Day: September 4, 2020

Begin by reading the Module Notes and Chapters 18-20 of your textbook. Then, think about the major organizing themes of this course over the past 8 weeks. Next, provide a detailed description of what you think our planet and human beings will look like a million years from now. Include the following information in your post and make sure to give a scientific rationale for your descriptions:

1. Ecology and biodiversity of the planet

2. Physical appearance, life span, and lifestyle of humans

3. Habitat of humans

4. Interactions between species

Submit a summary of six of your articles on the discussion board. Discuss one strength and one weakness to each of these six articles on why the article may or may not provide sufficient evidence for your practice change.

1-Wunderlich GS, Sloan F, Davis CK. Nursing staff in hospitals and nursing homes: is it adequate. Washington, DC: National Academy Press; 1996.

2-Nursing Shortage. Retrieved from,
https://www.aacnnursing.org/news-information/fact-sheets/nursing-shortage

3- Infant and Young Child Feeding: Model Chapter for Textbooks for Medical Students and Allied Health Professionals.(2009). Retrieved from,
https://www.ncbi.nlm.nih.gov/books/NBK148967/

4- Berwick D. A users manual for the IOMs Quality Chasm report. Health Aff. 2002;21(3):8090.
National Heart, Lung, and Blood Institute. Retrieved from,
https://www.nhlbi.nih.gov/health-topics/high-blood-pressure

5-  Altman, S. H., Butler, A. S., Shern, L., & National Academies of Sciences, Engineering, and Medicine. (2016). Removing Barriers to Practice and Care. In Assessing Progress on the Institute of Medicine Report The Future of Nursing. National Academies Press (US).

6- Correa-de-Araujo, R. (2016). Evidence-based Practice in the United States: Challenges, progress, and future directions. Health care for women international, 37(1), 2-22.

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?

PLEASE USE CASE STUDY BELOW FOR THE REFERENCE CASE

Chief complaint: Im 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.