NURS-6540 Adv Pract Care Older Adults – Spring 2023<\/p>\n
April 8, 2023<\/p>\n
Focused SOAP
\nPatient Information: BM, 77-year-old, Female, Caucasian<\/p>\n
S
\nCC (Chief Complaint): Palpitations started this morning.<\/p>\n
HPI: A 77-year-old woman with myelofibrosis, which was diagnosed on bone marrow biopsy on 8\/22\/22 and was concerning for post-thrombocythemia myelofibrosis, presented to the ED for a repeat bone marrow test and initiation of treatment. However, this morning, she reported palpitations and a fast heartbeat. Since her last blood transfusion on 2\/17\/23, her symptoms of fatigue, dyspnea with exertion, and sedentary behavior have been progressively worsening. She has lost 30 pounds in the past 6 months without trying, and she has been feeling cold even on warm days. Additionally, she developed diffuse eczema and was supposed to start Dupixant therapy, but the medication has not yet been delivered. She complains of palpitations but denies chest pain. She reports that she scratches her skin, which leads to petechial changes but no bruising. She denies diarrhea, dysuria, changes in taste or smell, night sweats, and nightmares.<\/p>\n
Current Medications:
\nMultivitamin daily
\nLosartan 50mg daily
\nFish Oil 1 tablet daily
\nMetformin 500mg BID<\/p>\n
Allergies: Atorvastatin, rash<\/p>\n
PMHx: Hypertension, Diabetes, Osteoporosis, Chronic Allergic Rhinitis. She is up to date with childhood vaccinations, including Tetanus and MMR. She received a booster dose of her Covid Vaccine and is up to date with her flu vaccine.<\/p>\n
Soc and Substance Hx: The patient lives with her son and verbalizes that she feels safe and well-cared for at her house. She denies any history of smoking or recreational drug use. She also denies any problems with eating.<\/p>\n
Fam Hx: Father died at age 67 with Hypertension. Mother, died 65, with High cholesterol. Brother aged 58 with Hypertension and High cholesterol. Sister, died at 55, with CVA.<\/p>\n
Surgical Hx: Appendectomy, Abdominal hysterectomy, Bone marrow biopsy, Bilateral breast reduction, Cholecystectomy, Foot joint operations.<\/p>\n
Mental Hx: She denies anxiety and depression. She denies any history of self-harm practices or suicidal and homicidal ideation.<\/p>\n
Violence Hx: She denies any problems or history with personal safety. She feels safe living at home and in the community, and she has no issues with sexual violence.<\/p>\n
Reproductive Hx: Post-menopausal. Denies use of contraceptives.<\/p>\n
ROS:
\n\u2022 GENERAL: Verbalizes weight loss, weakness, and easy fatiguability. No fever or chills.
\n\u2022 HEENT: Head: Denies headache. Eyes: Denies blurred or double vision or pain or redness. Ears: Denies pain or decrease in hearing. Nose: Denies runny nose, blockage, or bleeding. Throat: Denies sore throat.
\n\u2022 SKIN: Complains of scattered and diffuse large patches of papular eruptions with rough bases and evidence of excoriations over trunk and limbs.
\n\u2022 CARDIOVASCULAR: Complains of irregular or rapid heartbeat. Denies chest pain or edema in upper and lower extremities.
\n\u2022 RESPIRATORY: Denies shortness of breath, dyspnea on exertion, cough, and
\nsputum production.
\n\u2022 GASTROINTESTINAL: Denies abdominal pain, nausea, vomiting, constipation, or diarrhea.
\n\u2022 GENITOURINARY: Denies dysuria, hematuria, or changes in urinary frequency or urgency.
\n\u2022 MUSCULOSKELETAL: Denies joint pain, stiffness, or swelling.
\n\u2022 NEUROLOGICAL: Denies changes in sensation, coordination, balance, or memory loss.
\n\u2022 PSYCHIATRIC: Denies anxiety, depression, or any changes in mood or behavior.
\n\u2022 ENDOCRINE: Reports a history of diabetes and denies any symptoms of hypoglycemia or hyperglycemia.
\n\u2022 HEMATOLOGICAL\/LYMPHATIC: Reports a history of myelofibrosis and reports fatigue, easy fatiguability, and petechial changes in the skin.
\n\u2022 IMMUNOLOGICAL: Reports a history of allergic rhinitis and denies any new allergies or symptoms of an allergic reaction.<\/p>\n
O
\nVital Signs:
\n\u2022 Blood pressure: 132\/80 mmHg
\n\u2022 Heart rate: 110 bpm
\n\u2022 Respiratory rate: 18 bpm
\n\u2022 Oxygen saturation: 96% on room air
\n\u2022 Temperature: 98.6\u00b0F<\/p>\n
Physical Exam:
\n\u2022 General: Appears tired and weak.
\n\u2022 Skin: Scattered and diffuse large patches of papular eruptions with rough bases and evidence of excoriations over trunk and limbs.
\n\u2022 Cardiovascular: Irregularly irregular rhythm with no murmurs, rubs, or gallops. No edema in upper and lower extremities.
\n\u2022 Respiratory: Clear breath sounds bilaterally with no wheezing, rales, or rhonchi.
\n\u2022 Abdomen: Soft and non-tender with no hepatosplenomegaly or masses palpated.
\n\u2022 Neurological: Alert and oriented to person, place, and time. Cranial nerves II-XII grossly intact. No motor or sensory deficits appreciated.<\/p>\n
A\/P
\nAssessment:<\/p>\n
Palpitations – likely secondary to atrial fibrillation.
\nFatigue, dyspnea with exertion, and sedentary behavior – likely related to myelofibrosis.
\nDiffuse eczema – planned to start Dupixant therapy.
\nWeight loss – needs further evaluation.
\nPetechial changes in the skin – likely due to thrombocytopenia from myelofibrosis.
\nPlan:<\/p>\n
Admit the patient to the hospital for further management of atrial fibrillation, myelofibrosis, and weight loss.
\nObtain an EKG to confirm atrial fibrillation and initiate rate control with diltiazem.
\nConsult with hematology\/oncology for management of myelofibrosis and thrombocytopenia.
\nStart Dupixant therapy for eczema.
\nObtain a nutrition consult for evaluation and management of weight loss.
\nFollow-up with the patient’s primary care provider for outpatient management and monitoring.<\/p>\n
References:
\nBlick C, Nguyen M, Jialal I. Thyrotoxicosis. [Updated 2022 Jul 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK482216\/
\nNesheiwat Z, Goyal A, Jagtap M. Atrial Fibrillation. [Updated 2022 Jul 31]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK526072\/.
\nRobert R, Porot G, Vernay C, Buffet P, Fichot M, Guenancia C, Pommier T, Mouhat B, Cottin Y, Lorgis L. Incidence, Predictive Factors, and Prognostic Impact of Silent Atrial Fibrillation After Transcatheter Aortic Valve Implantation. Am J Cardiol. 2018 Aug 01;122(3):446-454.
\nTaylor K, Jones EB. Adult Dehydration. [Updated 2022 Oct 3]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK555956\/<\/p>\n","protected":false},"excerpt":{"rendered":"
NURS-6540 Adv Pract Care Older Adults – Spring 2023 April 8, 2023 Focused SOAP Patient Information: BM, 77-year-old, Female, Caucasian S CC (Chief Complaint): Palpitations started this morning. HPI: A 77-year-old woman with myelofibrosis, which was diagnosed on bone marrow biopsy on 8\/22\/22 and was concerning for post-thrombocythemia myelofibrosis, presented to the ED for a […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[548,1826,1129],"tags":[2619,3598],"class_list":["post-7873","post","type-post","status-publish","format-standard","hentry","category-case-study-help-writers","category-i-need-help-answering-a-case-study","category-nursing-case-study-writing-help-examples-how-to-guide","tag-help-write-my-paper","tag-hpi-a-77-year-old-woman-with-myelofibrosis-nurs-6540"],"_links":{"self":[{"href":"https:\/\/www.colapapers.com\/us\/wp-json\/wp\/v2\/posts\/7873","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.colapapers.com\/us\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.colapapers.com\/us\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.colapapers.com\/us\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/www.colapapers.com\/us\/wp-json\/wp\/v2\/comments?post=7873"}],"version-history":[{"count":0,"href":"https:\/\/www.colapapers.com\/us\/wp-json\/wp\/v2\/posts\/7873\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.colapapers.com\/us\/wp-json\/wp\/v2\/media?parent=7873"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.colapapers.com\/us\/wp-json\/wp\/v2\/categories?post=7873"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.colapapers.com\/us\/wp-json\/wp\/v2\/tags?post=7873"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}