1) **********minimum 3 full pages ( not words)**************************** ( cover or reference page not included) 2)¨**********APA norms  ( All paragraphs need to be cited properly. All responses must be in a narrative format) 3)********** It will be verified by Turnitin and SafeAssign***************** 4) **********References from the last 5 years   5) The points don't be must copied in the work. It must be identified by numbers. This assignment has two parts. ______________________________________________________________ Part 1: Minimum 2 full pages. Chronic Stable Angina E.H. is a 45-year-old African American man who recently moved to the community from another state. He requests renewal of a prescription for a calcium channel blocker, prescribed by a physician in the former state. He is unemployed and lives with a woman, their son, and the woman’s 2 children. His past medical history is remarkable for asthma and six “heart attacks” that he claims occurred because of a 25-year history of drug use (primarily cocaine). He states that he used drugs as recently as 2 weeks ago. He does not have any prior medical records with him. He claims that he has been having occasional periods of chest pain. He is unable to report the duration or pattern of the pain. Before proceeding, explore the following questions: What further information would you need to diagnose angina (substantiate your answer)? What is the connection between cocaine use and angina? Identify at least three tests that you would order to diagnose angina. Diagnosis: Angina 1. List specific goals of treatment for E.H. 2. What dietary and lifestyle changes should be recommended for this patient? 3. What drug therapy would you prescribe for E.H. and why? 4. How would you monitor for success in E.H.? 5. Describe one or two drug–drug or drug–food interactions for the selected agent. 6. List one or two adverse reactions for the selected agent that would cause you to change therapy. 7. What would be the choice for the second-line therapy? 8. Discuss specific patient education based on the prescribed first-line therapy. 9. What over-the-counter and/or alternative medications would be appropriate for E.H.? ____________________________________________________________ Part 2:  Minimum 1 page Chief complaint:  “I’m here for a medication refill because I ran out of my medicines”. HPI:  Mrs. Allen is a 68-year-old African American who presents to the clinic for prescription refills. The patient indicates that she has noticed shortness of breath which started about 3 months ago. The SOB gets worse with exertion, especially when she is walking fast, and it is resolved when she is resting. She reports that she is also bothered by shortness of breath that wakes her up intermittently during her sleep. Her symptoms of shortness of breath resolve after sitting upright on 3 pillows. She also has lower leg edema pitting 1+ which started 2 weeks ago. She indicates tha ...

1. 1) **********minimum 3 full pages ( not
words)****************************
(
cover
or reference page not included)
2)¨**********APA norms ( All paragraphs need to be cited
properly. All responses must be in a narrative format)
3)********** It will be verified by Turnitin and
SafeAssign*****************
4) **********References from the last 5 years
5) The points don't be must copied in the work. It must be
identified by numbers.
This assignment has two parts.
_____________________________________________________
_________
Part 1: Minimum 2 full pages.

2. Chronic Stable Angina
E.H. is a 45-year-old African American man who recently
moved to the community from another state. He requests
renewal of a prescription for a calcium channel blocker,
prescribed by a physician in the former state. He is unemployed
and lives with a woman, their son, and the woman’s 2 children.
His past medical history is remarkable for asthma and six “heart
attacks” that he claims occurred because of a 25-year history of
drug use (primarily cocaine). He states that he used drugs as
recently as 2 weeks ago. He does not have any prior medical
records with him. He claims that he has been having occasional
periods of chest pain. He is unable to report the duration or
pattern of the pain. Before proceeding, explore the following
questions: What further information would you need to diagnose
angina (substantiate your answer)? What is the connection
between cocaine use and angina? Identify at least three tests
that you would order to diagnose angina.
Diagnosis: Angina
1. List specific goals of treatment for E.H.
2. What dietary and lifestyle changes should be recommended
for this patient?
3. What drug therapy would you prescribe for E.H. and why?
4. How would you monitor for success in E.H.?
5. Describe one or two drug–drug or drug–food interactions for
the selected agent.

3. 6. List one or two adverse reactions for the selected agent that
would cause you to change therapy.
7. What would be the choice for the second-line therapy?
8. Discuss specific patient education based on the prescribed
first-line therapy.
9. What over-the-counter and/or alternative medications would
be appropriate for E.H.?
_____________________________________________________
_______
Part 2: Minimum 1 page
Chief complaint:
“I’m here for a medication refill because I ran out of my
medicines”.
HPI:
Mrs. Allen is a 68-year-old African American who presents to
the clinic for prescription refills. The patient indicates that she
has noticed shortness of breath which started about 3 months
ago. The SOB gets worse with exertion, especially when she is
walking fast, and it is resolved when she is resting. She reports
that she is also bothered by shortness of breath that wakes her
up intermittently during her sleep. Her symptoms of shortness
of breath resolve after sitting upright on 3 pillows. She also has
lower leg edema pitting 1+ which started 2 weeks ago. She
indicates that she often feels light headed at times with

4. intermittent syncope episodes while going up a flight of stairs,
but it resolves after sitting down to rest. She has not tried any
over the counter medications at home.
She started taking her medications, but failed to refill the
prescriptions because she cannot afford the medications as she
only works part-time and lives alone. In addition, she reports
that she does not think taking all these medications would help
her condition anyway.
PMH:
Primary Hypertension, Previous history of MI 1 year ago
Surgeries:
1 year ago-Left Anterior Descending (LAD) cardiac stent
placement
Allergies
:
Penicillin
Vaccination History:
Up-to-date
Social history:
High school graduate married and no children. Drinks one 4-
ounce glass of red wine daily. She is a former smoker and
stopped 5 years ago.
Family history:
Both parents are alive. Father has history of MI and valvular
heart disease; mother alive and cardiac history is unknown. He
has one brother who is alive and has history of MI 5 years ago

5. at age 52.
ROS:
Constitutional: Lightheaded and faint with exertion.
Respiratory: Shortness of breath with exertion. + Orthopnea.
Cardiovascular: + 2 pitting leg edema for 3 weeks.
Psychiatric: Non-contributory.
Physical examination:
Vital Signs:
Height: 5 feet 1 inches Weight: 175 pounds BMI: 32, Obese,
BP 160/92, T 98.0, P 111, R 22 and non-labored
HEENT
: Normocephalic/Atraumatic, Bilateral cataracts; PERRLA,
EOMI; Teeth intact. Negative for gum disease.
NECK
: Neck supple, no palpable masses, no lymphadenopathy, no
thyroid enlargement.
LUNGS
: + Mild Crackles on inspiratory phase not clearing with cough.
Equal breath sounds. Symmetrical respiration. No respiratory
distress.
HEART
: Normal S1 with S2 during expiration. An S4 is noted at the
apex; + systolic murmur noted at the right upper sternal border
without radiation to the carotids. Pulses are 2+ in upper
extremities and 2+ in pedal pulses bilaterally. 2+ pitting edema
to her knees noted bilaterally.
ABDOMEN
: No abdominal distention. Nontender. Bowel sounds + x 4
quadrants. No organomegaly. Normal contour; No palpable
masses.

6. GENITOURINARY
: No CVA tenderness bilaterally. GU exam deferred.
MUSCULOSKELETAL
: + Heberden's nodes at the DIP joints, hands. + Crepitus,
bilateral knees. Slow gait but steady. No Kyphosis.
PSYCH
: Normal affect. Cooperative.
SKIN
: No rashes. Positive for dry skin.
Labs
: Hgb 13.2, Hct 38%, K+ 4.0, Na+137, Cholesterol 228,
Triglycerides 187, HDL 37, LDL 190, TSH 3.7, glucose 98.
A:
Primary Diagnosis:
Congestive Heart Failure (CHF)
Secondary Diagnoses:
Primary Hypertension, Obesity, Osteoarthritis (OA)
Differential Diagnosis:
Peripheral Vascular Disease (PVD)
Plan:
Medications:
Tylenol 650 mg PO Q4 hours as needed for arthritis pain
Labs:
UA; Brain natriuretic peptide (BNP); LFTs and TSH; 12-lead
EKG, Chest X-ray; Initial 2D echo with Doppler; Ankle-
brachial index.
Additional lab results

7. :
Echo results 1 week ago: Left ventricular EJ Fraction decreased
to 35 %
BNP – not available.
As a future FNP, you need to determine the medications for
CHF/ASCVD. (Arteriosclerotic Cardiovascular Disease).
Questions:
1. According to the ACC/AHA guidelines, what medications
should this patient be prescribed?
2. Does he need medication(s) given his history of MI?