PNC220 Assessment: Case Study #1 Mrs. Smithers arrives at the

Please help with this case study: Case Study 2 Complete the attached case study. Use a different color font or highlight and bullet list your answers. This is not a group activity. All cases/questions must be completed. Submit your case study to the link provided by the due date. Provide a source for your answers. I. Drugs Affecting the Autonomic Nervous System Case Study A 47-year-old female patient is in for a follow-up visit to monitor her treatment for type 2 diabetes. You added regular insulin to her treatment regimen last month. She tells you that she has not had any symptoms of hypoglycemia with the new plan and her glucose levels have been between 60 and 80. She tells you that her visit to her cardiologist went well and she was prescribed a new medication, atenolol. 1. Discuss the problems and/or complications that might result when a patient with diabetes is treated with a beta blocker. 2. Would there be a difference if the beta blocker was not atenolol? 3. Is there something about the rest of her treatment plan that needs to be addressed? 4. Discuss the possible complications when patients with diabetes are treated with a beta blocker. Are certain beta blockers more likely to create problems than others? 5. What action of beta blockers is a concern if taken by patients with a diagnosis of diabetes? 6. What educational measures must be discussed with this patient if a beta blocker is medically indicated? 7. Describe any changes to the treatment plan that are important to address considering her glucose reading. II. Drugs Affecting the Central Nervous System Case Study Complaint Annual examination; fatigue History Angela is a 54-year-old married woman with three adult children. She has been the office manager of a small law firm for 20 years and has enjoyed her work until this past year. She has rheumatoid arthritis with minimal impairment that has been managed well with NSAIDs. She has been taking conjugated estrogens for 8 years and decided to stop taking them because of her concern of their risks without sufficient medical benefit. She has tolerated the discontinuation without difficulty. Assessment At her annual medical checkup appointment, she told her primary care provider that she seemed to be tired all of the time, and she was gaining weight because she had no interest in her usual exercise activities and had been overeating, not from appetite but out of boredom. She Case Study 2 denied that she and her husband have had marital difficulties beyond the ordinary and she was pleased with the achievements of her children. She noticed that she has difficulty falling asleep at night and awakens around 4 a.m. most mornings without her alarm and cannot go back to sleep even though she still feels tired. She finds little joy in her life but cannot pinpoint any particular concern. Although she denies suicidal feelings, she does not feel that there is meaning to her life: “My husband and kids would go on fine if I died and probably would not miss me that much.” The primary care provider asks Angela to fill out a Beck’s Depression Scale, which indicates that she has moderate depression. 1. What would be the initial management plan? 2. At the follow-up visit the patient reports no improvement in symptoms and states she stopped taking the SSRI antidepressant because it wasn’t working. 3. The patient was prescribed citalopram for her depression and has been complaining of morning nausea and vertigo. What would be a treatment option? 4. After taking 2 weeks of escitalopram, Angela returns to the clinic for a follow-up visit. She states that she does not feel much different but may be less tired. She reports that the nausea and vertigo she experienced with citalopram has not occurred with escitalopram. What would be the next step in treatment? III. Drugs Affecting the Cardiovascular and Renal Systems Instructor Case Study Jack is a 54-year-old patient who has difficulty coming in for primary care visits. He sees cardiology, pulmonary clinic, and endocrine clinic for his comorbid conditions of diabetes mellitus, postcoronary artery bypass grafting (CABG) 2 years ago, and mild chronic obstructive pulmonary disease issues from a 30-pack year history of smoking. His last visit with you was over a year ago. Today, your registered nurse brings you a telephone triage call requesting a refill of his Crestor prescription, which was ordered by cardiology soon after his CABG. Per the electronic links to the cardiology service within your facility, the medication was due to be renewed about 2 months ago. His last lipid labs were a year ago and his last complete metabolic panel (CMP) was done at the same time. He was recently at the pulmonary clinic and his last recorded HgA1C was 9.0 from a visit to endocrine 4 months ago. Review of records include a prescription for his hypertension (Lisinopril 20 mg daily), metformin 1,000 mg twice a day for his diabetes, and no known medications for his pulmonary issues. The Crestor prescription appears to have multiple dosing levels over the past few refills. His last vital signs were blood pressure (BP) 170/110 mm Hg, pulse 88, and respirations 22. His body mass index is 30 and he indicates a pain level of four out of five. His pulse oximetry was 92% on room air. 1. How do you respond to this telephonic request? 2. What steps are required to get Jack’s therapeutic plan under control? 3. What is the role of the primary care provider (PCP) in this scenario?

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