What is your goal for AK today?describe in patient-centered language.

Your answers should reflect your original thought process. All answers should be posted in your own words. Please be concise in your answers. Think like an advanced nurse in an out-patient setting when formulating your answers. You do not need to provide references, however, you should be able to cite your source if requested. Answers MUST be based on evidence-based practice and drugs prescribed MUST be generic with dosages.

Question 1 (Think/ Rule out infecion) :

AK is a 26 year old female teacher who comes to the clinic reporting she was bite by the family dog last night. On her right hand there are four puncture marks which are clean, mildly red, without discharge or edema. She has full use of her hand, no neurological impairment. She reports her dog’s vaccinations are up to date and the dog receives regular vet care.

AK’s last tetanus was 2011. T 98.2, P 70, R 14, BP 104/70, htg 55 inches, weight 120 lbs. Drug allergy PCN causes rash. Current medication Seasonal birth control (levonorgestrel/ethinyl estradiol) daily, frovatriptan prn migraine headaches.

1. What is your goal for AK today?

2. Do you need to perform any lab today? If so, what lab would you order?

3. What is your drug therapy for AK today?

4. Three patient teaching points for AK, please describe in patient-centered language.

Question 2:

MS is a 43 year old Asian man who works as an officer manager and lives with his wife and two teen-agers in a single family home. At the last office visit for a flu vaccine in October his blood pressure was 140/88 and 140/86. Gave him information on hypertension, life-style modification, and DASH diet and asked him to return in about three months. He returns to the clinic today on January 30th , he states he has decreased the amount of salt in his food and is walking at least 2-3 times a week. Family history is positive for HTN in father and older brother. NKDA, current medication MVI, Fish Oil capsule, aspirin 81mg daily, fluoxetine for depression. Today his vital signs are BP 148/88 and 148/90, P 72, R 16, wtg 188lbs, htg 70 inches. Exam is WNL and there is no JVD or LE edema. Diagnosis Hypertension

1. What are your goals for MS today?

2. What lab would you order today?

3. What is your patient teaching based on your care plan?

4. When do you want MS to return to the clinic?

PS. Please refer to recent guidelines for Hypertension by Joint National Committee (JNC) VIII