Discussion Part One (graded)\t\u00a0\t\u00a0\tB.J., a 70-year-old Caucasian female has been seen in the clinic several times over the last 3 years. However, she missed her last annual appointment-last appointment was 18 months ago and today you are the nurse practitioner seeing her. She arrived to the clinic alone and states she is “here for my check-up”\ufffd.\u00a0\t\u00a0\t\u00a0\tBackground:\t\u00a0\t\u00a0\tThe patient reports that “my feet just burn and tingle all the time and it is so much worse at night that I can hardly sleep at all”\ufffd. She also indicates that “I need some new pillows; I use 3 of them now to just get comfortable at night to sleep. Those pillows help me catch my breath so I can sleep better”\ufffd.\u00a0 She also reports dyspnea just walking to the bathroom, but it only happens when her legs are “swole up”\ufffd and also states, “the coughing also keeps me up at night”\ufffd.\u00a0 To be honest, “I’m just tired in general whether my feet are “swole”\ufffd or not”\ufffd. She also indicates that she cannot see well, especially at night. She also reported that at her last visit to the clinic, she was told that she had a “heart beat problem”\ufffd and that she is supposed to be taking aspirin every day. She said she thinks all of her “heart pains”\ufffd went away after she started taking the aspirin and “putting that pill under the tongue”\ufffd.\u00a0 One of her concerns she has today is that since her husband died last year, she tells you, “I just don’t like doing things that I liked to do before my husband died. We used to like to do all sorts of stuff, but anymore”\ufffd.I just feel blue all the time”\ufffd.\t\u00a0\tPMH:\t\u00a0\tChronic back pain\t\u00a0\tHypertension\t\u00a0\tPrevious history of MI in 2010\t\u00a0\tDiabetes?\t\u00a0\tHypothyroidism?\t\u00a0\tConstipation?\t\u00a0\tCongestive Heart Failure?\t\u00a0\tCurrent medications:\t\u00a0\t \ufffd \ufffd\u00a0 Coreg 6.25 mg PO BID\t\u00a0\t \ufffd \ufffd\u00a0 Colace 100 mg PO BID\t\u00a0\t \ufffd \ufffd\u00a0 Glucotrol XL 10 mg PO daily\t\u00a0\t \ufffd \ufffd\u00a0 Lantus insulin 20 units at HS\t\u00a0\t \ufffd \ufffd\u00a0 K-dur 20 mEq PO QD\t\u00a0\t \ufffd \ufffd\u00a0 Furosemide 40 mg PO QD\t\u00a0\t \ufffd \ufffd\u00a0 L-Thyroxine 112 mcg PO QD\t\u00a0\tAspirin?\t\u00a0\tNitroglycerine?\t\u00a0\tSurgeries:\t\u00a0\t2010-Left Anterior Descending (LAD) cardiac stent placement\tAllergies: Amoxicillin\t\u00a0\tVaccination History:\t\u00a0\tShe receives an annual flu shot. Last flu shot was this year\tHas never had a Pneumovax\t\u00a0\tHas not had a Td in over 20 years\t\u00a0\tHas not had the herpes zoster vaccine\t\u00a0\tOther:\t\u00a0\tHas not seen a dentist in over 15 years, the time she got her dentures\t\u00a0\tLast colorectal screening was 11 years ago\t\u00a0\tLast mammogram was 5 years ago\t\u00a0\tHas never had a DEXA\/Bone Density Test\t\u00a0\tLast dilated eye exam was 4 years ago\t\u00a0\tLabs from last year’s visit: Hgb 12.2, Hct 37%, Hgb A1C 8.2%, K+ 4.2,\tNa+140,Cholesterol 186, Triglycerides 188, HDL 37, LDL 98, TSH 3.7,\tALT\/AST WNL.\t\u00a0\tSocial history:\t\u00a0\tShe graduated from high school, and thought about college, but got married right away and then had kids a short time later. Her two sons and their wives live with her, take her to church and to the local senior center; they do all the cleaning, run errands, and do grocery shopping.\tFamily history:\t\u00a0\tBoth parents are deceased. Father died of a heart attack; mother died of natural causes.\u00a0 She had one brother who died of a heart attack 20 years ago at the age of 52.\t\u00a0\tHabits:\t\u00a0\tPatient is a current tobacco user and has smoked 1 pack of cigarettes daily for the last 50 years and reports having no desire to quit. She uses occasional chew.\u00a0 She drinks one 4 ounce glass of red wine daily.\t\u00a0\t\u00a0\t\t\u00a0\tDiscussion Part One:\t\u00a0\t\u00a0\t\u00a0\tProvide differential diagnoses (DD) with rationale.\t\u00a0\tFurther ROS questions needed to develop DD.\t\u00a0\tBased on the patient data provided, choose geriatric assessment tools that would be appropriate to use in conducting a thorough geriatric assessment. Provide a rationale on why you are choosing these particular tools.<\/p>\n","protected":false},"excerpt":{"rendered":"
Discussion Part One (graded) \u00a0 \u00a0 B.J., a 70-year-old Caucasian female has been seen in the clinic several times over the last 3 years. However, she missed her last annual appointment-last appointment was 18 months ago and today you are Read More …<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[],"tags":[],"class_list":["post-230104","post","type-post","status-publish","format-standard","hentry"],"_links":{"self":[{"href":"https:\/\/www.benedictsol.com\/blogs\/wp-json\/wp\/v2\/posts\/230104","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.benedictsol.com\/blogs\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.benedictsol.com\/blogs\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.benedictsol.com\/blogs\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.benedictsol.com\/blogs\/wp-json\/wp\/v2\/comments?post=230104"}],"version-history":[{"count":0,"href":"https:\/\/www.benedictsol.com\/blogs\/wp-json\/wp\/v2\/posts\/230104\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.benedictsol.com\/blogs\/wp-json\/wp\/v2\/media?parent=230104"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.benedictsol.com\/blogs\/wp-json\/wp\/v2\/categories?post=230104"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.benedictsol.com\/blogs\/wp-json\/wp\/v2\/tags?post=230104"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}