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?

the test is for my Health Science terminology class it is on chapters 1-8. will be available under Content on Monday, July 9, 2018 from 6 AM-7PM. You have one attempt. There will be 50 questions. You will have 90 minutes. i will give you my log in and password. There is only one attempt.

Chapter 1. The Anatomy of Medical Terms

Chapter 2. The Body as a Whole

Chapter 3. The Integumentary System

Chapter 4. The Skeletal System

Chapter 5. Muscles and Tendons

Chapter 6. The Cardiovascular and Circulatory Systems 

Chapter 7. The Blood, Lymphatic, and Immune Systems

Chapter 8. The Respiratory System

  

The purpose of this paper is to complete a comparative ethical analysis of George’s situation and decision from the perspective of two worldviews or religions: Christianity and a second religion of your choosing. For the second faith, choose a faith that is unfamiliar to you. Examples of faiths to choose from include Sikh, Baha’i, Buddhism, Shintoism, etc.

In your comparative analysis, address all of the worldview questions in detail for Christianity and your selected faith. Refer to Chapter 2 of Called to Care for the list of questions. Once you have outlined the worldview of each religion, begin your ethical analysis from each perspective.

In a minimum of 1,500-2,000 words, provide an ethical analysis based upon the different belief systems, reinforcing major themes with insights gained from your research, and answering the following questions based on the research:

Understanding family structure and style is essential to patient and  family care. Conducting a family interview and needs assessment  gathers information to identify strengths, as well as potential  barriers to health. This information ultimately helps develop  family-centered strategies for support and guidance.

This family health assessment is a two-part assignment. The  information you gather in this initial assignment will be utilized for  the second assignment (Family Assessment Part II).

Develop an interview questionnaire to be used in a family-focused  functional assessment. The questionnaire must include three  open-ended, family-focused questions to assess functional health  patterns for each of the following:

1. Values/Health Perception
2. Nutrition
3. Sleep/Rest
4. Elimination
5. Activity/Exercise
6. Cognitive
7. Sensory-Perception
8. Self-Perception
9. Role Relationship
10. Sexuality
11. Coping

Select a family, other than your own, and seek permission from the  family to conduct an interview. Utilize the interview questions  complied in your interview questionnaire to conduct a family-focused  functional assessment. Document the responses as you conduct the interview.

Upon completion of the interview, write a 750-1,000-word paper.  Analyze your assessment findings. Submit your questionnaire as an  appendix with your assignment.

Include the following in your paper:

1. Describe the family structure. Include individuals and any    relevant attributes defining the family composition, race/ethnicity,    social class, spirituality, and environment.
2. Summarize the    overall health behaviors of the family. Describe the current health    of the family.
3. Based on your findings, describe at least    two of the functional health pattern strengths noted in the    findings. Discuss three areas in which health problems or barriers    to health were identified.
4. Describe how family systems    theory can be applied to solicit changes in family members that, in    turn, initiate positive changes to the overall family functions over  time.

Cite at least three peer-reviewed or scholarly sources to complete  this assignment. Sources should be published within the last 5 years  and appropriate for the assignment criteria.

Prepare this assignment according to the guidelines found in the APA  Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the  rubric prior to beginning the assignment to become familiar with the  expectations for successful completion.