American Sentinel N521-19B_21 Assignment 2

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Assignment 2

R. W. is a 64-year-old Caucasian postal clerk who has smoked a pack of cigarettes a day for the past 35 years. He reports to his CNP in his family practice clinic. He presents with progressive difficulty getting his breath while doing simple tasks. He is having difficulty doing any manual work, but he has no symptoms when working behind his desk. He also reports a cough, fatigue, and weight loss. He has been treated for three respiratory infections a year for the past 3 years and feels like another one is developing now. On physical examination, you notice clubbing of his fingers, use of accessory muscles for respiration, wheezing in the lungs, and hyperresonance on percussion of the lungs. Pulmonary function studies show an FEV1 of 58%. American Sentinel N521-19B_21 Assignment 2

In a paper not to exceed six pages, excluding title and reference pages, please answer the following:

What is R. W.’s likely diagnosis?
What stage of disease does RW have?
List specific pharmacotherapeutic treatment goals for R. W.
What drug therapy would the CNP likely prescribe? Why?
What are the parameters for monitoring the success of the therapy?
Describe specific patient education based on the prescribed therapy.
List one or two adverse reactions for the selected agent that would cause the CNP to change therapy.
What would be the choice for second-line therapy?
What health promotion activities should be recommended for this patient?
If RW was currently taking metoprolol for “headaches” would a change be recommended?

Please use the Case Study Analysis rubric provided to guide you in completing this assignment. It will be used to evaluate your submitted work.

Competency	40	36	33	0	Points Earned
Case Study questions completely and thoroughly answered with accurate evidence-based supported rationales	Accurate and well defined discussion of all 10 questions for the case study using current evidence-based resources. American Sentinel N521-19B_21 Assignment 2	Accurate discussion of nine case study questions presented with use of current evidence-based resources.	Accurate discussion of 8 questions using current evidence-based resources	Missing response to questions or inappropriate answers to questions. No use of evidence-based resources.	/40
	40	36	33	0
Evidence of critical thinking therapeutic decision-making in drug selection and evaluation of patient care pathophysiology and current pharmacological research assessment of the effectiveness of drug therapy formulation of clinical care and teaching plans for persons from diverse populations	Well-defined evidence of critical thinking therapeutic decision-making in drug selection and evaluation of patient care pathophysiology and current pharmacological research assessment of the effectiveness of drug therapy formulation of clinical care and teaching plans for persons from diverse populations	Evidence of critical thinking in prescriptive therapy, monitoring and adverse events. May have lacked a teaching plan or pathophysiologic discussion.	Evidence of critical thinking but incompletely described therapeutic decision making and omitted teaching plan and pathophysiology.	Multiple bulleted points are absent or poorly defined in the assignment. There is no demonstration of critical thinking.	/40
	10	9	8	0	Points Earned
Grammar, spelling, and punctuation	There are no errors in grammar, spelling, and punctuation	There are a few minor errors in grammar, spelling, and punctuation that do not detract from the meaning (1-3 errors)	There are major errors in grammar, spelling, and punctuation .(4-5 errors)	No content or more than 5 errors	/10
	10	9	8	0
APA Compliance	The paper meets APA formatting guidelines	There are a few minor errors (1-3 errors)	There are significant errors in the format of the paper (4-5 errors)	No content or more than 5 errors	/10
Total Points					/100

Competency

Points Earned

Case Study questions completely and thoroughly answered with accurate evidence-based supported rationales

Accurate and well defined discussion of all 10 questions for the case study using current evidence-based resources.

Accurate discussion of nine case study questions presented with use of current evidence-based resources. American Sentinel N521-19B_21 Assignment 2

Accurate discussion of 8 questions using current evidence-based resources

Missing response to questions or inappropriate answers to questions. No use of evidence-based resources.

/40

Evidence of

critical thinking
therapeutic decision-making in drug selection and evaluation of patient care
pathophysiology and current pharmacological research
assessment of the effectiveness of drug therapy
formulation of clinical care and teaching plans for persons from diverse populations

Well-defined evidence of

Evidence of critical thinking in prescriptive therapy, monitoring and adverse events. May have lacked a teaching plan or pathophysiologic discussion.

Evidence of critical thinking but incompletely described therapeutic decision making and omitted teaching plan and pathophysiology.

Multiple bulleted points are absent or poorly defined in the assignment. There is no demonstration of critical thinking.

/40

Points Earned

Grammar, spelling, and punctuation

There are no errors in grammar, spelling, and punctuation

There are a few minor errors in grammar, spelling, and punctuation that do not detract from the meaning (1-3 errors)

There are major errors in grammar, spelling, and punctuation .(4-5 errors)

No content or more than 5 errors. American Sentinel N521-19B_21 Assignment 2

/10

APA Compliance

The paper meets APA formatting guidelines

There are a few minor errors (1-3 errors)

There are significant errors in the format of the paper (4-5 errors)

No content or more than 5 errors

/10

Total Points

/100

Discussion 4

R. S., a 65-year-old African-American man, was referred to the CNP in the hypertension clinic for evaluation of high BP noted on an initial screening. He reports having headaches and nocturia. He states that he has gained 8 pounds over the last year. Past medical history: Appendectomy 30 years ago, Peptic ulcer disease 10 years ago, Type 2 diabetes mellitus for 10 years; Family history: Father had hypertension; died of myocardial infarction at age 55, Mother had diabetes mellitus and hypertension; died of cerebrovascular accident at age 60; Physical examination: Height 69 in, weight 108 kg; BP: 140/89 mm Hg (left arm), 138/82 mm Hg (right arm); Pulse: 84 beats/min, regular; Funduscopic examination: mild arterial narrowing, sharp discs, no exudates or hemorrhages; Laboratory findings: Blood urea nitrogen: 24 mg/dL, Serum creatinine: 1.5 mg/dL, Glucose: 95 mg/dL, Potassium: 4.0 mEq/L, Total cholesterol: 201 mg/dL, High-density lipoprotein cholesterol: 30 mg/dL, Triglycerides: 167 mg/dL, Urinalysis: 1+ proteinuria; Electrocardiogram and chest radiograph: mild left ventricular hypertrophy; Social history: Tobacco: 35 pack years, Alcohol: pint of vodka/week, Coffee: 2 cups/day

Diagnosis: Stage 1 Hypertension

In this discussion forum:

Discuss specific goals for pharmacotherapy for treating R. S.’s hypertension and cholesterol
Discuss what you would consider to be first-line pharmacotherapy for R. S., and why.
Discuss the parameters for monitoring the success of the therapy.
Discuss health promotion recommendations you would consider for R. S.
Does the presence of Diabetes Mellitus impact your treatment selection?

Remember to respond to at least two of your peers. Please see the Course Syllabus for Discussion Participation Requirements and Grading Criteria. American Sentinel N521-19B_21 Assignment 2

Example Discussion 4

Specific goals for pharmacotherapy for treating R. S.’s hypertension and cholesterol would be to prescribe a antihypertensive medication to help manage the patient’s high blood pressure and to help reduce any further risk of cardiovascular disease (Arcangelo, V. P., & Peterson, A. M. (2017). The first-line in pharmacotherapy for R.S would be to prescribe a low dose thiazide diuretic such as hydrochlorothiazide. Diuretics help to decrease the blood pressure by helping the body to excrete and pull off the extra fluid in the body (Uptodate.com 2020). Having the body in a state of diuresis will help lower the amount of pressure that is placed on the heart to circulate the blood through the body. This patient also has diabetes and

The parameters for monitoring the success of the therapy will be based on making reasonable life style changes that will help the patient lower his blood pressure. I would have the patient monitor his blood pressures weekly and keep a log of what they are. I will instruct the patient to take the hydrochlorothiazide in the morning to avoid frequent awakening during the night. Health promotions I would promote would be to add light exercise in his routine and I would ask the patient to be mindful of current stressors in his life that can cause an increase in his blood pressure. I would also refer the patient for a nutrition consult to address diet changes that can help with managing high blood pressure and diabetes. I would also frequently monitor the patient electrolytes and labs to make sure they continue to be within normal limits. The presence of Diabetes Mellitus did not impact my overall treatment selection. After researching the thiazide, beta blockers and ace inhibitors I decided that due to the patient comorbidities a low dose thiazide would be clinically best.

References

Arcangelo, V. P., & Peterson, A. M. (2017). Pharmacotherapeutics for advanced practice: A practical approach (4th ed.). Philadelphia, PA: Wolters Kluwer/Lippincott Williams & Wilkins.

Mann, J. F. (2020). Choice of drug therapy in primary (essential) hypertension. Retrieved from

American Sentinel N521-19B_21 Assignment 2