R.W. is a married, 34-year-old Hispanic female with two young children who presents to her primary care provider with a productive cough, stiffness and pain in her hands and feet that comes and goes. She states, "It moves around from joint to joint. I'm worried I've got RA like my sister.” Her PCR test for COVID-19 has come back negative.
History of Present Illness
Five years ago, R.W. went to her PCP after four months of rashes that appeared on her arms and legs whenever she went into the sun. She had lost several small patches of hair on her scalp and stated she thought it was related to stress. She also complained of fatigue that required her to take daily naps. She had mild arthritic pain in her fingers and elbows but thought it was related to aging. A tissue biopsy of one of the multiple rash-like lesions from her arm revealed vasculitis (white blood cells within the walls of blood vessels). Her CBC indicated mild anemia, but microscopic examination of a peripheral blood smear revealed that red blood cells were normal in shape size and color, ruling out iron, folate and vitamin B12 deficiencies. A two-month course of prednisone caused all signs and symptoms to resolve.
Past Medical History
Unremarkable, current with all vaccinations including influenza.
Family History
She has two brothers and one sister. Her older sister has rheumatoid arthritis, and an aunt has pernicious anemia. Her mother has Graves' disease.
Social History
No smoking or drinking
Medications
Naproxen for joint pain, antacid for heartburn, no other over the counter drugs
Allergies
NKA
Vital Signs
BP 141/90 sitting, RA
HR 105
RR 20
T 100o F
HT 5'6"
WT 105 lbs
Review of Systems (only abnormal values presented)
Its not our scope to diagnose. It's the doctors. Our nursing diagnosis is based from NANDA not like that. We can be suspended or our license will be revoked if we diagnose patient clinically. Stop this discussion.
Specializes in Education, Informatics, Patient Safety.
7 minutes ago, magellan said:
Its not our scope to diagnose. It's the doctors. Our nursing diagnosis is based from NANDA not like that. We can be suspended or our license will be revoked if we diagnose patient clinically. Stop this discussion.
This is just for fun -no one is suggesting that nurses diagnose. It’s just to help us with our assessment skills and to know what to be alert for to tell the physician.
Its not our scope to diagnose. It's the doctors. Our nursing diagnosis is based from NANDA not like that. We can be suspended or our license will be revoked if we diagnose patient clinically. Stop this discussion.
Its not our scope to diagnose. It's the doctors. Our nursing diagnosis is based from NANDA not like that. We can be suspended or our license will be revoked if we diagnose patient clinically. Stop this discussion.
No, but it is within our scope to teach and reinforce what the provider has taught about a condition, including diagnosis and treatment. I believe case studies teach us so we can teach our patients.
Specializes in Education, Informatics, Patient Safety.
I was also thinking about all the nurse practitioners who use allnurses. And those who are going to school for their NP. This kind of critical thinking is great practice!
Specializes in Education, Informatics, Patient Safety.
Congrats!! Wow! That’s an incredible achievement. Thank you so much for supporting our learning:) good luck to you- we need more FNPs - so many folks will benefit.
Yes, but not to that point to diagnose a patient medically because that's not the scope of our practice. We have to be realistic in our practice everywhere we go because the next thing we would know, the patient is six feet below the ground already.
Congrats!! Wow! That’s an incredible achievement. Thank you so much for supporting our learning:) good luck to you- we need more FNPs - so many folks will benefit.
Ma'am, don't confuse us or fool us with that kind of scenario. As an RN, we are not allowed to diagnose a patient medically because its out of our practice. Only an MD can do that. Our nursing diagnosis should be based from NANDA. An example of that is, Alteration in comfort level due to pain or elevated temperature. You're promoting us to suspend or revoked our license if the Board knows about this. You should know how far we can go with our practice because in our profession, there's some kind of limitation that we should and can do.
SafetyNurse1968, BSN, MSN, PhD
60 Articles; 529 Posts
Spot Angel definitely did get it right. Nice work!