Case Study Scenario Chief Complaint A.C., is a 61-year old male with complaints of shortness of breath. History of Present Illness A.C. was seen in the emergency room 1 week ago for an acute onset of mid-sternal chest pain. The event was preceded with complaints of fatigue and increasing dyspnea for 3 months, for which he did not seek care. He was evaluated by cardiology and underwent a successful and uneventful angioplasty prior to discharge. Despite the intervention, the shortness of breath has not improved. Since starting cardiac rehabilitation, he feels that his breathlessness is worse. The cardiologist has requested that you, his primary care provider, evaluate him for further work-up. Prior to today, his last visit with your practice was 3 years ago when he was seen for acute bronchitis and smoking cessation counseling. Past Medical History? Hypertension? Hyperlipidemia? Atherosclerotic coronary artery disease Smoker Family History Father deceased of acute coronary syndrome at age 65 Mother deceased of breast cancer at age 58.? One?sister, alive, who is a 5 year breast cancer survivor. One son and one daughter with no significant medical history.? Social History 35 pack-year smoking history; he has cut down to one cigarette at bedtime following his cardiac intervention.? Denies alcohol or recreational drug use? Real estate agent?? Allergies No Known Drug Allergies? Medications Rosuvastatin?20 mg?once daily by mouth? Carvedilol 25 mg twice daily by mouth Hydrochlorothiazide 12.5 mg once daily?by mouth Aspirin 81mg daily by mouth Review of Systems Constitutional: Denies fever, chills or weight loss. + Fatigue. HEENT: Denies nasal congestion, rhinorrhea or sore throat.?? Chest: + dyspnea with exertion. Denies productive cough or wheezing. + Dry, nonproductive cough in the AM. Heart: Denies chest pain, chest pressure or palpitations. Lymph: Denies lymph node swelling. General Physical Exam?? Constitutional: Alert and oriented male in no apparent distress.?? Vital Signs:?BP-120/84, T-97.9 F, P-62, RR-22, SaO2: 93%? Wt. 180?lbs.,?Ht.?5'9" HEENT? Eyes: Pupils equal, round and reactive to light and accommodation, normal conjunctiva.? Ears: Tympanic membranes intact.? Nose: Bilateral nasal turbinates without redness or swelling. Nares patent.? Mouth: Oropharynx clear. No mouth lesions. Dentures well-fitting.?Oral mucous membranes dry.? Neck/Lymph Nodes? Neck supple without JVD.? No lymphadenopathy, masses or carotid bruits.? Lungs? Bilateral breath sounds clear throughout lung fields. + Bilaterally wheezes noted with forced exhalation along with a prolonged expiratory phase. No intercostal retractions. Heart? S1 and S2 regular rate and rhythm, no rubs or murmurs.? Integumentary System? Skin cool, pale and dry. Nail beds pink without clubbing. ? Chest?X-Ray? Lungs are hyper-inflated bilaterally with?a flattened?diaphragm. No effusions or?infiltrates. Spirometry PredictedPre-bronchodilator% PredictedPost-bronchodilator% PredictedChange FVC (L) 5.64 5.23 93 5.77 102 9% FEV1 (L) 4.57 2.92 64 3.01 66 2% FEV1/FVC (%) 81 56 69 52 64 -5% TLC 5.5 6.9 125 6.9 125 0% Case Study Questions Pathophysiology & Clinical Findings of the Disease Are the spirometry results consistent with obstructive or restrictive pulmonary disease? What is the most likely pulmonary diagnosis for this patient? Explain the pathophysiology associated with the chosen pulmonary disease. Identify at least three subjective findings from the case which support the chosen diagnosis. Identify at least three objective findings from the case which support the chosen diagnosis. Management of the Disease *Utilize the required Clinical Practice Guideline (CPG) to support your treatment recommendations. Classify the patient's disease severity. Is this considered stable or unstable? Identify two (2) "Evidence A" recommended medication classes for the treatment of this condition and provide an example (drug name) for each. Describe the mechanism of action for each of the medication classes identified above. Identify two (2) "Evidence A" recommended non-pharmacological treatment options for this patient.

ASSIGNMENT DETAILS Your coding manager asks you to review the above case (#ED322223) for any coding discrepancies. You notice that additional information from the provider would allow you to code the diagnosis to a higher level of specificity. Your manager requests that you generate a physician query to resolve the issue.Describe the deficiency that was present in the health record that would require a physician query to resolve. Record your response in the box below.Refer to the Unit 5 Supplemental Readings “Guidelines for achieving a compliant query practice” and compose a written query to the physician to clarify the deficiency in the health record. Create and record your completed query in the box below.Submit the completed assignment worksheet to the Unit 5 Assignment Dropbox. Requirements: I have attached the full assignment instructions Your assignment should have no more than 10% quoting.Please use paraphrasing, in-text citation, and a list of references, as appropriate. Your assignment should: Have a cohesive viewpoint that is clearly established and sustained.Follow the conventions of Standard English (correct grammar, punctuation, and spelling).Be well ordered, logical and unified, as well as original and insightful.Follow APA citation style as needed (Please note:You may access information regarding appropriate citation information at the Purdue Global Writing Center).The word count should be 75-100 words.

This is the Topic Professional development in nursing .Using at least 4 current (within the past 5 years), relevant, peer-reviewed resources, create a literature review that does the following:Describes the project's topic, resources reviewed, and conclusions of each article.Summarizes the principal findings of the research and their relevance to the project's proposed outcomes.This paper should be at least 2 pages in length and include a cover page and reference page with links to all researched articles. Be sure to use APA format.