NR508 Week 6 Discussions Latest

Discussion Part One (graded)

Jonathon is a 56 year-old retired automobile mechanic who has not been to the doctor in approximately 6-7 years. He presents to your office complaining that 3 weeks ago he was awoken with severe pain and inflammation in his knee, which has been consistent since that initial night. Upon physical examination of his knee, it appears swollen and erythematous with periarticular involvement. Upon physical examination and laboratory results you notice the following:

Physical examination:

GEN: well nourished, obese male (310 pounds)

VS: BP 191/112 HR 75 RR 15 T 98.6, HT 5’8”

EXT: Knee joint inflammation

Laboratory (fasting):

Na 139 mEq/L

K 3.8 mEq/L

Ca 9.1 mg/dL

CL 102 mmol/L

HCO3 22 mEq/L

BUN 10 mg/dL

SCr 0.9 mg/dL

Serum Uric Acid 6.5 mg/dL

Alb 4.1 g/dL

Cholesterol 300 mg/dL

UA: pH 6.8, uric acid 250 mg/24h

What problems can be identified in this patient? Please provide a list of differential diagnoses, as well as indication of your primary diagnosis.

What is your pharmacological plan for your primary diagnosis including the medication, dose, and mechanism of action?

Discussion Part Two (graded)

He returns to your clinic for follow-up blood work, and 4 values catch your attention:

AST 430 U/L

ALT 535 U/L

Bilirubin 41 mg/dl

BG 60 mg/dl

He admits to a history of moderate-to-high alcohol intake (>12 drinks/week for >10 years). He is slightly febrile (99.7°F) and has abdominal tenderness. He also admits to taking several, different over-the-counter pain relievers of different brands daily and continuously to combat the pain in his knee, in addition to his prescription(s) in Part One. You decide to run a toxicology lab, and it reveals a blood acetaminophen concentration of 58 µg/mL.

What is the diagnosis at this point in his case? Please explain the mechanism for how this occurs/occurred, and the antidote’s mechanism of action.
What is the subsequent management and treatment for this individual related to the diagnosis in Part One.

Discussion Part Three (graded)

This is your third time seeing this patient, and he reports the NSAID that he has been prescribed is not addressing his pain. He reports his pain is a 10 out of 10, HR 108, talking extremely fast, he is diaphoretic, unshaved, his clothes are a bit wrinkled and he is requesting that you prescribe him Percocet because he doesn’t think Tramadol, that you are considering prescribing, will work.

What are the possible signs of prescription drug abuse?
What should the NP do when a patient has continued to return?

KINDLY ORDER NOW FOR A CUSTOM-WRITTEN AND PLAGIARISM-FREE PAPER

NR508 Week 7 Discussions Latest

Discussion Part One (graded)

Adam is an active, healthy 5’10” 34 year-old man weighing 145 pounds. He presents to your clinic with complaints of wheezing, dyspnea, cough, and sputum production, especially when running. He informs you that he is an avid marathon runner competing in one to two 5 or 10K runs per month. He tells you that he is symptomatic more than 2 times per week, but less that 1 times per day, and nighttime symptoms hardly ever occur. He also adds that his symptoms can get worse after and sometimes during his runs, especially when the outside temperature drops below 50°F.

Please provide a list of differential diagnoses, as well as indication of your primary diagnosis.
What is your pharmacological plan for your primary diagnosis including the medication, dose, and mechanism of action?

Discussion Part Two (graded)

Your patient returns to your office 4 weeks following his initial appointment in Part one with only moderate reduction in symptomology and an increase in nightly symptoms to 1 time per week. Upon closer inspection of his medical records you notice that he has also been prescribed metoprolol (25 mg/day extended release) for uncontrolled familial hypertension.

What is the mechanism of action of metoprolol, and why is this an important issue in this patient? Be sure to contrast the differences between your prescribed/discussed medication in Parts One and the metoprolol just discovered. Also, include your new patient plan with medication changes and details of dose and mechanism of action.

Discussion Part Three (graded)

How would you monitor for efficacy and toxicity of the current drug regimen you prescribed in Part One, and what would be your subsequent steps if this patient did not have an adequate response?