601 Discussion week 2

1. Assigned Primary Diagnosis: PAD

2. Client Name: Erica Smith

3. Date of Birth: 6/8/1062

4. Chief Complaint: cramping, pain in legs during exercise

5. History of Present Illness: 64 y.o female with history of htn, hyperlipidemia and 30 pack smoking hx. who presents with a 6 month hx of progressing , aching, calf pain and tightness. pain occuring bilaterally but is constant in the right calf. Discomfort is triggered by walking or climbing stairs. it resolves within 3-5 minutes of rest. Denies sudden onset of severe limb pain, numbness, tinging or weakness. Reports no pain at rest or while laying down. On review of systems he notes skin is shiny on his lower les and had become more dry with decreased hair growth on shins. he denies any open sores, ulcers, or non-healing wounds on his feet or toes.

6. Physical Exam 

7. Height: 5ft 4in

8. Weight: 160lbs

9. BMI: 27.5

10. Blood pressure: 134/82 mmHg

11. Heart rate: 74 bpm

12. Respiratory rate: 16 

13. Oxygen saturation: 98% on room air

14. Temperature: 98.4F

15. Past Medical History (PMH) (Include at least three significant pieces of the client’s past medical history) 

16. Hypertension

17. Hyperlipidemia

18. Smoker

19. Allergies (Include any drug allergies and the client’s typical reaction) 

20. NKDA

21. Medications (Based on the client’s PMH, list at least three current medications, including dose, route, and frequency) 

22. Atorvastatin 40mg Oral once at bedtime

23. Lisinopril 10mg Oral once daily in the morning

24. Aspirin 81mg Oral Once daily

1. Social History (MUST include status of tobacco, ETOH, and drug use [e.g., usage, type, quantity, using or non-using] AND include at least two other significant social history elements, e.g., marital status, living conditions, social support, etc.)

2. Current daily Smoker - 35 pack-yea,r smoking history. mild interest in quitting

3. Current daily Smoker - 35 pack-year smoking history. mild interest in quitting

4. Social alcohol drinking 1-2 glasses of wine on weekends

5. Lives in a 2 story family home with husband

6. Diagnostics (To assist the FNP with diagnosing the client’s primary problem, list at least three expected diagnostic findings, which may include priority laboratory findings, diagnostic imaging, etc.) 

7. Diagnostic Test: Lipid panel 

8. Expected finding: Elevated total cholesterol 

9. Diagnostic Test: Ankle-Brachial Index with segmental pressures.

10. Expected finding ABI 0.65 on the right and 0.72 on the left confirming arterial insufficiency.

11. Diagnostic Test: Arterial Duplex Ultrasound

12. Expected finding Hemodynamically significant stenosis (> 50% narrowing) in the right sperficial femoral artery.

13. Diagnostic Test: Hemoglobin A1C

14. Expected finding 7.2% reflecting below ideal level.

15. Current Management Plan (List two priority non-pharmacological and two priority pharmacological interventions for this client based on assessment and diagnostic findings and CPG recommendations to allow the FNP to treat the assigned diagnosis.) 

16. Non-pharmacological interventions 

17. Supervised Exercise Therapy

18. Behavioral smoking cessation counseling

19. Pharmacological interventions 

20. Escalate to high-intesity statin therapy to 80mg lipitor

21. Add Rivaroxaban (Xarelto) to antiplatelet therapy