, such as CURB-65 scoring, selecting the appropriate antibiotic according to guidelines, and utilizing spirometry for COPD, provide care with a clear structure. Additional findings indicate the potential presence of peripheral arterial disease, necessitating further assessment. To get the best results and avoid problems in older adults with both respiratory and cardiovascular disorders, it is important to educate them, keep a close eye on them, and manage their comorbidities fully.

 

 

References

Jarhyan, P., Hutchinson, A., Khaw, D., Prabhakaran, D., & Mohan, S. (2022). Prevalence of chronic obstructive pulmonary disease and chronic bronchitis in eight countries: a systematic review and meta-analysis. Bulletin of the World Health Organization, 100(03), 216–230. https://doi.org/10.2471/blt.21.286870

Kahnert, K., Jörres, R. A., Behr, J., & Welte, T. (2023). The diagnosis and treatment of COPD and its comorbidities. PubMed, 120(25), 434–444. https://doi.org/10.3238/arztebl.m2023.027

Kanwal, K., Asif, M., Khalid, S. G., Liu, H., Qurashi, A. G., & Abdullah, S. (2024). Current Diagnostic Techniques for Pneumonia: A scoping review. Sensors, 24(13), 4291. https://doi.org/10.3390/s24134291

Miyashita, N. (2022). Atypical pneumonia: Pathophysiology, diagnosis, and treatment. Respiratory Investigation, 60(1), 56–67. https://doi.org/10.1016/j.resinv.2021.09.009

Pymer, S., Ibeggazene, S., Palmer, J., Tew, G. A., Ingle, L., Smith, G. E., Chetter, I. C., & Harwood, A. E. (2021). An updated systematic review and meta-analysis of home-based exercise programs for individuals with intermittent claudication. Journal of Vascular Surgery, 74(6), 2076-2085.e20. https://doi.org/10.1016/j.jvs.2021.03.063

Song, Q., Zhao, Y., Zeng, Y., Liu, C., Cheng, W., Deng, M., Li, X., Ma, L., Chen, Y., Cai, S., & Chen, P. (2021). The characteristics of airflow limitation and future exacerbations in different GOLD groups of COPD patients. Taylor & Francis. https://www.tandfonline.com/doi/full/10.2147/COPD.S309267

CLICK HERE TO ORDER A PLAGIARISM-FREE PAPER

Assessing, Diagnosing, and Treating Cardiovascular and Pulmonary Disorders

Cardiovascular conditions are among the leading causes of hospitalization and death among older adults, even though many of the risk factors that contribute to such conditions are preventable or manageable. In your role as an advanced practice nurse, you must be able to apply sound critical thinking and diagnostic reasoning skills to correctly assess and diagnosis these conditions. You also play an important role in helping patients manage disorders by planning necessary treatments, assessments, and follow-up care.

Resources

 

Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.

WEEKLY RESOURCES

Learning Resources

Required Readings

  • Kennedy-Malone, L., & Groenke-Duffy, E. (2023). Cardiovascular disorders. In Advanced practice nursing in the care of older adults (3rd ed., pp. 186-218). F.A. Davis.
  • Kennedy-Malone, L., & Groenke-Duffy, E. (2023). Peripheral vascular disorders. In Advanced practice nursing in the care of older adults (3rd ed., pp. 258-267). F.A. Davis.

Required Media

Recommended Media

  • Links to an external site. [Video]. https://engageil.com/modules/community-based-interprofessional-home-care-of-the-older-adult

    Note: View the Community-Based Interprofessional Home Care of the Older Adult video module available in this free course.

  • Engage-IL (Producer). (2017r). Optimizing physical activity in older adults
  • Links to an external site. [Video]. https://engageil.com/modules/optimizing-physical-activity-in-older-adults

    Note: View the Optimizing Physical Activity in Older Adults video module available in this free course.

  • Goldberg, C. (2018a). Cardiovascular exam
  • Links to an external site.. In C. Goldberg, Practical guide to clinical medicine. Regents of the University of California. https://meded.ucsd.edu/clinicalmed/heart.htm
  • Goldberg, C. (2018d). The lung exam
  • Links to an external site.. In C. Goldberg, Practical guide to clinical medicine. Regents of the University of California. https://meded.ucsd.edu/clinicalmed/lung.htm

To prepare:

  • Review the Week 5 Case Assignment document in the Learning Resources.
  • Reflect on the patient’s symptoms and aspects of disorders that may be present.
  • Consider how you might assess, perform diagnostic tests, and recommend medications to treat patients presenting with the symptoms in the case study.

The Assignment:

After reviewing the case and the accompanying case analysis questions, included in the document, answer the 10 questions directly in the Case Assignment document. When providing evidence to support your answers, be sure they evidenced-based, current (no more than 5 years old), and follow current standards of care. Follow APA 7th edition formatting.

By Day 7

Submit your Assignment.

submission information

Before submitting your final assignment, you can check your draft for authenticity. To check your draft, access the Turnitin Drafts from the Start Here area.

  1. To submit your completed assignment, save your Assignment as WK5Assgn_LastName_Firstinitial
  2. Then, click on Start Assignment near the top of the page.
  3. Next, click on Upload File and select Submit Assignment for review.

Rubric

NRNP_6540_Week5_Assignment_Rubric

NRNP_6540_Week5_Assignment_Rubric
Criteria Ratings Pts
This criterion is linked to a Learning Outcome Create documentation in the document about the patient in the case study to which you were assigned. Provide thorough answers to the questions asked in the assignment. 25 to >23.0 pts Excellent The response thoroughly and accurately answers the questions presented. The answers inform a differential diagnosis and a thorough cross-check of medications against the Beers Criteria has been completed and appropriate alternative drugs recommended if applicable.

23 to >20.0 pts Good The response answers the questions presented. The answers inform a differential diagnosis and a thorough cross-check of medications against the Beers Criteria has been completed and appropriate alternative drugs recommended if applicable.

20 to >18.0 pts Fair The response partially answers the questions presented. The answers inform a differential diagnosis, but is somewhat vague or contains minor inaccuracies. A cross-check of medications against the Beers Criteria has been completed but alternatives may be missing.

18 to >0 pts Poor The response provides an incomplete or inaccurate answers to questions presented. The answers may partially inform a differential diagnosis, but is somewhat vague or contains minor inaccuracies. A cross-check of medications against the Beers Criteria has not been completed. Or, other subjective documentation is missing.

 25 pts
This criterion is linked to a Learning Outcome In the Assessment section, provide: • At least three (3) differentials with supporting evidence. Explain what rules each differential in or out, and justify your primary diagnosis selection. Include pertinent positives and pertinent negatives for the specific patient case. 25 to >23.0 pts Excellent The response lists in order of priority at least three distinctly different and detailed possible conditions for a differential diagnosis of the patient in the assigned case study, and provides a thorough, accurate, and detailed justification for each of the conditions selected.

23 to >20.0 pts Good The response lists in order of priority at least three different possible conditions for a differential diagnosis of the patient in the assigned case study and provides an accurate justification for each of the conditions selected.

20 to >18.0 pts Fair The response lists three possible conditions for a differential diagnosis of the patient in the assigned case study, with some vagueness and/or inaccuracy in the conditions and/or justification for each.

18 to >0 pts Poor The response lists two or fewer, or is missing, possible conditions for a differential diagnosis of the patient in the assigned case study, with inaccurate or missing justification for each condition selected.

 25 pts
This criterion is linked to a Learning Outcome In the Plan section, list the treatment plan for the patient that addresses each diagnosis, as applicable. Includes documentation of diagnostic studies that will be obtained, referrals to other health-care providers, therapeutic interventions, education, disposition of the patient, and any planned follow up visits. • A discussion related to health promotion and disease prevention taking into consideration patient factors, PMH, and other risk factors. 25 to >23.0 pts Excellent he response thoroughly and accurately outlines a treatment plan for the patient that addresses each diagnosis and includes diagnostic studies need, referrals, therapeutic interventions, patient education and disposition, and planned follow-up visits. A thorough and accurate discussion of health promotion and disease prevention related to the case is provided.

23 to >20.0 pts Good The response accurately outlines a treatment plan for the patient that addresses each diagnosis and includes diagnostic studies need, referrals, therapeutic interventions, patient education and disposition, and planned follow-up visits. An accurate discussion of health promotion and disease prevention related to the case is provided.

20 to >18.0 pts Fair The response somewhat vaguely or inaccurately outlines a treatment plan for the patient. The discussion on health promotion and disease prevention related to the case is somewhat vague or contains inaccuracies.

18 to >0 pts Poor The response does not address all diagnoses or is missing elements of the treatment plan. The discussion on health promotion and disease prevention related to the case is vague, inaccurate, or missing.

 25 pts
This criterion is linked to a Learning Outcome Provide at least three evidence-based peer-reviewed journal articles or evidenced-based guidelines which relate to this case to support your diagnostics and differentials diagnoses. Be sure they are current (no more than 5 years old) and support the treatment plan in following current standards of care. 10 to >9.0 pts Excellent The response provides at least three current, evidence-based resources from the literature to support the treatment plan for the patient in the assigned case study. Each resource represents the latest in standards of care and provides strong justification for treatment decisions.

9 to >8.0 pts Good The response provides at least three current, evidence-based resources from the literature to support the treatment plan for the patient in the assigned case study. Each resource represents current standards of care and supports treatment decisions.

8 to >7.0 pts Fair Three evidence-based resources are provided to support treatment decisions, but may not represent the latest in standards of care or may only provide vague or weak justification for the treatment plan.

7 to >0 pts Poor Two or fewer resources are provided to support treatment decisions. The resources may not be current or evidence-based, or do not support the treatment plan.

 10 pts
This criterion is linked to a Learning Outcome Written Expression and Formatting—Paragraph Development and Organization: Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused–neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria. 5 to >4.0 pts Excellent Paragraphs and sentences follow writing standards for flow, continuity, and clarity. A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria.

4 to >3.0 pts Good Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time. Purpose, introduction, and conclusion of the assignment are stated, yet are brief and not descriptive.

3 to >2.0 pts Fair Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time. Purpose, introduction, and conclusion of the assignment is vague or off topic.

2 to >0 pts Poor Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time. No purpose statement, introduction, or conclusion were provided.

 5 pts
This criterion is linked to a Learning Outcome Written Expression and Formatting—English writing standards: Correct grammar, mechanics, and proper punctuation 5 to >4.0 pts Excellent Uses correct grammar, spelling, and punctuation with no errors.

4 to >3.0 pts Good Contains a few (one or two) grammar, spelling, and punctuation errors.

3 to >2.0 pts Fair Contains several (three or four) grammar, spelling, and punctuation errors.

2 to >0 pts Poor Contains many (≥ five) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.

 5 pts
This criterion is linked to a Learning Outcome Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running heads, parenthetical/in-text citations, and reference list. 5 to >4.0 pts Excellent Uses correct APA format with no errors.

4 to >3.0 pts Good Contains a few (one or two) APA format errors.

3 to >2.0 pts Fair Contains several (three or four) APA format errors.

2 to >0 pts Poor Contains many (≥ five) APA format errors.

 5 pts

Total Points: 100

Great news! We Can Now Complete Your i-Human Assessment Within 24 Hours With a Guaranteed Grade A Result.

 

CHAT US NOW
Close Welcome Bar