NR 601 Week 2-2 health care questions with answers 2021

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Discussion Part Two (graded) Physical examination: Vital Signs Height: 5 feet 2 inches Weight: 163 pounds BMI: 29.8 BP 150/86 T 98.0 po P 100 R 22, non-labored; Ur HEENT: normocephalic, symmetric... . Bilateral cataracts; PERRLA, EOMI; Upper and lower dentures in place a fitting well. No tinnitus NECK: Neck supple; non-palpable lymph nodes; no carotid bruits. Thyroid nonpalpable LUNGS: inspiratory crackles HEART: Normal S1 with S2 split during expiration. An S4 is noted at the apex; systolic murmur noted at the right upper sternal border without radiation to the carotids. ABDOMEN: Normal contour; active bowel sounds all four quadrants; no palpable masses. PV: Pulses are 2+ in upper extremities and 1+ in pedal pulses bilaterally. 2+ pitting edema to her knees noted bilaterally GENITOURINARY: no CVA tenderness; not examined MUSCULOSKELETAL: Heberden’s nodes at the DIP joints of all fingers and crepitus of the bilateral knees on flexion and extension with tenderness to palpation medially at both knees. Kyphosis and gait slow, but steady. PSYCH: normal affect; her Mini-Cog Score is 3. Her PHQ-9 score is 22. SKIN: Sparse hair noted on lower legs and feet bilaterally with dry skin on her ankles and feet. Discussion Part Two: Summarize the history and results of the physical exam. Discuss the differential diagnosis and rationale for choosing the primary diagnosis. Include one evidencebased journal article that supports your rationale and include a complete treatment plan that includes medications, possible referrals, patient education, ICD 10 codes, and plan for follow up. If you chose to order a statin, indicate name, dosage and rationale for selecting it. In the patient education plan, make sure to include important information the patient needs to know about taking a statin drug. Dr. McFarland and class, Patient Information: B.J., a 70-year-old black female S. CC: “ran out of blood pressure medicine”. HPI: 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. Onset: None reported. Location: Ankles and legs (swelling), lungs (shortness of breath), head (lightheadedness, faintness). Duration: 1 week (swelling). Characteristics: Shortness of breath (SOB), lightheadedness and faintness, swelling bilateral ankles and legs. Aggravating Factors: (SOB) Playing with grandchildren, (SOB) worse at night and wakes her up at night, (lightheadedness and faintness) going up the stairs. Relieving Factors: Exertional SOB/lightheadedness and faintness resolve after sitting down to rest, SOB at night resolves when sitting upright on 3 pillows. Treatment: None reported. Current Medications:  Coreg 6.25 mg PO BID  Colace 100 mg PO BID  K-dur 20 mEq PO QD  Furosemide 40 mg PO QD 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. Allergies: Amoxicillin PMHx: Hypertension, previous history of MI in 2010. Surgeries: 2010-Left Anterior Descending (LAD) cardiac stent placement. 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 Soc Hx: 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. She drinks one 4-ounce glass of red wine daily. She is a former smoker that stopped 20 years ago. Fam Hx: 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. ROS: CONSTITUTIONAL: No reported weight loss, fever, chills, weakness, or fatigue. (+) lightheadedness and faintness when climbing stairs. HEENT: None reported. SKIN: None reported. CARDIOVASCULAR: No chest pain, chest pressure, or chest discomfort reported. No palpitations. Edema bilateral ankles and legs x 1 week (+). RESPIRATORY: Shortness of breath while playing with grandchildren, and wakes her up at night. No report of cough or sputum. GASTROINTESTINAL: None reported. GENITOURINARY: None reported. NEUROLOGICAL: None reported [Show More]

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