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Scenario: Cardiovascular: body system 54 year old man with CHEST, SHORTNESS OF BREATH, FEVER MSN 572 Week 8 Diagnostics Assignment Scenario: Cardiovascular: body system 54-year-old man with S/S: shortness of breath, chest pain and fever. You can use CHF or Heart failure for shortness of breath Ischemic heart disease or myocarditis for chest pain Endocarditis for fever Diagnostics Assignment (lab and radiology) Each group will be assigned a body system and the signs/symptoms presenting with that system. From this, each group member of the group will formulate at least one different, primary care differential diagnosis with lab and radiology (as applies) workup and plan for that differential. For the lab and radiology that you include, you will need to provide interpretation, to include what the high/low values are as well as common indications that occur with highs/lows. Your differential and diagnostic workup and treatment must be supported by peer-reviewed, recent references and resources pointing to best practices. There must be a minimum of three references per differential. All of this should be laid out in APA style and presented in a format of your choosing. Each member will outline or narrate their work-up for their differential. The workup should include the appropriate lab work or other diagnostics with rationale and interpretation, and a treatment plan (including any medications, education, follow-up plan) with supporting references. The group must submit all workups in one document. If a student drops from the course midterm, the remaining group members must still present a minimum of three differentials for the case. Note: Please see the rubric in the course for weighting of each section. Rubric is on top of the sample that I attached. MSN 572 Case Study Kirsten McBurney Chandarong Shawn Lam Case Study Scenario Scenario: GI is your body system, 42-years-old female with abdominal pain and constipation Criteria Exceeds Expectations Meets Expectations Below Expectations Far Below Standard Group Identifies 3 Appropriate Differentials 25\% Differentials are appropriate to presenting symptoms, each group member has identified a differential, and differentials are medical diagnoses. 25 points Differentials are appropriate for entry- level providers and all group members have unique differentials, but differentials may not be medical diagnoses 20 points All group members have unique differentials, but differentials are not applicable, or relevant, or are not medical diagnoses. 16 points Not all group members have unique differentials or differentials chosen are not medical diagnoses/do not relate to symptoms 10 points Each Differential Includes a complete and applicable lab and radiology workup, as appropriate 30\% Workup is specific to the chosen differential and does not include unnecessary testing. Student considers insurance coverage or costs. 30 points Workup is specific to chosen differential, but may include too many or not enough labs/testing. May or may not consider insurance or costs. 25 points Workup is only generally applicable to differential, and does not narrow objective findings. No mention of insurance or cost. 20 points Workup is not appropriate to the differential. This would be labs/radiology that would not provide needed information towards final diagnosis. No mention of insurance or cost. 15 points Each workup Includes complete interpretation of lab work/ radiology, as necessary 30\% Interpretation includes high/low values, as well as all/most clinical conditions associated with high/low values. 30 points Interpretation includes high/low values, but only includes several conditions associated with high or low values 25 points Interpretation includes high/low values, but only includes some/few associated conditions 20 points Interpretation does not include high/low values or misidentifies/ confuses associated conditions 15 points Appropriate attribution (at least 3 peer-reviewed, recent references to support each differential/work- up, in APA format) 5\% No errors in APA format. In-text citations present, and 3 peer reviewed, recent (less than 10 years old) references included 5 points Minimal errors in APA format or missing in- text citations. 3 references included 4 points Major errors in APA format or references are not scholarly or recent. 2.5 points Poor citations or references, poor paraphrasing or incorrect use of quotations. Plagiarized assignments may take a zero in all categories. 0 points Mechanics (spelling, grammar, format) 5\% Clear writing without errors. Perfect grammar and engaging written voice. 5 points Clear writing with minimal errors. Some passive voice or other minimal errors that could be improved but do not detract from readability. 4 points Writing is difficult to understand due to multiple errors in spelling, grammar, composition. 2.5 points Writing cannot be understood due to extensive errors. 1.5 point Style & Formatting (weighted 5\%) The assignment is organized and easy to read. Fonts and text formatting are consistent and readable. There is some element or originality and style. There is consistency and flow with how the data is reported. 5 points The assignment is organized and easy to read. Fonts and text formatting are usually consistent and readable. There is consistency and flow. Might be missing the element or originality and style. 4 points The assignment is somewhat organized but not always easy to read. Fonts and text formatting are not always consistent and readable. Missing the element or originality and style. 2.5 points The assignment is choppy with bad editing. The style of the chart/outline or format is difficult to read and inconsistent. Fonts and headings are inconsistent. 1.5 points TOTAL 100 82 63.5 43 Differential for Diverticulitis Risk factors include: ● Overweight ● >40 Years of age ● Cigarette smoker ● Lack or little exercise ● Diet high in fat and red meat but deficient in fiber ● Taking medications such as steroids, opioids, and nonsteroidal anti-inflammatories(NSAIDS) (mayo clinic, 2018) Differential for Diverticulitis Symptoms Fever Leukocytosis Left lower quadrant pain Constipation Bloating Pelvic tenderness on rectal exam (When Constipation Becomes Chronic, n.d.) Differential for Diverticulitis Labs CBC with differential $4.31 Stool culture $11.99 C-reactive protein $3.41 Amylase $3.24 Helicobacter Pylori $10.11 Lipase $3.44 IgE antibodies $3.48 Fecal Occult blood or fecal immunochemical test $4.38 Labs CBC with differential-measurement of the number of red blood cells, platelets, and different white blood cells. Those being neutrophils, lymphocytes, monocytes, basophils, and eosinophils. WBC Normal values 4,500-11,000 cells/mcl Abnormal low indicates bone marrow disorders, sepsis, autoimmune disorders, immune disorders, lymphoma and other cancers to name a few Abnormal high indicates Infection, inflammation, leukemia, allergies, asthma, severe stress to name a few Hemoglobin Men 14-17.5 gm/dL Women 12.3-15.3 gm/dL Abnormal low indicates anemia, acute or chronic bleeding, Bone marrow disorder, chronic inflammatory disease, Nutritional deficiencies, and chronic kidney disease Abnormal high indicates dehydration, pulmonary disease, kidney disease, high altitude living, and polycythemia Hematocrit Men 41.5-50.4 \% Women 36.9-44.6\% Same as hemoglobin (Connor, 2020) CBC Continued RBC Men 4.5-5.9 million cells/ mcL Women 4.1-5.1 million cells/ mcL Abnormal low indicates anemia, acute or chronic bleeding, Bone marrow disorder, chronic inflammatory disease,nutritional deficiencies, chronic kidney disease Abnormal high indicates dehydration, pulmonary disease, kidney disease, high altitude living, and polycythemia MCV 80-96 fL Abnormal low indicates Anemia (Iron deficiency), thalassemia Abnormal high indicates Anemia (Vitamin deficiency) , hypothyroidism RDW (Red Cell distribution width) 11.5-14.5 fL Abnormal low indicates RBC size uniformity Abnormal high indicates iron deficiency anemia CBC and Differential Platelets 150,000-450,000 platelets/mcL Abnormal low indicates Thrombocytopenia, viral infection Abnormal high indicates Cancer, Inflammatory bowel disease, Rheumatoid Arthritis Neurtrophils 41.0-77.0\% Abnormal low indicate Sepsis, immunodeficiency, bone marrow damage, dietary restrictions Abnormal high indicates inflammation, heart attack, acute bacterial infection, stress, Cushing syndrome Lymphocytes 14.0-48.0\% Abnormal low indicates infection, bone marrow damage, autoimmune disorder Abnormal high indicates acute viral infection, inflammatory disorders, toxoplamosis CBC with differential Monocytes 4.0-13.0\% Abnormal low indicates not medically significant Abnormal high indicates asthma, parasitic infections, inflammatory disorders, some cancers Eosinophil 0.0-8.0 \% Abnormal low indicates not medically significant Abnormal high indicates inflammation, allergic reactions, leukemia Basophil 0.0-1.5 \% Abnormal low indicates allergic reaction, overactive thyroid, infection Abnormal high indicates chronic infammation More lab studies Amylase 50-123 U/L Abnormal high indicates acute pancreatitis, cholecystitis, alcohol abuse Lipase 10-50 UI/L Abnormal high indicates cirrhosis, celiac disease, cholecystitis CRP Abnormal high indicates bacterial infections 2nd Differential for Gastrointestinal Disease Gastrointestinal (GI) diseases most often present with one or more of four common classes of Symptoms and Signs: ● (1) Abdominal or chest pain; ● (2) Altered ingestion of food (eg, resulting from nausea, vomiting, dysphagia, odynophagia, or anorexia ● (3) Altered bowel movements (ie, diarrhea or constipation); and ● (4) GI tract bleeding (Mills & Ciorba, 2019) Labs ● Molecular diagnosis-primary immunodeficiency diseases (PIDDs)) with 344 distinct molecular etiologies reported according to the International Union of Immunological Sciences (IUIS) to detect Gastrointestinal Disease (Hartono et al., 2019). ● WBC-assess for infections Test for Gastrointestinal Disease ● Barium swallow $300-$450 ● Computed tomography scan (CT or CAT scan). $350-$650 ● Fecal occult blood test. A fecal occult blood test checks for hidden (occult) blood in the stool. It involves placing a very small amount of stool on a special card. The stool is then tested in the healthcare providers office or sent to a lab. ● Stool culture. A stool culture checks for the presence of abnormal bacteria in the digestive tract that may cause diarrhea and other problems. A small sample of stool is collected and sent to a lab by your healthcare providers office. In 2 or 3 days, the test will show whether abnormal bacteria are present. ● Magnetic resonance imaging (MRI) avg cost $1751 ● Magnetic resonance cholangiopancreatography (MRCP) (Dalwadi, Herman, Das, & Holliday, 2020) Treatment for Gastrointestinal Disease ● Weight control-Diet high in fruits and vegetables ● Quit smoking ● Exercise ● Increase fiber ● Increase water intake ● Avoid medications such as steroids, opioids, and nonsteroidal anti-inflammatories(NSAIDS) ● Radiotherapy (Dalwadi, Herman, Das, & Holliday, 2020) ● Complementary therapy-acupuncture, diet, probiotics, and dietary supplements and herbs (Dossett, Cohen, & Cohen, 2017). References Complete Blood Count (CBC) - Understand the Test & Your Results. (2015, June 25). Labtestsonline.org. https://labtestsonline.org/tests/complete-blood-count-cbc Connor, G. J. (2020). Lab values interpretation : the ultimate laboratory tests manual of reference ranges and what they mean. Dalwadi, S. M., Herman, J. M., Das, P., & Holliday, E. B. (2020). Novel Radiotherapy Technologies in the Treatment of Gastrointestinal Malignancies. Hematology/oncology clinics of North America, 34(1), 29–43. https://doi.org/10.1016/j.hoc.2019.08.016 Dossett, M. L., Cohen, E. M., & Cohen, J. (2017). Integrative Medicine for Gastrointestinal Disease. Primary care, 44(2), 265–280. https://doi.org/10.1016/j.pop.2017.02.002 Hartono, S., Ippoliti, M. R., Mastroianni, M., Torres, R., & Rider, N. L. (2019). Gastrointestinal Disorders Associated with Primary Immunodeficiency Diseases. Clinical reviews in allergy & immunology, 57(2), 145–165. https://doi.org/10.1007/s12016-018-8689-9 Mayo clinic. (2018). Diverticulitis - Symptoms and causes. Mayo Clinic; https://www.mayoclinic.org/diseases-conditions/diverticulitis/symptoms-causes/syc-20371758 Mills, J. C., & Ciorba, M. A. (2019). Chapter 13: Gastrointestinal Disease. Retrieved from https://accessmedicine.mhmedical.com/content.aspx?sectionid=198222337 https://labtestsonline.org/tests/complete-blood-count-cbc https://doi.org/10.1016/j.hoc.2019.08.016 https://www.mayoclinic.org/diseases-conditions/diverticulitis/symptoms-causes/syc-20371758 References When Constipation Becomes Chronic. (n.d.). GI Associates. Retrieved June 24, 2021, from https://gi.md/resources/articles/when-constipation-becomes-chronic Slide 1 Case Study Scenario Slide 3 Differential for Diverticulitis Differential for Diverticulitis Differential for Diverticulitis Labs CBC Continued CBC and Differential CBC with differential More lab studies 2nd Differential for Gastrointestinal Disease Labs Test for Gastrointestinal Disease Treatment for Gastrointestinal Disease References References