Topics discussed (20-50 words): Interview notes (50-100 words) include notes about the verbal and non-verbal communication skills you used during the interview: Interview 2 Date of interview: Interview conducted with a colleague/client (delete as necessary)

Topics discussed (20-50 words): Interview notes (50-100 words) include notes about the communication skills (verbal and non-verbal) you used during the interview:

Mr. EBR is a 74-year-old retired Hispanic gentleman with known coronary artery disease (CAD), who presents to your clinic with substernal chest pain for the past 3 months. It is not positional; it reliably occurs with exertion, approximately one to two times daily, and is relieved with rest, or one or two sublingual nitroglycerin (NTG) tabs.

It is similar in quality, but is much less severe, than the chest pain that occurred with his previous inferior myocardial infarction (MI) 3 years ago. Until the past 3 months, he has felt well.

The chest pain is accompanied by diaphoresis and nausea, but no shortness of breath (SOB) or palpitations.

He does not vomit. He denies orthopnea, paroxysmal nocturnal dyspnea (PND), syncope, presyncope, dizziness, lightheadedness, and symptoms of stroke or transient ischemic attack (TIA). An echocardiogram done after his MI demonstrated a preserved left ventricular ejection fraction (LVEF).

Other medical problems include well-controlled type 2 diabetes mellitus (DM), well-controlled hypertension (HTN), and hyperlipidemia, with low-density lipoprotein (LDL) at goal. He also has stage 3 chronic kidney disease (CKD) and diabetic neuropathy.

He no longer smokes and does not use alcohol or recreational drugs. His daily medications include: Atenolol 25 mg PO bid, Lisinopril 20 mg PO bid, aspirin 81 mg PO daily, Simvastatin 80 mg PO each evening, and metformin 500 mg PO bid.

Mr. EBR’s physical examination includes the following: height 68 inches, weight 185 lb, Blood pressure (BP) 126/78, heart rate (HR) 64, Respiratory rate (RR) 16, and temperature 98.6°F orally.

He is alert and oriented, and in no apparent distress (NAD). His neck is without jugular venous distention (JVD) or carotid bruits.

Lungs are clear to auscultation bilaterally. Cardiovascular: normal S1 & S2, RRR, without rubs, murmurs or gallops. Abdomen has active bowel tones and is soft, nontender, and nondistended (NTND).

Extremities are without clubbing, cyanosis, or edema. Distal pedal pulses are 2+ bilaterally

1. What would you add to the current treatment plan? Why?
2. Would you discontinue any of the currently prescribed medication? Why or why not?
3. How does the diagnosis stage 3 chronic kidney disease affect your choices?
4. Why is the patient prescribed more than one antihypertensive?
5. What is the benefit of the aspirin therapy in this patient?

Discussion Question #2

List three classes of drugs affecting the Hematopoietic System. List the mechanism of action for each class of drug. Choose one medication from the three classes and discuss what disorder the drug is used to treat?

How often the medication is given? What labs should get monitored while the patient is taking this

Mrs. Martin is hospitalized for an exacerbation of her multiple sclerosis. She tells the nurse she is tired of being ill and is not getting any better. She says, “When I am in the hospital, I cannot attend church, which is my only enjoyment.” Later in the day, Mrs. Martin is tearful and withdrawn when the nurse makes rounds.

1. What further data collection should the nurse obtain to identify Mrs. Martin’s patient-centered needs?
2. What possible nursing diagnoses would be appropriate for Mrs. Martin?
3. What patient-centered care interventions could the nurse use to assist Mrs. Martin in meeting her wish to attend church?
4. How would the nurse know that Mrs. Martin’s goal has been met?

Sleep disorders in diagnostic categories, one related to sleep apnea and the other related to the failure to stay awake due to stress.

• The use of over-the-counter sleep aids should be encouraged over prescription drugs because they are safer and not habit-forming.
• Menopause has no impact on insomnia.
• As a backup to over-the-counter sleep aids, benzodiazepines are the most useful.
• Discuss best practice for insomnia assessment.

Focused Thyroid Exam. Kali, a 44-year-old female is in the office for a complete physical examination. She complains of proptosis and feeling fatigued. Her TSH levels are elevated, she has hyperlipidemia, her neck appears swollen, and is overweight.

 

question: Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient’s condition and identify at least five possible conditions that may be considered in a differential diagnosis for the patient.