NUR603 Week 3-Case Discussion Cardiovascular Part One

Week 3: PBL Case Discussion: Cardiovascular

Setting: large rural clinic; family practice clinic that
employs physicians and nurse practitioners

You open the chart to review for your next patient, and you
see it is Larry M. Larry is a 60 year-old African American male with a history
of hypertension. You note he is not due for a follow up at this time, so you
look at the chief complaint.

CC: chest pain three days ago

You enter the room and introduce yourself. Larry M. is
sitting in the chair. You ask what brings him in today. Larry M. smiles,
shaking his head and says “My wife made me come, I feel fine.” Three days ago
Larry M. felt short of breath, had this heavy feeling in his chest, and he got
kind of nauseous and sweaty. It lasted only about 3 minutes, and it has not
happened again, but he does feel a little more tired. “It could be that I have
not worked out since it happened.”

PMHx: Reports general health as good. He had been feeling
great since starting to work out and lost weight. Had lots of energy and felt
great until this episode three days ago. Now he is a little concerned because
he feels a little more tired when he works out. He has not done as much
strenuous running and has not worked out since the episode.

Childhood/previous illnesses: chicken pox.

Chronic illnesses: Hypertension- lifestyle changes
recommended. Elevated cholesterol, lifestyle management was initiated.

Surgeries: T and A, cholecystectomy, vasectomy

Hospitalizations: None aside from surgeries listed above

Immunizations: Does not receive the flu shot.

Allergies: NKDA

Blood transfusions: None

Enjoys a beer or a glass of whiskey and the occasional cigar
when playing poker with his buddies

Current medications: None

Social History: Married for 20 years, works as an architect.

Family History: Parents are deceased. Father had lung cancer
and mother died from complications of a stroke. Brother died at 44 from
malignant melanoma. Other sister and brother are healthy.

PE:

Height: 5’8” weight: 220 pounds; BMI 33.5 vital signs: BP
146/90 P 70 Sao2 97%

General: African American male in NAD. Alert, oriented, and
cooperative. Pain: 0/10 at present

Skin: Skin warm, dry, and intact. Skin color is light
skinned brown, no cyanosis or pallor.

HEENT: Head normo-cephalic. Hair thick and distribution even
throughout scalp.

Eyes: Sclera clear. Conjunctiva: white, PERRLA, EOMs intact.
No AV nicking noted.

Ears: Tympanic membranes gray and intact with light reflex
noted. Pinna and tragus non-tender

Nose: Nares patent without exudate. Sinuses non-tender to
palpation, Right-sided Deviation

Throat: Oropharynx moist, no lesions or exudate. Teeth in
poor repair, gums reddened and receding, filled cavities noted. Tongue smooth,
pink, no lesions, protrudes in midline.

Neck supple. No cervical lymphadenopathy or tenderness
noted. Thyroid midline, small and firm without palpable masses. Mild JVD in
recumbent position

Lungs: Lungs clear to auscultation bilaterally. Respirations
unlabored. No rashes or vesicles noted on chest. CV: Heart S1 and S2 noted,
RRR, no murmurs, noted. No parasternal lifts, heaves, and thrills. Peripheral
pulses equally bilaterally. PMI 5th ICS displaced 4cm laterally. No edema in
lower extremities.

Abdomen: Abdomen round, soft, with bowel sounds noted in all
four quadrants. No organomegaly noted.

Labs from 3 months ago:

Total Cholesterol: 230

Ldl 180

Hdl 38

· EKG In office TODAY: ST depression

Click here to access the EKG (Links to an external
site.)Links to an external site.

Discussion Questions:

· What is your primary diagnosis causing Larry M.’s chest
pain? Include ICD 10 codes (no differentials)

· List any relevant labs/diagnostic tests and link them to
Larry’s specific case. Remember to include evidence-based support for any
testing you order along with rationale if you feel no testing is warranted.

· What leads demonstrate the ST depression?

· What other secondary diagnoses does Larry M. have that
need to be addressed?

· Include the rationale and a reference for your diagnoses

· Based on JNC 8 guidelines, is Larry M. hypertensive?

· Review the ACA 2017 Recommendations for Antihypertensive
Therapy and design a plan for Larry M. Please discuss the pharmacological
properties of the therapy you chose including rationale for why this is the
best choice for Larry M.

· Plan for your primary diagnosis (Include referral,
education and follow up) based on one current evidence-based journal article.

· Further diagnostic work-up not included above

· Medications

Explanation & Answer

Our website has a team of professional writers who can help you write any of your homework. They will write your papers from scratch. We also have a team of editors just to make sure all papers are of HIGH QUALITY & PLAGIARISM FREE. To make an Order you only need to click Order Now and we will direct you to our Order Page at Litessays. Then fill Our Order Form with all your assignment instructions. Select your deadline and pay for your paper. You will get it few hours before your set deadline.