A 6o-year-old white man presents with an accelerated decline in lungfunction. Last year he was diagnosed with metastatic ling cancer.?oday he is dyspneic,pale, and seems almost listless. He continues to smoke and his pack-year history is 40?ears. He says “I am tired of this fight”.CC: “I have to sleep in my recliner because I can’t lie in bed, and I have no energy to?o anything? don’t even have energy to eat, I just want to die.”Physical exam: Blood pressure, 120/74; pulse rate, 120 beats/min; respiration rate,?6/min?eight, 5?9??; weight, 130 lbs.?P to lateral diameter: 1:1?ough with clear mucoid sputum?iminished breath sounds?ullness overright lower and middle lung fields on percussion and use of?accessory muscles during respirationChest x-ray film: Mass noted RML and RLL, tracheal shift to left, no cardiomegalyArterial blood gases: pH 7.2, PaO2 55, pCO2 60, HCO3 26Questions:1. Subjective data: What subjective data should the APN obtain? How is the complaint investigated ie HPI?This area should discuss history, ROS, and HPI format.2. You will reassess to verify the presented information.?or what additional objective data will you assess and why?3. What co-morbid conditions should be investigated through the physical exam, how and why?4.?hat National Guidelines are appropriate to this case??hat do the guidelines state?What level of evidence supports these guidelines?5. What diagnostic tests will you order? Why do they apply to this case? What is the sensitivity and specificity? When it is positive or?egative what does that mean?6.?hat is your medical diagnosis? What are the differential diagnoses?7. Treatment plan should clearly state what exact orders you are ordering.?ll medications must have a name, a dose, a route, and a frequency.?he diet must be specific. The diagnostics must be specific.?o not say XRAY say type of Xray ie AP/Lat chest Xray8.?re there any Healthy People 2030 goals that you should consider? How will you promote health with this case? How does it meet the 20309.?hat specific patient teaching is needed? Do not say “how to use an inhaler” state?xactly what you will teach10. What billing codes would you recommend? This must include the CPT code for outpatient office visits. ICD classify diagnoses ie HTN i10, CPT codes are 992–, Describe the difference between the first visit billing code and follow up billing code.11. Follow up and evaluation. When will the next office visit occur? What will you assess??ow will you revise the plan based upon this assessment??or instance, if you are assessing the HgbA1c and it is 9, what will you order??f it is 6.5 what will you do?Health ScienceScienceNursingNURS NS582
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