Analyze the possible conditions from your colleagues’ differential diagnoses. Determine which of the conditions you would reject and why. Identify the most likely condition, and justify your reasoning.
Case study 1
CC: Shortness of breath and cough
HPI: Mr. Hendrix a Caucasian male who complains of SOB and cough that started a few days ago. The patient describes SOB as severe and constant. The patient reports that walking makes the SOB symptoms worse and nothing improves his SOB. The patient reports that he coughs with clear phlegm. The patient also reports experiencing fatigue. The SOB get worst at night.
Current Medications: Diuretic medications
Allergies: No known allergies
Past medical history: CHF
Social Hx: Mr. Hendrix smoke 3 cigarette per day
Fam History: Not mentioned.
General: Positive for fever, chills, night sweats, and fatigue.
HEENT: No vision changes, visual disturbances, injury, or history of eye disease. No nasal congestion, nosebleeds, or postnasal drip. Hearing loss and pain noted to right ear only. No drainage or tinnitus.
Throat: No sore throat, hoarseness or difficulty swallowing.
Skin: Cool and dry, no rash, lesions, itching, or pigment changes
Cardiovascular: No chest pain, palpitations, edema, or exercise intolerance
Respiratory: Positive for productive cough and SOB.
Gastrointestinal: Distended abdomen, No nausea, vomiting, heartburn, indigestion, constipation or diarrhea.
Genitourinary: No urinary urgency, hesitation, frequency, pain, or incontinence.
Neurological: No headache, dizziness, loss of coordination, tremors, or numbness.
Musculoskeletal: No muscle pain, joint pain, joint stiffness, or muscle weakness.
Hematological: No bruising, bleeding, or history of anemia.
Lymphatics: No tenderness or enlargement of the lymph nodes.
Psychiatric: No anxiety, depression, suicidal or homicidal ideations.
Endocrinological: No heat/cold intolerance, increased thirst, or increased urination.
Allergies: No history of asthma or allergies.
VITAL SIGNS: T 97.9 R 22 labored, P 94 B/P 162/90 02 sats 92% at room air, wt 215
GENERAL: Patient awake, alert, and oriented x3. Patient appears anxious noted wringing hands constantly. Patient answers questions and responds appropriately. Patient’s posture is tense, but his movements are well coordinated. Patient well-dressed with no body odor
SKIN: Cool and dry
CARDIOVASCULAR: Heart rate is regular with good S1, S2; with S3 extra heart sound with heart murmurs present with 3/6 systolic murmur
RESPIRATORY: Thorax is symmetrical, with vesicular breath sounds with scattered rales all throughout the lung fields, no rhonchi, or wheezes; breath sounds heard.
GASTROINTESTINAL: Abdomen is distended with normoactive bowel sounds auscultated in all 4 quadrants.
PERIPHERAL VASCULAR: 3+ peripheral edema noted extending to the knee bilaterally,
He has 2+ dorsalis pedis pulses bilaterally
Diagnostic results: Blood work and EKG to rule out cardiac involvement. Chest x-ray to check for pneumonia, pulmonary emboli (PE), and any other reasons patient is having shortness of breath (González, Martínez, J Romero, & Belmonte, 2018). Complete blood count to check white count for infection and hemoglobin since the patient has been coughing.
Pneumonia is a lung infection caused by bacteria, viruses, and fungi that causes the alveoli in the lungs to become inflamed. When the alveoli become inflamed, they fluid instead of air causing productive cough, dyspnea, fever, chills, and fatigue (Driver, 2014). Pneumonia was chosen as a possible diagnosis based on the patient’s symptoms and history of smoking. According to Driver (2014), cigarette smoking increases the risk of developing pneumonia.
- Acute Bronchitis
Acute bronchitis is a lung infection caused by viruses, bacteria, and airway irritants that caused the lining of the bronchial tubes to become inflamed (Hart, 2014). Inflammation of the bronchial tubes causes a productive cough, thick phlegm production, fatigue, wheezing, and dyspnea. Acute bronchitis was chosen as a possible diagnosis based on the patient symptoms as compared to common symptoms of bronchitis and the patient’s history of cigarette smoking, which can cause acute or chronic bronchitis (Hart, 2014).
- Chronic Obstructive Pulmonary Disease (COPD)
COPD is a chronic inflammatory lung disease caused by long-term exposure to airway irritants such as cigarette smoke. Chronic exposure to airway irritants causes damage to alveoli and bronchial tubes which causes symptoms like a cough, phlegm production, dyspnea, wheezing, fatigue, and activity intolerance (Roche et al., 2015). COPD was chosen as a possible diagnosis based on the patient’s history of cigarette smoking which is the number one cause of COPD (Roche et al., 2013).
- Lung Cancer
Lung cancer is a disease that causes abnormal cancerous cells to divide uncontrollably, spread, and destroy healthy cells and tissue (Ridge, McErlean, and Ginsberg, 2015). Lung cancer causes symptoms like a productive cough, blood-tinged sputum, dyspnea, wheezing, and fatigue. Lung cancer was chosen as a possible diagnosis based on the patient’s symptoms and history of cigarette smoking. History of heavy cigarette smoking is the most common cause of small cell lung cancer (Ridge et al., 2015).
- Pleurisy- M J has symptoms of pleurisy which are inflammation of the tissues that line the lungs and chest and can cause coughing, chest pain that is worsened by breathing, and shortness of breath (Huether & McCance, 2017).
Cukic, V. (2015). The Most Common Detected Bacteria in Sputum of Patients with the Acute Exacerbation of COPD. Materia Socio-Medica, 25(4), 226–229. https://doi-org.ezp.waldenulibrary.org/10.5455/msm.2013.25.226-229
Driver, C. (2014). Understanding pneumonia: anatomy and pathology. Nursing & Residential Care, 16(3), 136. Retrieved from https://ezp.waldenulibrary.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=edb&AN=94574404&site=eds-live&scope=site
Ekpo, E. U., Egbe, N. O., & Akpan, B. E. (2015). Radiographers’ performance in chest X-ray interpretation: the Nigerian experience. The British Journal of Radiology, 88(1051), 20150023. https://doi-org.ezp.waldenulibrary.org/10.1259/bjr.20150023
Fogel, N. (2015). Tuberculosis: A disease without boundaries. TUBERCULOSIS, 95(5), 527–531. https://doi-org.ezp.waldenulibrary.org/10.1016/j.tube.2015.05.017
Huether, S. E., & McCance, K. L. (2017). Understanding pathophysiology (6th ed.). St. Louis,
Hart, A. M. (2014). Evidence-based diagnosis and management of acute bronchitis. The Nurse Practitioner, 39(9), 32–39. https://doi-org.ezp.waldenulibrary.org/10.1097/01.NPR.0000452978.99676.2b
Ridge, C. A., McErlean, A. M., & Ginsberg, M. S. (2015). Epidemiology of Lung Cancer. Seminars in Interventional Radiology, 30(2), 93–98. https://doi-org.ezp.waldenulibrary.org/10.1055/s-0033-1342949
Roche, N., Chavannes, N. H., & Miravitlles, M. (2015). COPD symptoms in the morning: impact, evaluation and management. Respiratory research, 14(1), 112.
The Owl and the Pussy-Cat In this paper I will dissect Edward Lear's sonnet 'The Owl and the Pussy-Cat' (Appendix 1), first giving a specialized expressive investigation focusing on sound designing, furthermore finding its place in the historical backdrop of verse for youngsters, and thirdly how the lyric conceives youth. Written in December 1867 for the girl of a dear companion of Lear, it was first distributed in a compilation by Lear entitled Nonsense Songs, Stories, Botany, and Alphabets (1871). From that point forward it has been distributed, represented, made an interpretation of, and set up with a good soundtrack ordinarily. In 2001 it was casted a ballot Britain's preferred sonnet. Lear utilizes basic, however imaginative language to recount to the captivating story of the voyaging sweethearts; the indistinguishable winged animal and feline. Including three stanzas, every eleven lines in length, it comprises of twin number quatrains and a three-line hold back, formed in a particular versifying meter. The rhyme plan is 'abcbdefe' switching back and forth somewhere in the range of four and three focused on syllables for every line, trailed by the hold back 'eee' comprising of two lines with only one focused on syllable, and a last line with three. This uniform rhyme plot gives the sonnet melodic structure, yet in addition adheres the altogether different pieces of the story. The musical parallelism of the holds back, in which every one of the three lines end with the equivalent focused on word, is an exacting example in itself and frontal areas this piece of the sonnet as it takes on an incantatory feel. Despite the fact that the holds back are not the predominant structure of the sonnet, they do include melodic support. The customary metrical example is the thing that gives the lyric its rising cadence (anapests) and sing melody structure and there is little to upset the progression of the mood, or the story. The point at that point is effortlessness and redundancy; undoubtedly the primary case of reiteration happens in the opening line, which highlights the sonnet's title words accordingly reaffirming the focal point of the ballad. Yet, in the primary stanza, the most discernible sound example is the convergence of/p/sounds; a phonological parallelism that reaches out over the content with the words 'Pussy', 'pea', 'bounty' and 'pound' just as happening in 'wrapped' and 'up'. The repeat of this plosive consonant copies the culling of guitar strings, which upgrades the musicality as well as the enhanced visualization of the serenading owl. While the plosive/p/in 'Pussy' combined with the/b/in 'wonderful' isn't exactly alliterative, it is resonating and enticing of music, mirroring the profundity and enthusiasm of the owl's charms. Note that Lear likewise utilizes accentuation to stress meaning; the outcry marks toward the finish of lines ten and eleven signify a statement of the owl's sentiments recommending that the relationship is surely something other than kinship. Notwithstanding reiteration and similar sounding word usage, Lear utilizes solid full rhymes to fortify sound, which means and beat, and they have a functioning influence in the state of mind and motivation behind this ballad. Flawless end rhymes are the most discernible, yet there are additionally solid inward rhymes, to be specific happening in each third line of every stanza, yet in addition in the fifth line in the second and third ones. This blend of one and two syllable rhymes go about as a sub-abstain bringing the tune sound 'all around' again to our ears while the content turns out to be increasingly capricious. Sound and musicality are additionally drawn out into the open by the tolling end rhyme among 'sing' and 'ring' in lines thirteen and fifteen. The words are splendid and short, similar to the vowel sound, yet pursued by the consonant/ng/the sound is broadened, and the redundancy of 'ring' in the hold back mimickes the ringing of a chime where we may hear the onomatopoeic reverberation of 'bong' (from 'bong-tree'). The third stanza comes full circle in a centralization of inner and harmonious rhymes which invoke a visual and aural gala to coordinate the wedding dinner itself, with the last lines inspiring the who-o-o, who-o-o of an owl through the long vowel/oo/in 'moon'. Every one of the characteristics of tune are available: delight, simplicity of reiteration, memorability, cadence, rhyme and abstains. The clear suddenness of these components rise up out of customary standards and Lear's clever association. Other than musicality, the other fundamental element of the lyric is 'word-play' with Lear fusing intermittent created words: 'bong-tree', 'Piggy-wig' and the babble descriptor 'runcible'. Just as having a comical impact, they present components of unconstrained dream that accentuate the dreamlike adventure of the anthropomorphised creatures. In spite of the fact that these words seem made-up regardless they stay, just, inside our typical desires for English. Nonetheless, the way that they do veer off from the ballad's encompassing basic language implies they are foregrounded, in this manner, the peruser/audience gives especially consideration to them since they are fulfilling to state without fundamentally appearing well and good. Despite the fact that 'runcible' has no genuine importance (in spite of the fact that it has since been famously characterized as a three-pronged fork bended like a spoon) it has a phonological fun loving nature with the moving of the 'r' in 'run' trailed by the two syllables in 'cible'. The hyphenation of 'Piggy-wig' really fuses the phonemes and implications of two words, 'pig' and 'wig', managng to prevail as an interior rhyme. While the consideration of these words doesn't generally add anything to the significance of the expression, they do at any rate continue, and perhaps fortify the musicality. It isn't until the last stanza that the mood is upset somewhat by the 'running over' of line twenty-three into twenty-four immediately. The impact of this enjambment is that we are rushed on to a vital stage in the story, the time when an exchange happens. The caesura at the word 'ring' makes a delay, yet additionally a short strain as we anticipate the pig's answer. Note that the immediate discourse in these lines references conventional marriage promises strengthened by the weight on the words 'willing' and 'will'. Moreover, this exchange likewise brings the 'genuine' world closer to the surface. Without a ring the marriage can't occur. Just when the 'bargain' has been done can the story, and therefore the sonnet, proceed as in the past. When the customary musicality resumes it drives the story ahead, finishing with cat and fowl moving 'connected at the hip, on the edge of the sand… by the light of the moon'. Symbolism made by the evening glow (generally summoned as being sentimental) implies the charm of the scene moves on with the dream sweethearts and is the place the peruser/audience needs to leave them. Despite the offbeat story and word-play the sonnet is firmly tied down by the solid versifying 'walk' woven through the conventional melody type of tetrameter and trimeter. The rising rhythms move the ballad along while being constrained by the full and stable rhymes, making it fulfilling. Lear's ability originally came around in A Book of Nonsense (1846) containing a gathering of his limericks and interesting representations which demonstrated a prompt accomplishment with perusers and faultfinders. Lear's work, alongside that of Lewis Carroll, created and promoted rubbish writing, particularly with respect to their utilization of 'babble' words, in this manner, it is regularly observed as an unmistakably 'Victorian classification'. Be that as it may, abstract rubbish existed some time before this and, as Styles calls attention to in her exposition about the historical backdrop of verse for youngsters, can be followed back to the 'ferocity of the nursery rhyme' (Styles, p. 211). These old and customary rhymes from the oral convention, naturally known as 'Mother Goose' rhymes, are an accumulation of sections, bedtime songs, rhymes and tunes offering silliness, redundancy and narrating, albeit few were initially made or planned for kids. Eighteenth century verse considered reasonable for kids was generally instructional or moralistic, and frequently dastardly. Its main points were worried about sparing the spirit and making great character and, as other youngsters' writing, generally mirrored the thoughts that grown-ups held about what kids ought to be keen on. Be that as it may, as Puritanism wound down and new thoughts regarding adolescence rose, beautiful accumulations composed explicitly for kids started to show up. Tommy Thumb's Song Book (1744) was the main endeavor to put nursery rhymes from the oral custom into print, and two accumulations from William Blake in 1789 and 1794, despite the fact that not explicitly composed for kids, captured the quintessence of adolescence. Different volumes of tyke focused verse showed up in the early piece of the nineteenth century, and despite the fact that writers as of now kept on following in the equivalent moralistic custom there was a developing enthusiasm for kids' feelings and encounters. The mid and late nineteenth century delivered Stanzaan bounty of verse for kids, including that of Lear, which harmonized with the changing perspectives on youth. Despite the fact that the foundations of babble refrain are sooner than the nineteenth century, this is the period the most celebrated and remarkable models show up. Lear's limericks and rubbish rhymes were delighted in by youngsters, yet additionally by grown-ups, who discovered them an appreciated help from the prohibitive lessons of the Church and Victorian culture when all is said in done. These clever and comical rhymes were enjoyable to peruse so anyone might hear and simple to recollect. Be that as it may, Lear's work isn't simply recognized by his semantic play; it additionally included unusual and funny illustrations. In spite of the fact that his representations for 'The Owl and the Pussy-Cat' are to some degree preservationist in that the creatures are delineated reasonably and seem blank, they do offer an interpretative impact and would have incredibly improved the impression of the lyric at the season of distribution. On the other hand, the single delineation in 100 Best Poems for Children (P>GET ANSWER