MHACB/515 Competency 3 Assessment and Rubric Course Title: Scanning the
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, post coronary 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 his primary care provider was over a year ago. Today, the registered nurse brings the provider 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 documentation within your facility, the Crestor prescription was due to be renewed about 2 months ago for the patient to obtain a refill. His last lipid panel and CMP are from a year ago. He was recently at the Pulmonology clinic. His last recorded HgA1C is from an Endocrinology office visit 4 months ago, it was 9.0 mg/dL at that time. Review of past 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. Jack has several comorbidities. Identify two psychosocial concerns for Jack. Are there any potential drug to drug interactions if he were prescribed an anticoagulant? How should his primary care provider respond to this telephonic request? In addition to being the prescriber what other role does the provider have to fill in this scenario? Explain your response.
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