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Pulmonary Diseases

General Information: GY is a 70 years old White American male at the emergency department of NYP Medical
Center with multiple complications.
CC: “I feel weakness and difficulty of breathing”.
HPI: GY is a 70 years old male presents to the emergency department with multiple complications. He has not
felt well last couple of weeks and lost appetite and lost weight 15 lb in the last month. GY has diabetic
nephropathy which has progressed to ESRD for 10 years. He has renal failure and has been on hemodialysis
for 5 years (2 times/week). He has history of coronary heart disease for last 10 years, COPD for last 15 years
and abnormality in secretion of corticosteroid hormone from birth. He occasionally feels pain in his chest which
disappears after taking nitroglycerine sublingual tablet or rest. He complains shortness of breath and becomes
weak after walking several blocks.
PMH: Ischemic Heart Disease X 10 years and controlled by medication
Chronic Obstructive Pulmonary Disease X 15 years and uncontrolled
Adrenal insufficiency X from birth
FH: Mother died at the age of 90 from diabetes.
Father died of heart attach at the age of 75.
He has no siblings.
SH: Ethanol drinking with 2 beers x daily, he smokes 1 pack of cigarettes daily, he is single and live in
government shelter.
ROS: None
All: NKA
Meds: Nitroglycerine SL 0.4 mg prn for chest pain
Atenolol 50 mg po qd
Levalbuterol neb 0.63 mg tid every 6 hours
Ipratropium neb 500 mcg every 6 hours
Lipitor 10 mg po daily
Prednisone 5 mg po daily
Glyburide 10 mg po daily
Furosemide 40 mg po daily
PE: VS: BP 130/74 P 79 RR 18, T 98ºF, Wt 62 kg, Ht 5’8”
CHEST: RRR, no murmur, rales bilaterally chest wall NT.
CV: S1 S2 normal, no chest pain, no palpitation, no shortness of breath
Abd: No bruits tenderness, no masses.
Skin: Rash at lower extremities
HEENT: No history of headaches, dysphasia or odonyphasia
Mental status: Normal.
Labs: Na 135; K 4.3; Cl 102; CO2 24; BUN 27 (H); Scr 2.1 (H); Glu 170 (H); ALT 26; AST 21; total Chol 175;
LDL 120; HDL 39; TG 115; Albumin 4.8; Hgb 18; Hct 43% RBC 5.6; WBC 9; Plt 250, A1C 9.0, DST 450.
Problem List: 01. Coronary Heart Disease (CHD)

  1. Chronic Kidney Disease (CKD)
  2. Chronic Obstructive Pulmonary Disease (COPD)
  3. Adrenal Insufficiency
  4. Coronary Heart Disease (CHD)
    S: GY is a 70 year old male who is suffering from coronary heart disease from last 10 years. He complains
    weakness and difficulty of breathing. He occasionally feels pain in his chest which disappears after taking
    nitroglycerine sublingual tablet or rest. He drinks beer and smokes regularly.
    O: Age 70; BP 130/74 P 79 RR 18; ALT 26; AST 21; total Chol 175; LDL 120; HDL 39; TG 115; Hgb 18; Hct
    43% RBC 5.6

Sample Solution

e one limitation of Chealldurai’s model is that it assumes the leader is in a position of complete positional power over the group, and can implement any leadership style of their choosing without constraints. Positional power is the authority and influence a leader has over a group, if the leader has positional power, they will be able to implement the leadership style they best see fit for the situation. Positional power cannot be measured or quantified, making it highly ambiguous and hard for a leader to understand whether they have it or how then can gain it. It becomes the responsibility of the organisation to have policies in place to provide leaders with some positional power, usually by establishing a clear hierarchal structure. By establishing a hierarchy, the leader is perceived by the group to be able to make demands and expect compliance from them giving the leader legitimate power (French and Raven, 1959). Secondly, by providing the leader with the ability to reward compliance and punish non compliance from the group, the leader has reward and coercive power (French and Raven, 1959). To obtain complete power over the group the leader must gain the trust and belief of the group that they are capable of success, by ensuring the group are both satisfied and meeting performance goals. The importance of establishing a hierarchy became evident during the planning stage of the outdoor management course for the red team, the coordinators within the team assumed leadership roles but were unable to gain positional power due to the team being a peer group (Pettinger, 2007). The leaders selected had little authority and influence over the group as everyone was perceived to have the same rank, status and occupation, hence the leaders had none of French and Ravens five bases of power (Pettinger, 2007). The result was leaders with no positional power over the group, so could not direct the group with the method of leadership required for the situation. The task had significant constraints, particularly a short time frame and a large group size, for this situation Che
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