CASE SUMMARY: Case Setting: This is a focused visit in

CASE SUMMARY: Case Setting: This is a focused visit in a primary care setting. Case: Jamie Mackey is a 65-year-old Caucasian male with chief complaint of progressive increased in shortness of breath, recently. Patient’s actual diagnosis is heart failure. Case Setting: A 65-year-old male presents to clinic to see the nurse practitioner for increased breathlessness. Patient states, “I’m having difficulty breathing.” This is a focused visit in a primary care setting. OBJECTIVE DATA (not in the Video) Physical findings and vital signs: Vital Signs: BP: 150/100, OT: 98.4 orally HR: 90 & regular RR: 22 Ht: 5 ft, 11 inches, Wt: 220 General: Well developed, overweight male, appears stated age; no acute distress Respiratory: Chest – dullness and decreased breath sounds at the right base; bibasilar rales. Cardiovascular/peripheral vascular: JVD to the angle of the jaw in the sitting position. LV impulse diffuse, laterally displaced. Parasternal lift present. S2 physiologically split, S3 at apex, grade II/VI pansystolic murmur at apex; 2+ pedal edema bilaterally. Gastrointestinal: Abdomen – liver enlarged. Patient has discomfort in upper right abdomen. Skin: warm, dry to touch; color pink Answer the following questions: 1. What are the pertinent positives and negatives learned from the HPI and review of systems (ROS)? 2. Based on the subjective findings of the chief complaint and HPI, what are the top three differential diagnoses? Support your choices with rationales. 3. Is/are there any medication(s), over the counter drugs, vitamins or herbs that can potentially be causing this patient’s symptoms? 4. In conducting a physical examination in a patient with suspected heart failure, what are the physical findings that may present in a patient with heart failure? 5. Identify pertinent positives and negative in the physical findings. Explain the meaning of these findings. How do they assist in the ruling in or out a differential diagnosis? 6. What diagnostic test are the most appropriate to order during this visitation? Explain your rationale or ordering each test(s). 7. Based on the differentials and plan of care what are some preventative care measures or health promotion initiatives that could be included?

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