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Unit 9 Discussion-Sexuality and the Geriatric Client

Unit 9 Discussion-Sexuality and the Geriatric Client

Sample Answer 

Unit 9 Discussion-Sexuality and the Geriatric Client

Sexuality and the Geriatric Client

Pertinent Positives

  • Slightly high caffeine intake.
  • The patient is overweight, weighing 200lbs, and has a BMI of 29.53.
  • The patient is drinking excess fluids without satisfaction/relief.
  • Urgent and frequent urination.
  • The patient has a familial history of hypertension and cardiovascular diseases.

Pertinent Negatives

  • There is no history of Urinary Tract infection.
  • There’s no recent urinary tract examination, and the last colonoscopy was done ten years ago.
  • There is no penile discharge or blood in the urine.
  • There’s no swelling in the lower extremities, and genitalia appears normal.
  • Normal lung and cardiovascular examination and normal blood pressure of 122/81.

Missing Information

Dietary information for the client is missing, which could be a guide in the assessment of his overweight condition. There’s no lab information on urinary examination to investigate probable urinary tract infection. The last colonoscopy was done 10 years ago, which may not offer credible guidance in the diagnosis. As noted by Alegría et al. (2008), missing information in the assessment of elderly people presents a point of diagnosis bias; hence, clinicians should create rapport to improve presents revelations. Besides, the assessment does not include ethnic and racial backgrounds, which is another point of concern. According to Alegría et al. (2008), ethnicity is a modifying factor in the relationship between symptoms reported and the likelihood of a missed diagnosis.

Differential and Actual Diagnosis

The differential diagnoses for the patient are Urinary Tract Infection, Diabetes, Prostatitis, Chlamydia, Multiple Sclerosis, and Cystitis. The actual diagnosis for the client is dysuria due to the suspected Urinary Tract Infections.

Plan for Priority Diagnosis

  1. The patient to continue on the current painkillers while pursuing serial examinations such as MRI, CFU, and BPH.
  2. The patient should cut down on caffeine intake and, if possible, quit the occasional drinking due to concerns about his weight, indicative of probable diabetes.
  3. They should follow up with urine culture and tests for STIs.
  4. Dysuria for probable UTIs. The client is advised to start Bactrim treatment for a suspected urinary tract infection.

Dysuria is a common disorder among the elderly that is manageable (Michels & Sands, 2015). The client is advised to be open and truthful in future hospital visits to enhance accurate diagnosis and easy management of the condition.

References

Alegría, M., Nakash, O., Lapatin, S., Oddo, V., Gao, S., Lin, J., & Normand, S. L. (2008). How   Missing Information in Diagnosis Can Lead to Disparities in the Clinical     Encounter. Journal of public health management and practice: JPHMP14(Suppl),        S26.

Michels, T. C., & Sands, J. E. (2015). Dysuria: Evaluation and Differential Diagnosis in   Adults. American family physician92(9), 778-786.

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Question 


Unit 9 Discussion-Sexuality and the Geriatric Client

Instructions

It is anticipated that the initial discussion response should be in the range of 250-300 words. Response posts must demonstrate topic knowledge and scholarly engagement with peers. This is not the only criteria utilized for evaluation; substantive content is imperative. All questions in the topic must be addressed. Please proofread your response carefully for grammar and spelling. Do not upload any attachments. All responses need to be supported by a minimum of one scholarly resource. Journals and websites must be cited appropriately. Citation and reference must adhere to APA format.

Sexuality and the Geriatric Client

Sexuality and the Geriatric Client

Discussion Prompt 

Unit 9 focuses on sexuality of the geriatric client.  Sexual health is an area we often write, “deferred.” How do we break down that personal barrier and talk openly with our clients about sexual health?

Initial Post Instructions: 

  • Please critically evaluate the subjective and objective information provided to you in the attached file below.
    The first part of the discussion board is to identify all pertinent positive and, negative information and list missing information.
  • Then create a differential diagnosis list with at least 3 possibly actual diagnosis based on your findings.
    Second part is to create a plan utilizing clinical practice guidelines for the priority diagnosis.
  • Be sure to utilize template, in-text citations and provide full reference citation at the end of the discussion.

 

NU627 Unit 9 Discussion Case C.C. “I am having burning with urination.” HPI: T.B. 82 y.o. M reports that he noticed burning with urination started about a week ago. Reports his stream is not affected. He also reports urgency with urination. Drinking lots of fluids without relief. Oxycodone is not helping with pain. He denies abdominal or flank pain. Denies fever, chills, lesions, hematuria or penile discharge. He has never had a urinary tract infection. PMH: Chronic pain syndrome, spondylosis of the lumbosacral region, and hypertension. Last colonoscopy was approximately 10 years ago per patient. Allergies: No known drug allergies. Medications: Oxycodone HCl 20 mg tablet; PO every 6 hours for pain, Atenolol 50 mg PO daily, Colace 100 mg capsule BID PO. Social History: He resides in an apartment for 50+. He is a non-smoker and denies recreational drug use. He drinks 2 beers every week He is sexually active with 1 partner. Does not use condoms. He drinks 2-3 cups of caffeine per day. He walks 30 minutes per day for exercise. Family History: Mother: deceased, HTN, smoker, CAD. Father: unknown history. Health Maintenance/Promotion: Influenza, TDaP, Hep A, shingrix vaccine up to date. ROS: General: Patient denies fever, chills, malaise, weight loss. Skin: Patient denies any recent rash, abnormal skin lesions, or open wounds. Neck: Patient denies neck stiffness or pain. HEENT: He denies any visual changes, ear pain or drainage, denies hearing loss, denies sore throat or nasal drainage. He reports last eye examination in August 2019 with minor changes to his vision. CV: Patient denies chest pain, chest tightness, heart palpitations or irregular heartbeats. He denies any swelling in lower extremities. He denies dizziness, syncope, or lightheadedness. Lungs: Patient denies any shortness of breath at rest or with exertion. He denies a cough. He denies wheezing or difficulty catching breath with exercise. GI: He denies abdominal pain, change in bowel habits, or noticing bloody or black colored stools. He denies constipation with long term opioid use. He reports that he has a bowel movement every morning. GU: Patient reports burning with urination and urgency started one week ago. He denies penile discharge or blood in urine. He denies flank pain. He denies incontinence, straining or dribbling urine. He denies splitting or spraying during urination. He denies intermittent urinary stream and feels like he is emptying his bladder. MSK: Patient denies muscle pain or aches. Neuro: Patient reports chronic pain is managed well with oxycodone that is prescribed by pain management. He denies any numbness or tingling, loss of coordination or balance. He denies any recent falls. He denies blurred or double vision. Psych: He denies little interest of pleasure in doing things and denies feeling down, depressed, or hopeless. Objective VS: Temp: 98.8 F, BP: 122/81 mm Hg, HR: 56 BPM, RR: 18, Oxygen saturation: 98% on Room Air, Ht: 69 in, Wt.: 200 lbs., BMI: 29.53 Index. General: Patient appears in no acute distress, well developed, well nourished. Skin: Skin is without redness, rash, or lesions. Head: Normocephalic. Neck: Neck supple; thyroid gland without enlargement. ENT: Both eyes, fundus normal. Ears: auditory canal intact and clear; tympanic membrane appears pearly grey. Oral mucosa pink and moist; throat without redness or exudate. CV: Regular rate and rhythm, normal S1 S2 without murmurs or clicks. No evidence of swelling in lower extremities. Radial and pedal pulses 2+. Lungs: Breath sounds clear on auscultation bilaterally. Chest expansion symmetrical without any evidence of respiratory distress. No wheezes, rhonchi, or rales heard on auscultation. Abd: Bowel sounds present in all quadrants. Abdomen soft, non-tender, and non-distended. GU: Male genitalia appears normal. Prostate: Digital rectal examination performed, prostate non-tender, no nodules and is of normal size. MSK: Normal muscle tone and bulk. Neuro: Coordination and balance intact. PERRLA. Muscle strength 5/5 in all extremities.

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