Apply the ICD-10-CM Official Guidelines for Coding and Reporting of the Principal Diagnosis for Inpatient Care (Guidelines I A- J) to identify the principal diagnosis in the following scenario.

The physician's discharge summary includes the final diagnoses of (1) coronary artery disease, (2) hypertension, and (3) benign prostatic hypertrophy. The coder notes in the patient's laboratory reports that the patient has an elevated cholesterol level and an elevated PSA positive finding.

Mrs. Tom, a 79 year old female presents to the ER with complaints of a persistent productive cough, fatigue, fever and shortness of breath. Mrs. Tom reports that she has had a persistent cough and shortness of breath with activity for several months. She was given a prescription for antibiotics for a presumed infection 4 weeks ago, with only slight improvement in symptoms. Her past medical history includes stroke 6 months ago. She also smokes 20 cigarettes per day. On exam, she has a fever with decreased lung sounds bilaterally to auscultation with the right side slightly more obvious than the left. She is obviously short of breath and presents with 4-word dyspnea. Her vital signs are BP 110/70, HR 99, SP02 94% on 4 L of oxygen via nasal prongs, Temp 38.9.

1. Identify the infection of inflammatory response that Mrs. Tom is experiencing? (2)

2. Explain the pathology of how smoking affects the innate defense system of the lungs? (5)

3. What diagnostic tools could you expect to be used in this case? (xray,CT,laboratory data etc). (2)

4. Identify risk factors that Mrs. Tom has that are associated with the diagnosis? (3)

5. Internal medicine assesses Mrs. Tom and orders a STAT lactate and arterial blood gasses. Based on the patient’s vital signs above, what would you expect to see in the results of these tests? (5)

1. The nurse working in a long-term care facility incorporates a focused assessment of
the immune system for all newly admitted patients over the age of 65. Older adults

are more likely to develop problems related to immune function than are middle-
aged people. The focused immune assessment includes a systemic approach based

on age-related changes in immunologic function. (Learning Objective 4)
a. What changes in the immune system in the older adult increase the incidence of
infection and cancer in this population?
b. Explain why older adults may have decreased inflammatory responses.
c. Why are older adults at increased risk of gastroenteritis and diarrhea secondary
to proliferation of intestinal organisms?

2. The nurse educator for an oncology unit is preparing an in-service presentation for
new nurses about the care of patients with immunodeficiencies. Patients with cancer
who are receiving chemotherapy, as well as those with bone marrow transplants, are
immunocompromised and require special attention to assess for signs of infection.
The nurse educator focuses on special care needs of this patient population.
a. What is the rationale for assessing the pulse and respiratory rates for 1 full
minute in a patient with immunodeficiency?
b. What special precautions about dietary restrictions and food preparation should
be included in the teaching for a patient with immunodeficiency?
c. What nursing actions should be implemented to decrease the risk of infection in
the patient with immunodeficiency?
3. Molly Baker, a 22-year-old patient, presents to the clinic with the diagnosis of
allergic rhinitis. She states that she develops paroxysmal sneezing, clear nasal
drainage and congestion, watery, red eyes, and nasal itching from the late spring
until the first frost in the fall. She states that she has a dry cough and voice
hoarseness. She complains of feeling extremely tired, unable to sleep at night, and
having difficulty concentrating on her collegiate course work.
a. What further assessment should the nurse provide?

1. Ellie Long, a 55-year-old patient, presents to the pain clinic with the diagnosis of
   fibromyalgia syndrome. The nurse at the clinic obtains a history and physical
   assessment of the patient. (Learning Objective 2)
   a. On what areas should the nurse concentrate when interviewing the patient
   during the history process?
   b. On what areas should the nurse concentrate when assessing the patient?
   c. What diagnostic tests are used with fibromyalgia syndrome?

Jennifer Williams is a 43-year-old recently divorced female who has two teenage daughters aged 18 and
16 years. Her 16-year old daughter is 7 months pregnant. Jennifer's ex-husband is an alcoholic and is
involved with her daughters but cannot be relied on for financial assistance. She lives in an older home
in a low-income neighborhood. Her aging and widowed mother, who lives a few blocks away, is in the
early stages of Alzheimer's disease and needs regular assistance. Ms. Williams is the main caregiver for
her mother. She is employed full-time as an office assistant and regularly has difficulty making ends
meet financially.

A number of recent events have been challenging for Jennifer. Her pregnant daughter recently broke up
with her boyfriend and Jennifer knows she will be largely supporting and raising her grandchild. She also
recently had an intense argument with her oldest daughter about attending college—something she
supports but can't afford. In addition to all of these issues, Jennifer's mother fell and broke her arm. She
is now trying to meet the increasing care her mother needs.

All these events have been weighing heavily on Jennifer's mind. She is feeling highly anxious and is
experiencing difficulty sleeping. She has had intermittent diarrhea and has become highly irritable,
leading to arguments at work with her coworkers. Jennifer also began experiencing headaches. Fearing
she had something seriously wrong with her, she went to an urgent care clinic. After a brief visit focusing
on her headache, she was told not to worry because she was “only experiencing a tension headache”
and was a little hypertensive, and she was advised to see her primary care physician. Jennifer was
relieved to learn she did not have a brain tumor, but she has no intention of seeing another physician for
the headaches. She does not want to spend any more money on herself.

        ZOOM         Case Analysis Template:
Select your case and use this format to analyze the important Concepts you identify.
Remember, there are likely more than 3, but use 3 as your maximum.
1.) Identify relevant data from the present problem/ situation:
- Summarize the current situation and factors
2.) Personal/ Social history:
- Summarize: familial, occupational, and recreational aspects of the patient's personal life
that have the potential to be clinically significant.
3.) What are the interrelated Concepts for this case that you have identified and choose to
focus your paper? Discuss the principles within the Concept/s selected, apply those
principles to the case.
Ex/ Adherence Case and Class Activity Example
1) Adherence
2) Health Promotion
3) Patient Education
4.) Bring in a research article to further support your case, how can the research support further
investigation of the concepts you are looking at, how as a nurse can the research help you
support (ie. Education, collaboration, communication) a patient/ family.
5.) Conclusion: What outcomes would be important to include for this patient/ case?
What is your conclusion (wrap -up) and key elements of the case?