Assignment: Prescription Medicine Study

Assignment: Prescription Medicine Study
Assignment: Prescription Medicine Study
Assignment: Prescription Medicine Study
Week 2 discussion PART 1 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 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. 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. 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 differential diagnoses (DD) with rationale. Further ROS questions needed to develop DD. 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)? · Based on the patient data provided, choose 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. PART 2 Patient Information B.J., 70 y/o, Female, African-American Week 3 discussion PART 1 Mr. M.J. is a 64-year-old patient of Hispanic descent who presents to the clinic today with concerns about epigastric and substernal pain that has gotten progressively worse over the past 3 months. He complains of mild “heartburn after eating a large meal for at least 2 years. He has tried over the counter products occasionally with adequate response. Three months ago, he was awakened with severe burning discomfort that extended from his mid-chest to his jaw that lasted 30 minutes before he was able to fall back to sleep. He is now experiencing these attacks about 3 times per week. He has tried avoiding large meals and is now sleeping on two pillows at night to relieve his pain which has improved his pain. The pain now occurs regularly after meals and randomly during the day. He takes antacids with each meal, but the pain still persists. Overall, he considers himself to be very healthy. Past Medical History Depression diagnosed 6 months ago Family History Unknown; was adopted from an orphanage when he was 3 months old; Wife died of breast cancer approximately 8 months ago. They were unable to have children. Social History Drinks beer occasionally when out with friends No smoking history Current Medications Multivitamin daily Discussion Questions Part One Describe how you would work-up this patient’s abdominal pain based on current clinical guidelines. Provide further ROS questions needed to develop differential diagnoses. Provide the differential diagnoses (DD) with rationale. Decide whether or not this patient should also be worked-up for depression. Why or why not? Based on the data provided, what types of screening tools would be useful in this patient’s case?