NR601NP wk 2 discussion

General Instructions

Step 1: As a family nurse practitioner (FNP) at a primary care clinic, you will create a case study of a client you saw at the clinic today. First, review the primary diagnosis and the reason for the clinic visit based on the first letter of your last name in the chart below.

Peripheral artery disease (PAD)–Clinical Scenario

Reason for todays clinic visit: The client has noticed more frequent pain and cramping in their bilateral lower legs, especially when they try to walk for any length of time. The pain seems to go away with rest.

Step 2: Use the assigned primary diagnosis and the reason for the clinic visit to create a case example of a client using the prompts below. Answer the initial and response prompts below with explanation and detail, providing complete references for all citations. Use this weeks Explore pages, relevant CPGs, and additional scholarly sources (including the course text) to create your case example. You may list case information in bullets or complete sentences.

Step 3: In your initial discussion post, present the client, include holistic assessment findings and diagnostic results aligning with the primary diagnosis and a management plan incorporating pharmacological and non-pharmacological treatment.

Step 4: In your response discussion post, create a forward-focused management plan that considers ongoing monitoring, client education needs, pertinent referrals, and a follow-up plan. Your response post must address a peer with a different assigned primary diagnosis.

Include the following sections:

1. Application of Course Knowledge: Answer all questions/criteria with explanations and detail.
2. Include the following sections in your initial post. You may use bullet points; complete sentences are not required.
3. Client Information and Assessment Data
4. Assigned Primary Diagnosis: [Type here]
5. Client Name: [Type here]
6. Date of Birth: [Type here]
7. Chief Complaint: [Type here]
8. History of Present Illness: [Type here]
9. Physical Exam
10. Height: [Type here]
11. Weight: [Type here]
12. BMI: [Type here]
13. Blood pressure: [Type here]
14. Heart rate: [Type here]
15. Respiratory rate: [Type here]
16. Oxygen saturation: [Type here]
17. Temperature: [Type here]
18. Past Medical History (PMH) (Include at least three significant pieces of the clients past medical history)
19. [Type here]
20. [Type here]
21. [Type here]
22. Allergies (Include any drug allergies and the clients typical reaction)
23. [Type here]
24. Medications (Based on the clients PMH, list at least three current medications, including dose, route, and frequency)
25. [Type here]
26. [Type here]
27. [Type here]
28. Social History (MUST include status of tobacco, ETOH, and drug use [e.g., usage, type, quantity, using or non-using] AND include at least two other significant social history elements, e.g., marital status, living conditions, social support, etc.)
29. EXAMPLE: Mobility: Ambulates with a cane.
30. [Type here]
31. [Type here]
32. [Type here]
33. Diagnostics (To assist the FNP with diagnosing the clients primary problem, list at least three expected diagnostic findings, which may include priority laboratory findings, diagnostic imaging, etc.)
34. EXAMPLE: Diagnostic Test: Lipid panel
35. Expected finding: Elevated total cholesterol
36. Diagnostic Test: [Type here]
37. Expected finding [Type here]
38. Diagnostic Test: [Type here]
39. Expected finding [Type here]
40. Diagnostic Test: [Type here]
41. Expected finding [Type here]
42. Current Management Plan (List two priority non-pharmacological and two priority pharmacological interventions for this client based on assessment and diagnostic findings and CPG recommendations to allow the FNP to treat the assigned diagnosis.)
43. Non-pharmacological interventions
44. [Type here]
45. [Type here]
46. Pharmacological interventions
47. [Type here]
48. [Type here]
49. Include the following sections in your response post. Be sure to reply to a peer with a different primary diagnosis than your assigned one. You may use bullet points; complete sentences are not required.
50. Ongoing Management Plan
51. Ongoing Monitoring (List at least three ongoing monitoring needs for this client, including frequency of monitoring, e.g., BP checks, labs, etc.)
52. [Type here]
53. [Type here]
54. [Type here]
55. Client Education (List at least three priority client education topics for this client.)
56. [Type here]
57. [Type here]
58. [Type here]
59. Referrals (List at least two priority referrals for this client.)
60. [Type here]
61. [Type here]
62. Follow-up (List the clients next recommended follow-up appointment and rationale for your recommendation)
63. Follow-up: [Type here]
64. Rationale: [Type here]

Example:

Client Information and Assessment Data

Assigned Primary Diagnosis: Coronary Artery Disease (CAD)

Client Name: Michael Turner

Date of Birth: March 15, 1968

Chief Complaint:

• Increased fatigue during evening walks
• Recently told blood pressure was a little high during pharmacy screening

History of Present Illness

• 58-year-old male presenting with progressive fatigue and reduced exercise tolerance for 2 months
• Previously walked 2 miles nightly, now becomes fatigued after 12 mile
• Reports mild chest pressure during exertion, relieved with rest within a few minutes
• Denies severe chest pain, nausea, vomiting, diaphoresis, or syncope
• Recent pharmacy BP reading 148/92 mmHg
• Family history significant for father with myocardial infarction at age 60
• Symptoms consistent with stable ischemic heart disease associated with coronary artery disease (Virani et al., 2023)

Physical Exam

Height: 510

Weight: 210 lbs

BMI: 30.1 (Class I obesity)

Blood pressure: 146/90 mmHg

Heart rate: 82 bpm

Respiratory rate: 18 breaths/min

Oxygen saturation: 97% on room air

Temperature: 98.4F

Past Medical History (PMH)

• Hypertension (diagnosed 5 years ago)
• Hyperlipidemia (diagnosed 3 years ago)
• Prediabetes

These conditions significantly increase the risk for atherosclerotic cardiovascular disease (Arnett et al., 2022).

Allergies

• Penicillin rash and pruritus

Medications

• Lisinopril 10 mg PO daily hypertension
• Atorvastatin 20 mg PO daily hyperlipidemia
• Metformin 500 mg PO twice daily prediabetes

Social History

• Tobacco: Former smoker; 1 pack/day for 20 years, quit 5 years ago
• Alcohol (ETOH): Drinks 23 beers on weekends
• Drug use: Denies illicit drug use
• Marital status: Married, lives with spouse
• Occupation: Office manager with sedentary work
• Exercise: Previously active walker, decreased activity due to fatigue

Diagnostics

Diagnostic Test: Lipid panel

Expected finding: Elevated LDL cholesterol and total cholesterol

Diagnostic Test: Electrocardiogram (ECG)

Expected finding: Possible ST-segment depression or T-wave inversion indicating myocardial ischemia

Diagnostic Test: Exercise stress test

Expected finding: Reduced exercise tolerance and ischemic ECG changes during exertion

Diagnostic Test: Cardiac troponin

Expected finding: Typically normal in stable coronary artery disease but useful for ruling out acute coronary syndrome

Diagnostic testing helps evaluate myocardial ischemia and cardiovascular risk (Virani et al., 2023).

Current Management Plan

Non-pharmacological interventions

Lifestyle modification:

Mediterranean or DASH diet, reduce saturated fats and sodium, increase intake of fruits, vegetables, whole grains, and lean proteins.

Exercise and weight management:

Gradual increase to 150 minutes of moderate aerobic activity per week with weight reduction goals to improve cardiovascular risk factors.

Pharmacological interventions

Aspirin 81 mg PO daily

• Antiplatelet therapy to reduce risk of myocardial infarction and thrombotic cardiovascular events (Arnett et al., 2022; USPSTF, 2022)

Metoprolol tartrate 25 mg PO twice daily

• Beta-blocker therapy to reduce myocardial oxygen demand and improve symptoms of exertional angina (Virani et al., 2023)