Clinical 2 (Primary Care of Adult/Gerontological Population)

Clinical Application Assignment #2

1) Hypertension (25 points)

a. In non-black patients without concurrent disease, the Hypertension Guideline Management Algorithm indicates that first-line anti-hypertensive medication may include thiazide-type diuretics, OR ace inhibitors, OR angiotensin receptor blockers, OR calcium channelblockers used alone or in combination. (2.5 points)

True / False

If false, correct the statement so it is true.

b. In black patients without concurrent disease, the Hypertension Guideline Management Algorithm indicates that first-line anti-hypertensive medication may include thiazide-type diuretics, OR beta blockers used alone or in combination. (2.5 points)

True / False

If false, correct the statement so it is true.
c. JNC-8 recommendations regarding the use of Beta Blockers for the primary management of HTN is (10 points):

d. A 44 year old, Caucasian male has been diagnosed with hypertension. Lifestyle modifications for one month did not bring his BP to goal. Prescribe a medication for the patient utilizing JNC-8 guideline for Pharmacological Therapy (10 points):

Name: A.A.MaleDOB: 1-23-1971Date: May 27, 2015

Medication:

Sig:

Quantity:

Refills allowed:
(continued)
2) Dyslipidemia (25 points)

a) Counseling your patient with dyslipidemia about lifestyle modifications would include a diet that is: (2.5 points)
b) Routine monitoring of liver enzymes during statin therapy is necessary. (2.5 points)

True / False

If false, correct the statement so it is true.
c) Your patient has been diagnosed with dyslipidemia. Lifestyle modifications for 2 months have not altered the patient’s lipid panel. Describe the patient education you will provide your patient regarding the need for pharmacological therapy: (10 points)
d) A 54 year old, Caucasian female has been diagnosed with dyslipidemia(non-diabetic; LDL 192) . Lifestyle modifications for two months did not change her lipid panel. She is very concerned about the cost of a medication for a chronic condition. Prescribe a medication for the patient (10 points):
Name: A.A.FemaleDOB: 1-23-1961Date: May 27, 2015

Medication:

Sig:

Quantity:

Refills allowed:
(continued)
3) Acute Coronary Syndrome (25 points)

a. A diagnostic test that should be done promptly for a patient with chest pain is: (2.5 points)

a. 12-Lead Electrocardiogram
b. Echocardiogram
c. Lipid panel
d. Nuclear Scanning

b. The best laboratory tests to rule out MI is / are: (2.5 points)

a. ESR
b. Chemistry Profile
c. Cardiac specific troponin / enzymes

c. A 50 year old female patient presents with “heartburn” that she has had for one week. Identify 3 differential diagnosis of concern for this patient and provide rationale for why it is a differential to consider: (10 points)
d. Write a prescription for a patient with stable angina for Nitroglycerin to use as needed: (10 points)

Name: A.A.MaleDOB: 1-23-1951Date: May 27, 2015

Medication:

Sig:

Quantity:

Refills allowed:
(continued)

4) Putting it all together (25 points)
Patient:
65 year old female with complaints of “Heartburn” and severe “fatigue” for one week. Pain radiated to Right posterior shoulder. No nausea, shortness of breath, or sweating.
She was evaluated in the primary care clinic and eventually admitted to the hospital with chest pain. It was determined she did have a myocardial infarction. She was told her BP was consistently high while in the hospital and that her cholesterol was “too high”
The patient is now being seen by you in the primary care clinic.

Today:
BP: 160/96
Pain free

Identify the things you need to assure are in place as she returns to your care:

Medications (at least 3 things to consider; more if you think of them):

Lifestyle Education:

Hypertension
The newest EBP guidelines (JNC8) were released early in 2014. There are still many resources online that do not contain these new guidelines.

Dunphy (2015) 4th Edition: Chapter 10 Cardiovascular Problems – pg 435 – 449 (Hypertension)
Caboral-Stevens, M. F. & Rosario-Sim, M. (2014). Review of the Joint National Committee’s Recommendations in the Management of Hypertension. The Journal of Nurse Practitioners, 10, pp. 325-330.

2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults. Report from the Panel Members Appointed to the Eighth Joint National Committee (JNC8) [you do not need to read this in its entirety but it is a good reference to have]
Dyslipidemia

These are pretty new guidelines as well – with some significant changes from previous guidelines. I will review these in the lecture.

Dunphy (2015) 4th Edition: Chapter 10 Cardiovascular Problems – pg 449-454 (Dylipidemia)
Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Disease Risk in Adults: Synopsis of the 2013 American College of Cardiology/American Heart Association Cholesterol Guideline
2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults: A Report of the American College of Cardiology / American Heart Association Task Force on Practice Guidelines. (You do not need to read this article in its entirety but it is available for you if you’d like. I would like you to focus on pages: 13-15, 22-24, 27, 30, 42-48)
ASCVD Risk Calculator:

https://myamericanheart.org/cvriskcalculator (Links to an external site.)

Coronary Heart Disease / Acute Coronary Syndrome

Dunphy (2015) 4th Edition: Chapter 10 Cardiovascular Problems – pg 454-470 (Coronary Heart Disease [Atherosclerotic Coronary Heart Disease] and Acute Coronary Syndrome)

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