Scenario Joan is a 78-year-old female she

Scenario Joan is a 78-year-old female she needs her blood pressure medication refilled. You notice that she has not been in for 14 months. She has missed appointments on record, and that Joan has been calling for medication refills. During the last call, the office nurse told Joan that she would need to come in for a visit to obtain the refills. Joan’s medications at her last visit included Lisinopril/hctz 10/12.5 and simvastatin 20mg daily. Joan reports that she takes her blood pressure medication “most of the time” but doesn’t take the simvastatin regularly because her neighbor developed liver problems from it. She remembers that she was told she has a “touch of sugar.” She feels well but she wants to get checked out and wants to “get her act together” and start taking care of herself because her brother just found out that he has “clogged arteries.” She would like some help with quitting smoking as well. She also tells you that she had a “little heart attack” when she was 72. Objective Exam Findings: Height: 5’9″ Weight: 221 lbs. BP: 168/94 Resp: 18 Remember that the case study needs to include a minimum of two evidence-based practice articles to support your work. All papers must conform to the most recent APA standards. Answer these questions: What additional subjective information do you need to obtain? Subjective findings: Review of system unremarkable What other objective information do you need to obtain? What labs/diagnostic tests are indicated and why? The diagnostic tests and laboratory test you ordered were normal with the exception of the following: EKG: Afib with a rate of 82 Fasting lipids: Total cholesterol: 242; LDL: 176; HDL: 36; triglycerides: 250 Fasting glucose: 162 F/u HgbA1c done the following day: 7.3 Assessment: List three differential diagnoses with cited rationale. List three medical diagnosis with cited rationale including the ICD-10 codes. Plan: For each of the three medical diagnoses you have identified, create an individual plan of care. Remember to include any primary and secondary prevention details that are important for this patient and this diagnosis. Be sure to include each of these points in your plan: Diagnostic testing Pharmacologic interventions including dosage, route, and frequency and non-pharmacologic Education including health promotion, maintenance, and psychosocial needs Referrals Follow-up, including return to clinic (RTC) with time frame and reason and any labs that are needed for next visit What is Joan’s CHADS-VASc score? What is her yearly risk for stroke? What treatment will you recommend based on her score and why? Please estimate Joan’s 10-year ASCVD.

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