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Differential Diagnosis from Physical Examination Essay

Differential Diagnosis from Physical Examination Essay

NR 601 Week 7 Health Promotion, Health Protection, Disease Prevention, and Treatment Considerations in End-Of-Life Care:
Differential Diagnosis from Physical Examination Discussion Part One (graded)
A 69-yearl-old male patient known as C.G has a history of neck and right head cancer that you have been interested in for a year. Initially, the carcinoma was localized to the neck and the head- particularly at the left lingual tonsil area and proceeded to finish a radiation and chemotherapy session that lasted a total of six weeks. Lately, the latest PET scan demonstrated certain metabolic activity within the lest lymph node location alongside other regions that had abnormal metabolic activity within the body. Differential Diagnosis from Physical Examination Essay. These regions specifically entailed the lungs and the liver demonstrating metastasis. Further, C.G. complains that he has gotten fatigued of the impacts of radiation and chemotherapy and consequently is not interested in pursuing further treatment for the cancer.
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Differential Diagnosis from Physical Examination

Background:

Right head and neck cancer with metastasis to liver and lungs; patient is refusing further treatment.

PMH:

Hypertension
Hyperlipidemia
Stomatitis
Anemia
Neutropenia

Current medications:

Carvedilol 12.5 mg po 1 daily
Furosemide 40 mg po daily. Differential Diagnosis from Physical Examination Essay

Surgeries:      

2012: right radical neck dissection

Allergies:

None

Vaccination History:

Influenza vaccine last received 1 year ago
Received pneumovax at age 65
Received Tdap 5 years ago
Has not had the herpes zoster vaccine

Social history and Risk Factors:

Former smoker-stopped smoking at the time his cancer was diagnosed-2 years ago
Negative for alcohol intake or drug use
Patient does not have an advanced directive or living will. He is refusing further treatment for his cancer and his wife and children are in disagreement with him. The patient wants to know what his options are for the remainder of his life.

Family history:

Negative

Discussion Part One:
Provide differential diagnoses (DD) with rationale.
Further ROS questions needed to develop DD.
Identify the legal/ethical issues involved with the patient and describe your approach to addressing end-of-life care for this patient.Differential Diagnosis from Physical Examination Essay

Differential Diagnosis from Physical Examination: Discussion Part Two (graded)

Physical examination:

Vital Signs: Height:  6’0   Weight: 140 pounds; BMI: 19.0   BP: 156/84  P: 84 regular R: 20
HEENT: normocephalic, symmetric PERRLA, EOMI; poor dentition
NECK: left neck supple; non-palpable lymph nodes; no carotid bruits. Limited ROM
LUNGS: rhonchi in anterior chest bilaterally.
HEART: S1 and S2 audible; regular rate and rhythm
ABDOMEN: active bowel sounds all 4 quadrants; Normal contour; RUQ tenderness; liver palpable
NEUROLOGIC: negative
GENITOURINARY: negative
MUSCULOSKELETAL: negative
PSYCH: PHQ-9 is 15
SKIN: oral mucosa irritated-stomatitis. Differential Diagnosis from Physical Examination Essay
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Differential Diagnosis from Physical Examination Discussion Part Two:
Summarize the history and results of the physical exam. Discuss the differential diagnosis and rationale for choosing the primary diagnosis. Include one evidence-based journal article that supports your rationale and include a complete treatment plan that includes medications, possible referrals, patient education, ICD 10 Codes, and plan for follow up.Differential Diagnosis from Physical Examination Essay

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