Chief complaint: “I’m here for a medication refill because I ran out of my medicines”.

HPI:  Mrs. Allen is a 68-year-old African American who presents to the clinic for prescription refills. The patient indicates that she has noticed shortness of breath which started about 3 months ago. The SOB gets worse with exertion, especially when she is walking fast, and it is resolved when she is resting. She reports that she is also bothered by shortness of breath that wakes her up intermittently during her sleep. Her symptoms of shortness of breath resolve after sitting upright on 3 pillows. She also has lower leg edema pitting 1+ which started 2 weeks ago. She indicates that she often feels light headed at times with intermittent syncope episodes while going up a flight of stairs, but it resolves after sitting down to rest. She has not tried any over the counter medications at home.

She started taking her medications, but failed to refill the prescriptions because she cannot afford the medications as she only works part-time and lives alone. In addition, she reports that she does not think taking all these medications would help her condition anyway.

PMH: Primary Hypertension, Previous history of MI 1 year ago

Surgeries:

1 year ago-Left Anterior Descending (LAD) cardiac stent placement

Allergies: Penicillin

Vaccination History:  Up-to-date

Social history:

High school graduate married and no children. Drinks one 4-ounce glass of red wine daily. She is a former smoker and stopped 5 years ago.

Family history:

Both parents are alive. Father has history of MI and valvular heart disease; mother alive and cardiac history is unknown. He has one brother who is alive and has history of MI 5 years ago at age 52.

ROS:

Constitutional: Lightheaded and faint with exertion. Respiratory: Shortness of breath with exertion. + Orthopnea. Cardiovascular: + 2 pitting leg edema for 3 weeks.

Psychiatric: Non-contributory.

Physical examination:

Vital Signs: Height: 5 feet 1 inches Weight: 175 pounds BMI: 32, Obese, BP 160/92, T 98.0, P 111,  R 22 and non-labored

HEENT: Normocephalic/Atraumatic, Bilateral cataracts; PERRLA, EOMI; Teeth intact. Negative for gum disease. NECK: Neck supple, no palpable masses, no lymphadenopathy, no thyroid enlargement. LUNGS: + Mild Crackles on inspiratory phase not clearing with cough. Equal breath sounds. Symmetrical respiration. No respiratory distress. HEART: Normal S1 with S2 during expiration. An S4 is noted at the apex; + systolic murmur noted at the right upper sternal border without radiation to the carotids. Pulses are 2+ in upper extremities and 2+ in pedal pulses bilaterally. 2+ pitting edema to her knees noted bilaterally. ABDOMEN: No abdominal distention. Nontender. Bowel sounds + x 4 quadrants. No organomegaly. Normal contour; No palpable masses. GENITOURINARY: No CVA tenderness bilaterally. GU exam deferred. MUSCULOSKELETAL: + Heberden’s nodes at the DIP joints, hands. + Crepitus, bilateral knees. Slow gait but steady. No Kyphosis. PSYCH: Normal affect. Cooperative. SKIN: No rashes. Positive for dry skin.

Labs: Hgb 13.2, Hct 38%, K+ 4.0, Na+137, Cholesterol 228, Triglycerides 187, HDL 37, LDL 190, TSH 3.7, glucose 98.

A:

Primary Diagnosis: Congestive Heart Failure (CHF)

Secondary Diagnoses: Primary Hypertension, Obesity, Osteoarthritis (OA)

Differential Diagnosis: Peripheral Vascular Disease (PVD)

Plan:

Medications: Tylenol 650 mg PO Q4 hours as needed for arthritis pain

Labs: UA; Brain natriuretic peptide (BNP); LFTs and TSH; 12-lead EKG, Chest X-ray; Initial 2D echo with Doppler; Ankle-brachial index.

Additional lab results: Echo results 1 week ago: Left ventricular EJ Fraction decreased to 35 %

BNP – not available.

As a future FNP, you need to determine the medications for CHF/ASCVD. (Arteriosclerotic Cardiovascular Disease).

Questions:

1.     According to the ACC/AHA guidelines, what medications should this patient be prescribed?

2.     Does he need medication(s) given his history of MI?

  Hi dear,

can help me to finish this assignment with good quality and be on time please?

answer one of the discussion questions in well-developed paragraphs.   Use citations from reputable sources (for example, our textbook).  Grammar and spelling are taken into consideration when grading. Answer this question as if you are writing a mini paper, with a clear introduction, conclusion and supporting evidence.  This an academic writing space for you to demonstrate that you have read the weekly chapters, understood the question.  This should be 2-3 substantial paragraphs that reflect key ideas from the week. Include citations at the end from journal articles, our book, or other scholastic sources. 

Pick Topic 1 or 2 for your discussion:

Topic 1

• Describe the major obstacles to gay, lesbian, bisexual, and transgendered (GLBT) people in obtaining adequate health care.
  • To help answer this question, be sure to read Chapter 13 from your textbook
  • Please be thorough with your response and be sure to back up all information with reputable sources

Topic 2

• Recognizing that all individuals are unique, what are some basic “conditions for good sex” developed by Zilbergeld? 
  • To help answer this question, be sure to read Chapter 14 in your textbook.
  • Please be thorough with your response and be sure to back up all information with reputable sources.
• Thanks,

The growth, development, and learned behaviors that occur during the   first year of infancy have a direct effect on the individual   throughout a lifetime. For this assignment, research an environmental   factor that poses a threat to the health or safety of infants and   develop a health promotion that can be presented to caregivers.

Create a 10-12 slide PowerPoint health promotion, with speaker   notes, that outlines a teaching plan. For the presentation of your   PowerPoint, use Loom to create a voice over or a video. Include an   additional slide for the Loom link at the beginning, and an additional   slide for references at the end.

Include the following in your presentation:

1. Describe the selected environmental factor. Explain how the     environmental factor you selected can potentially affect the health     or safety of infants.
2. Create a health promotion plan that     can be presented to caregivers to address the environmental factor     and improve the overall health and well-being of infants.
3. Offer recommendations on accident prevention and safety     promotion as they relate to the selected environmental factor and     the health or safety of infants.
4. Offer examples,     interventions, and suggestions from evidence-based research. At     least three scholarly resources are required. Two of the three     resources must be peer-reviewed and no more than 6 years old.
5. Provide readers with two community resources, a national     resource, and a Web-based resource. Include a brief description and     contact information for each resource.
6. In developing your     PowerPoint, take into consideration the health care literacy level     of your target audience, as well as the demographic of the     caregiver/patient (socioeconomic level, language, culture, and any     other relevant characteristic of the caregiver) for which the     presentation is tailored

  Topic:

GMO’s

Type of paper: Research paper

Discipline: Biology

Format or citation style: APA

 Genetically modified organisms (GMOs). What is the purpose genetic engineering of crop plants and domestic animals? Briefly explain how GMOs are created. What foods in your supermarket contain GMOs? Are foods that contain GMOs safe for human consumption? What types of regulations exist for these foods? Clearly explain your reasoning for each answer. The following website from FDA regarding GMO regulation may be helpful: http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm352067.htm