An 82-year-old male patient, Jeff Raines, comes

An 82-year-old male patient, Jeff Raines, comes in to see the primary care NP complaining of feeling “lightheaded.” The patient lives with his family and manages his own medications. He tells you that he was at the gym earlier today and had to sit down because he got “lightheaded” and thought he was going to pass out while walking on the treadmill. After a short rest, the “dizziness went away.” When asked, he told you that he had similar episodes in the past when his “medications were adjusted.” Patient is also concerned with peripheral edema that worsened when his meds were adjusted by his cardiologist; he denies shortness of breath. Patient describes feeling constipated and trouble urinating, telling you he feels like he “has to go but it just won’t come out.” During his review of systems, patient tells you that he is “not sleeping well” for the past three months and thinks this is about when his Wellbutrin was increased. He has no appetite and feels “jittery at times.” Review his medications, labs, and physical exam findings. Medications per Patient Recent labs (completed in the last week) Physical Exam Findings Ramipril 10mg po bid BUN – 40 Laying – 142/72 – 76 Sitting – 120/66 – 72 Standing – 90/50 – 72 MVI 1 po qd Creat – 1.9 Respiratory Rate – 18 Benadryl 50mg po q 6 hrs prn Na – 135 General—fatigued; pale-looking male; oriented to person, place, and time; able to provide history Norvasc 10mg po qd K – 4 Head—normocephalic, mild temporal wasting, no sinus tenderness or associated swelling Flomax 0.4mg po qd TSH – 10 Eyes—sclera white, no erythema or drainage Wellbutrin XL 300mg po qhs Albumin – 2.9 Ears—TM’s intact bilat with good color and position HCTZ 50mg po qhs T-protein – 5.8 Nose—no nasal discharge Pseudoephedrine 60mg po q 4-6 hrs Cardiac—Irregular, irregular, systolic murmur 3/6 Levothyroxine 100mcg po qd Respiratory—CTA, normal exam ES APAP 1000mg po q 4 hrs Musculoskeletal—L Knee- crepitus noted, + boney deformity, R knee with midline scar Amitriptyline 100mg po qhs Abd—+BS, soft, NT Neuro—WN Here are the items to discuss: Make sure to focus on: renal function, abnormal labs/patient findings, polypharmacy (Beer’s Criteria), medication interactions, etc. 1.Address what medication changes you as the nurse practitioner student are going to make to help the patient. SCIENCE HEALTH SCIENCE NURSING NURS MISC

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