Chronic Obstructive Pulmonary Disease

Posted: February 20th, 2023

Discussion Topic: Select one of the topic mentioned below and discuses filling the attached form.

Topics: 

– Chronic Obstructive Pulmonary Disease

– Chronic Heart Failure

– Hypertension

ü Asthma

Requirements

– The discussion must address the topic

– Rationale must be provided

– Use at least 600 words (no included 1st page or references in the 600 words)

– May use examples from your nursing practice

– Formatted and cited in current APA 7

– Use 3 academic sources, not older than 5 years. Not Websites are allowed.

– Plagiarism is NOT permitted

Soap Note # ____ Main Diagnosis ______________

 

PATIENT INFORMATION

Name:

Age:

Gender at Birth:

Gender Identity:

Source:

Allergies:

Current Medications:

1.

PMH:

Immunizations:

Preventive Care:

Surgical History:

Family History:

Social History:

Sexual Orientation:

Nutrition History:

 

Subjective Data:

Chief Complaint:

Symptom analysis/HPI:

The patient is …

 

Review of Systems (ROS) (This section is what the patient says, therefore should state Pt denies, or Pt states….. )

CONSTITUTIONAL:

NEUROLOGIC:

HEENT:

RESPIRATORY:

CARDIOVASCULAR:

GASTROINTESTINAL:

GENITOURINARY:

MUSCULOSKELETAL:

SKIN:

 

Objective Data:

VITAL SIGNS:

 

GENERAL APPREARANCE:

NEUROLOGIC:

HEENT:

CARDIOVASCULAR:

RESPIRATORY:

GASTROINTESTINAL:

MUSKULOSKELETAL:

INTEGUMENTARY:

 

ASSESSMENT:

(In a paragraph please state “your encounter with your patient and your findings ( including subjective and objective data)

Example : “Pt came in to our clinic c/o of ear pain. Pt states that the pain started 3 days ago after swimming. Pt denies discharge etc… on examination I noted this and that etc.)

Main Diagnosis

(Include the name of your Main Diagnosis along with its ICD10 I10. (Look at PDF example provided) Include the in-text reference/s as per APA style 7th Edition.

Differential diagnosis (minimum 4)

–

–

PLAN:

Labs and Diagnostic Test to be ordered (if applicable)

1. –

1. –

Pharmacological treatment:

–

Non-Pharmacologic treatment:

Education (provide the most relevant ones tailored to your patient)

 

Follow-ups/Referrals

References (in APA Style)

 

SOLUTION

Topic: Asthma

Introduction

Asthma is a chronic respiratory condition that affects people of all ages. It is characterized by recurrent episodes of wheezing, breathlessness, chest tightness, and coughing, which are caused by the inflammation of the airways. Asthma is a common condition that affects millions of people worldwide. The goal of asthma management is to prevent and control symptoms, improve lung function, and minimize the risk of exacerbations. In this discussion, we will discuss the process of filling out an asthma action plan form.

Rationale

The asthma action plan is a written document that outlines the steps to take in managing asthma symptoms. It is designed to help patients and their caregivers identify the early signs of an asthma attack and take appropriate measures to prevent it from escalating. The asthma action plan should be completed by a healthcare provider, and it should be customized to the patient’s needs and asthma severity. The plan provides guidance on medication use, triggers to avoid, and what to do in case of an emergency. Filling out an asthma action plan form is a critical step in the management of asthma because it helps patients take control of their condition and reduce the risk of complications.

Filling out the Asthma Action Plan Form

The asthma action plan form is a standardized document that is used to guide the management of asthma. The form typically includes the patient’s personal information, such as name, age, and contact information, as well as the name and contact information of their healthcare provider. The form should also include the patient’s asthma history, including the frequency and severity of symptoms, as well as any previous hospitalizations or emergency room visits. The healthcare provider should also assess the patient’s asthma severity and classify it as intermittent, mild persistent, moderate persistent, or severe persistent, based on the frequency and severity of symptoms.

The asthma action plan should also include instructions on medication use. The healthcare provider should provide information on the types of medication the patient should take, how often they should take them, and the appropriate dosage. The healthcare provider should also explain the potential side effects of the medication and how to manage them. The asthma action plan should also include guidance on how to recognize the early signs of an asthma attack and what to do in case of an emergency. This may include instructions on how to use a rescue inhaler, when to call for emergency services, and what to do if the patient’s symptoms do not improve.