601 Discussion week 3

Application of Course Knowledge: Answer all questions/criteria with explanations and detail.  

a. Include the following sections in your  initial post . You may use bullet points; complete sentences are not required. 

· Client Information and Assessment Data 

· Assigned Primary Diagnosis: Aortic Stenosis 

· Client Name: Eric Morris

· Date of Birth: 09/18/1957

· Chief Complaint: Dizziness, shortness of breath, and chest discomfort with exercise.

· History of Present Illness: 68-year-old male presents with progressively worsening shortness of breath and dizziness during exercise classes at his local community center. Symptoms improve with rest. During his most recent exercise class yesterday, he also experienced mild substernal chest discomfort with exertion that resolved after stopping activity. He denies chest pain at rest, palpitations, fever, or recent respiratory illness. His exertional dyspnea, dizziness, and chest discomfort raise concern for symptomatic aortic stenosis.

· Physical Exam 

 Height: 5'10" (178 cm)

 Weight: 190 lb (86.2 kg)

 BMI: 27.3 kg/m²

 Blood pressure: 138/76 mmHg

 Heart rate: 72 bpm

 Respiratory rate: 18/min

 Oxygen saturation: 97% on room air

 Temperature: 98.2°F (36.8°C)

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

· [HYPERTENSION] 

· [HYPERLIPIDIMIA] 

· [OSTEOARTHRITIS] 

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

· [NKDA] 

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

· [ Losartan 50 mg PO once daily for HTN] 

· [ Atorvastatin 20 mg PO once daily — hyperlipidemia] 

· [ Acetaminophen 650 mg PO every 6 hours PRN — osteoarthritis pain] 

· 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.) 

· EXAMPLE: Mobility: Ambulates with a cane. 

· [ Tobacco: Former smoker; quit approximately 15 years ago. ] 

· [ ETOH: Drinks approximately 1–2 alcoholic beverages per week] 

· [Married and lives with spouse; independent with ADLs and IADLs.] 

· 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.) 

· Diagnostic Test: [Diagnostic Test: Transthoracic echocardiogram (TTE)] 

· Expected finding [Calcified/thickened aortic valve with restricted leaflet opening and increased transvalvular velocity/gradient. Severe high-gradient AS is characterized by Vmax ≥4.0 m/s, mean gradient ≥40 mmHg, and generally AVA ≤1.0 cm².] 

· Diagnostic Test: [Diagnostic Test: 12-lead ECG] 

· Expected finding [May demonstrate left ventricular hypertrophy (LVH) from chronic pressure overload] 

· Diagnostic Test: [Diagnostic Test: BNP/NT-proBNP] 

· Expected finding [May be elevated due to increased LV pressure/wall stress; useful for assessing cardiac strain and prognosis.] 

· 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.) 

· Non-pharmacological interventions 

· [Stop strenuous/exertional exercise until evaluated by cardiology] 

· [Urgent cardiology/Heart Valve Team evaluation] 

· Pharmacological interventions 

· [ Continue losartan 50 mg PO daily] 

· [ Continue atorvastatin 20 mg PO daily] 

b. Include the following sections in your  response post . Be sure to reply to a peer with a different primary diagnosis than your assigned one. You may use bullet points; complete sentences are not required. 

· Ongoing Management Plan 

· Ongoing Monitoring (List at least three ongoing monitoring needs for this client, including frequency of monitoring, e.g., BP checks, labs, etc.) 

· [ Symptoms: Monitor continuously for worsening exertional dyspnea, angina, dizziness/syncope, decreased exercise tolerance, orthopnea, or edema. New chest pain at rest, syncope, or severe/prolonged dyspnea → emergency evaluation.] 

· [ Blood pressure/heart rate: Check at each visit and encourage home BP monitoring, particularly while taking antihypertensive medication.] 

· [ Echocardiography: Repeat TTE according to cardiology recommendations and disease severity; reassess sooner with new or worsening symptoms] 

· Client Education (List at least three priority client education topics for this client.) 

· [Educate about warning symptoms of worsening AS: chest pain, shortness of breath, dizziness/syncope, declining exercise tolerance, and symptoms of heart failure.] 

· [Avoid strenuous exercise until cleared by cardiology; stop activity immediately if chest pain, significant dyspnea, or dizziness develops.] 

· [Explain that medications may manage associated conditions, but they do not correct the narrowed valve. Symptomatic severe disease may require aortic valve replacement.] 

· Referrals (List at least two priority referrals for this client.) 

· [Cardiology/Heart Valve Team] 

· [Cardiothoracic surgery/interventional cardiology] 

· Follow-up (List the client’s next recommended follow-up appointment and rationale for your recommendation) 

· Follow-up: [ Urgent cardiology evaluation, ideally within several days] 

· Rationale: [The patient has developed the classic concerning symptom pattern of exertional dyspnea, dizziness/presyncope, and angina. If echocardiography confirms severe AS, the presence of symptoms substantially changes management and generally indicates evaluation for valve intervention]