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NR 601 Discussion

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NR 601 Discussion

NR 601 Discussion
B.J., a 70-year-old black female has been seen in the clinic several times. The last time she was in for a check-up was 6 months ago to get her prescriptions refilled. She has returned to the clinic today because she “ran out of blood pressure medicine” and would like to get her prescriptions renewed. She has not taken any prescription medicine in approximately 6 months
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Background:
The patient indicates that she has noticed shortness of breath, especially when she is playing with her grandchildren. But, it goes away once she sits down to rest. She reports that she is also bothered by shortness of breath that wakes her up at night, but it resolves after sitting upright on 3 pillows. She also tells you that “I noticed over the last week that my legs and ankles have been swollen”. She also indicates that she often feels light headed and faint while going up the stairs, but it subsides after sitting down to rest. NR 601 Discussion.
PMH:
Hypertension
Previous history of MI in 2010
Current medications:
Coreg 6.25 mg PO BID
Colace 100 mg PO BID
K-dur 20 mEq PO QD
Furosemide 40 mg PO QD

Surgeries:
2010-Left Anterior Descending (LAD) cardiac stent placement
Allergies: Amoxicillin
Vaccination History:
She receives an annual flu shot. Last flu shot was this year
Has never had a Pneumovax
Has not had a Td in over 20 years
Has not had the herpes zoster vaccine
Other:
Last colorectal screening was 11 years ago
Last mammogram was 5 years ago
Has never had a DEXA/Bone Density Test
Last dilated eye exam was 4 years ago
Labs from last year’s visit: Hgb 12.2, Hct 37%, K+ 4.2,
Na+140 Cholesterol 186, Triglycerides 188, HDL 37, LDL 190, TSH 3.7
Blood pressure on day of visit: 150/90
Social history:
She graduated from high school, and thought about college, but got married right away and then had kids a short time later. Her son lives in another state,
Family history:
Both parents are deceased. Father died of a heart attack; mother died of natural causes. She had one brother who died of a heart attack 20 years ago at the age of 52. NR 601 Discussion.
Habits:
She drinks one 4-ounce glass of red wine daily. She is a former smoker that stopped 20 years ago.
Discussion Part One:
• Summarize the important data from the patient’s history and reason for the visit today.
• Provide a minimum of three differential diagnoses (DD) with rationale for the chief complaint.
• Include OLDCARTS and additional ROS questions needed to develop DD. NR 601 Discussion.
• Based on the LDL level above, indicate if you need to order a statin for this patient? Provide a rationale for your decision based on evidence based clinical guidelines.
• What other patient risk factors put the patient at risk for arteriosclerotic coronary vascular disease (ASCVD)? Reference the guidelines in your response.
• Based on the patient data provided, choose two geriatric assessment tools that would be appropriate to use in conducting a thorough geriatric assessment. Provide a rationale on why you are choosing these particular tools. NR 601 Discussion.

Physical Exam
Vital signs: BP 138/88; HR 88 (regular), RR 18, T 98.8 height 5’7″, weight 175 pounds
General appearance: Thin and mildly dyspneic
Lungs: Mild end-expiratory wheezing. Pursed-lip breathing noted and has a prolonged expiratory phase. Heart: S1 and S2 RRR with distant heart tones. No murmurs
Abdomen: Soft, non-tender with positive bowel sounds. No abdominal bruits
Extremities: Full ROM of all extremities. No edema. All pulses 2+
Labs/diagnostics: Chest x-ray shows pulmonary hyperinflation, flattening of the diaphragm; Pulmonary function test:
Prebronchodilation: FEV1/FVC ratio 53%, FEV1 50% of predicted value
Postbronchodilation with 2 puffs albuterol—FEV1/FVC ratio 0.60, FEV1 60% of predicted value
Discussion Questions Part Two:
Post your SOAP note for this patient’s encounter.
Review the SOAP note format for the course. Summarize the history and results of the physical exam. Include one evidence-based journal article that supports your rationale for all diagnoses with ICD 10 codes and include a complete treatment plan that include medications, further diagnostics, patient education, referral and plan for follow-up. Each step of the plan must include an in-text citation to a scholarly source. Review the Reference Guidelines document in Course Resources. NR 601 Discussion.

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