Case study

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This is  share assigment , i am in charge of one diffrential diagnosis: 

Case secnario:

22-month-old male is brought into the clinic by Mom for a sick visit/ fever today (TMax 102F Axillary from Daycare). Mom reports he has been fussy all week, more difficult to console, and pulling at his ears. 

We must work on: Acute otitis media (AOM), 

1- The reason why I choose  Acute otitis media“ it”, as the differential diagnosis .

 2- The diagnostic evaluation 

3- treatment plan 

APA reference less than 5 years old. 

You can Can use : Bates physical examination and History Taking and ICD.Data.com

No need for cover page. 

Case study

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Mrs. Lyons is a 57-year-old African American female who recently developed headaches and had an elevated blood pressure reading at her work health fair. Her blood pressure was taken at the health fair, and the reading was 168/99. She has returned to the drugstore three times to take her blood pressure. The readings have been: 145/90, 150/89, 140/88. At the health fair, she was told her BMI is elevated. Her cholesterol levels were also done at the health fair, and the results were: total cholesterol level of 250, LDL 138, HDL 48, and Triglycerides 170.  

She has not been to see a primary care provider in over 5 years. At her last office visit, which was 5 years ago, her blood pressure was (135/95). Her LDL and triglycerides were also elevated at that time. The patient was supposed to monitor her blood pressure at home and trial diet and lifestyle changes. She was supposed to return for a follow-up with her blood pressure log and for a recheck of her labs. She, unfortunately, did not do this. 

Today in the clinic, her vital signs are: BP 146/92, HR 90, Temp 98.4, RR 12, O2 98%, Height 5’5, Weight 220 lbs, BMI 36.6 

She is not currently taking any medications. She has NKDA. Family history: her brother and sister both have been diagnosed with hypertension and DM. Diagnoses for the patient are HTN, Obesity, and Hyperlipidemia. 

Q1. Please briefly discuss the first-line treatment recommendations from JNC8, and the AHA/ACC for a patient with no other major comorbidities. 

Q2. What are the recommended medications to start this specific patient on? Please provide the drug class, generic & trade name, and initial starting dose. 

Q3. Please discuss the mechanism of action of each of the drugs you listed.

Q4.  Please discuss the side effect profile of each medication you listed. 

Q5. Are there any interactions between any of the medications you prescribed?

Q6. What other non-pharmacological interventions would be suggested?

 

  1. 500 words 

Case study

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Discussion case study

 You are a new FNP in a restricted state and have your DEA license, and state furnishing for schedule II-V controlled substances. You are working at a busy family practice group, and you have a patient, ML, that is establishing care for the first time with your practice and comes to you with the following scenario: 

• ML is a 54 y.o. Hispanic female with hx of chronic shoulder and back pain that began 10 years ago when she was in a boating accident. • She lives in both US and Mexico, making regular visits across the border. Lately, she has stayed in the US due to Covid border crossing constraints, living with her daughter’s family.

ʉۢ She had rotator cuff surgery in 2011 and reports to you that due to a long operation and poor positioning, she has suffered from not only pain, but also chronic numbness and tingling in her R shoulder.

 â€¢ As “la abuela” (grandma), she is the primary caregiver of the children and homemaker for her family. Her pain is exacerbated with housework, and especially with the prolonged carrying of her grandchildren; one of which is 10 m.o.

 â€¢ Currently, her med list is as follows • Losartan 50 mg BID for HTN • Gabapentin 300 mg po BID for pain • Atorvastatin 40 mg daily for cholesterol • Diazepam 5 mg po up to TID prn pain • Norco 5/325 mg – takes up to two, sometimes up to 4-5x a day, prn pain 

• She is a smoker, only smokes outside the house, and drinks 2-3 cans of beer on the weekends, but more on family celebrations.

ʉۢ She denies recreational drugs and denies past overdoses.

ʉۢ She has recently moved to CA more permanently to stay to take care of children during Covid/school closures.

 â€¢ She asks you to refill all her meds for 6 months, like her doctor in Mexico did, so she doesn’t have to make another co-pay and come back and see you so often. It’s hard for her to get an appointment, and with Covid, her daughter has to take off of work to watch the kids so that she can come to you by bus (since there is only one family car).

ʉۢ Here VS are 135/75, 80, 97.5, 20 and PE unremarkable other than R shoulder exam with pain with ROM, but full ROM, no tenderness, otherwise normal, back exam including SLR are normal/neg.

* In 600 or fewer words, but a minimum of 250, please describe your approach with this patient. In your response, include the following: 

• What concerns do you have about her current regimen, and what alternatives will you discuss and offer? 

What other screenings might you apply? 

What are your own ethical standards on this case that you might consider in addition to legal standards? 

• Provide a sample of an appropriate pain contract that would suit this patient and address her specific safety concerns (cite it and attach the actual contract you found – you do not have to make your own – there are plenty online). 

• Include your steps to ensure safe prescribing. Include the registry you will search prior to any prescribing; name the CA registry, and if you are in a different state, you should name that registry also. (Texas).

 â€¢ If you were to keep her current list, what are the laws surrounding refills and the amounts you are allowed to dispense with the schedule II and III medications in the state of CA? In your own state? 

• Which medications on her list may you call into the pharmacy, and which would you need a written script or electronic order? 

What are some elements required to include on the prescription form (paper or electronic signature) for the scheduled medications?

  • After you prescribe, how, when, and where would you (or your staff) go about making a report of your scheduled prescription in the state registry so that other prescribers and pharmacies could be aware?

ʉۢ In restricted states, APRN prescribers must follow a standardized procedure or protocol for furnishing schedule II and III controlled substances with a patient-specific approach.

 Please outline the minimum required components of a protocol. 

You may outline this in bullet form. Alternatively, you may find an appropriate protocol, clinical guideline, or standardized procedure from a literature search and attach it in lieu of outlining your own protocol.  

Case study

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Post your answers to the 6 questions corresponding to this week’s content on primary care medication management. Provide your responses and rationales. Support your rationales with high-level evidence. (See Post Expectations) 

A 70-year-old woman is in your office complaining of recently having trouble maintaining her balance after taking diazepam (valium). She occasionally takes diazepam when she feels anxious and has trouble sleeping. She has a 15-year history of taking diazepam. • Q1. Explain the cause of this patient’s difficulty in maintaining her balance? 

• Q2. Diazepam experiences a significant first-pass effect. What is the first-pass effect, and how can first-pass metabolism be circumvented? 

A 75-year-old woman develops symptoms of a cold and buys an over-the-counter cold medication at the grocery store. The medication contains diphenhydramine, acetaminophen, and phenylephrine. She takes the recommended adult dose but soon after taking the medication, she becomes very confused and disoriented. 

• Q3. What is likely causing the signs of confusion? 

 A 26-year-old woman who has never been pregnant is seeking preconception care as she is planning to pursue pregnancy in a couple of months. Currently, she has no symptoms to report and on review of body systems, there were no concerns. Her past medical history is significant for a history of rheumatic fever as a child. She subsequently underwent valve replacement with a mechanical heart valve. She is followed by a cardiologist who has already evaluated her cardiac function and she has received clearance from her cardiologist to pursue pregnancy. Records from her cardiologist include a recent cardiac echocardiography report that reveals a normal ejection fraction indicating normal cardiac function.

  She has no alterations in her daily activities related to her heart. She has no other significant medical or surgical history. She is a non-smoker, drinks occasionally but has stopped as she is attempting to conceive, and does not use any non-prescription drugs. Current Medications: Her current medications include only prenatal vitamins, which she has begun in anticipation of pregnancy, and warfarin. She has no known drug allergies.  Vital Signs: On examination, her pulse is 80 beats per minute, blood pressure is 115/70 mm Hg, respiratory rate is 18 breaths per minute, and she is afebrile. Measurements: Weight = 152 pounds, Height = 5′5 ″, BMI= 25.29 

• Q4. How is warfarin metabolized? Does warfarin cross the placental barrier? 

• Q5. Explain the hepatic drug metabolism of children 1 year and older. How do they compare with the hepatic drug metabolism of infants and adults?

ʉۢ Q6. Explain protein binding in the neonate.

Case study

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A 30-year-old male presents with acute trauma.  The final diagnosis is DIC.

 

  1. Discuss the clotting mechanism.
  2. What do prolonged PT and aPTT tests indicate?
  3. Fibrin degradation and split products are common to DIC patients.  Why?
  4. Identify two additional conditions that can initiate DIC and how?

250 words , at least 2 references less than 5 years  APA.

Case study

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A 20-year-old female presents with severe migraines.  She has been treated for the last two years. • What is the pathophysiology involved with the prodrome associated with migraines? • Compare and contrast tension headache and cluster headache.  Use patho principles. • What is the pathophysiologic difference between migraine headache and tension headache?

  1. 250 words, no need for cover page. At least 2 references, APA, less than 5 years. 

Case study

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A 70-year-old female presents with dyspnea and cough.  Medical history includes: COPD, DM II, Hypertension and dyslipidemia. The labs are as follows:

T:   102.3

HR:  102

O2: 84% on room air,  90% nasal cannula

Bicarb: 23

X -Ray:  Focal consolidation Left Lower Lobe

 

  1. Compare and contrast hospital vs. community acquired pneumonia
  2. What is the ventilation perfusion matching required for good gas exchange?
  3. Increasing FIO2 will improve hypoxia. Why?
  4. How does Emphysema differ from Pneumonia?

Case study

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A  47-year-old female presents with Stage IV breast cancer.  Today, the PET scan reveals brain metastasis.

 

  1. Define proliferation and differentiation and relate these changes to cancer.
  2. Describe invasion, angiogenesis and metastasis.
  3. There are three underlying causes of growth and maturity abnormalities: telomerase, pRB changes and 53 changes.  Discuss these in relation to the patient. 
  4. Discuss tumor suppressor genes, oncogenes and DNA repair genes.

 

250 words , no need for cover page