Analyze the following case. Describe the patient’s status and relevant risk factors for worsening chest pain. Create a plan for the patient and suggest changes to her therapy.

Analyze the following case. Describe the patient’s status and relevant risk factors for worsening chest pain. Create a plan for the patient and suggest changes to her therapy.

Analyze the following case. Describe the patient’s status and relevant risk factors for worsening chest pain. Create a plan for the patient and suggest changes to her therapy. Write appropriate orders required for the patient. Patient called for a checkup and since EMR scheduler showed that she had not been seen for > 2 years, she was sent a lab slip to have lab work done prior to visit. She presents today with the following C.C.

G.G. (patient): “I’ve been having some chest discomfort since my last visit; I think it’s probably just hearburn but I thought I should get checked.”

History of present illness: G.G. is a fifty-four-year-old female with heart disease; she also has a strong family history of heart disease. She was advised several times in the past ten years to see a dietitian and to take better care of herself by eating right and entering a smoking cessation and exercise program. She did go to a dietitian once but failed to comply with any of the other programs. She saw a cardiologist two years ago in Ireland but has not followed up in the United States. Now, she complains of intermittent chest pain that awakens her from sleep and even occurs when she is at rest or when she is active. No pain during office visit.

Past medical history:

Hypertension for the past ten years
Peptic ulcer disease (PUD) two years ago
Family history: Her father died of a myocardial infarction (MI) at the age of forty-seven years; her mother, aged seventy-two, is alive with type 2 diabetes mellitus. An older brother died two years ago of an MI at the age of fifty-five. She has one younger sister aged forty-three with hypertension and hyperlipidemia and a sister aged forty-one with depression and no knowledge of her cholesterol levels.

SH: Drinks two or three vodka martinis every day after work and smokes a pack of cigarettes every day.

ROS: (+) For occasional headache in the morning; no chest pain, shortness of breath, abdominal pain, melena, or recent changes in bowel or bladder habits.

Medications:

Zestril 10 mg po qAM
HCTZ 25 mg po qAM
Occasional Tylenol use p.r.n
MVI one tablet po qd
Allergy: No known drug allergies

Significant Lab Findings:

Total Cholesterol……….325mg/dL
HDL Cholesterol……….40mg/dL
LDL Cholesterol……….160mg/dL
Triglycerides……………200mg/dL
FBS……………………..109mg/dL

General: Patient is an obese female who wears glasses. She is in no acute distress.

Vital Signs: BP: 147/80; P: 76; RR: 13; T: 98.9″F; Ht: 5’5″; Wt: 237.6 lbs.

Skin: Warm and dry, normal turgor, no lesions/tumors/moles

Head, eyes, ears, nose, and throat (HEENT): PERRLA; EOMI; funduscopic exam reveals mild arteriolar narrowing with AV ratio 1:3; no hemorrhages, exudates, or papilledema (Keith-Wagener-Barker funduscopic class: grade II); TMs intact; oral mucosa clear

Neck/LN: Neck supple with no lymphadenopathy; normal thyroid

Lungs/Thorax: Diffuse wheezing bilaterally

Cardiovascular/PV: Regular rate and rhythm (RRR), no murmurs, normal S1, and S2, no S3, or S4, no lower leg edema

Abdominal (ABD): (+) BS. liver and spleen not palpable

Neuro: A & 0 x 3; reflexes bilaterally equal; memory intact; coordination and gait normal; CN II to XII intact

Provide references with your explanations.

Submit your answers in a Microsoft Word document (maximum of 4 pages).

Name your document SU_NSG6005_W3_A2_LastName_FirstInitial.doc.

Explanation & Answer

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