Discussion QuestionSupport with 1 journals no older than 5 year.docx

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Discussion Question: Support with 1 journals no older than 5 years. Week 8 GI Case Study: H. Pylori infection Questions: As an NP student, needs to determine the medications for recurrent H. Pylori infection. According to the ACC/AHA Guidelines, what medication should this patient be prescribed? Write her complete prescriptions using the prescription writing format. ACC/AHA Guidelines Chief complaint: “ I have recurrent H. Pylori infection”. HPI: M.C. a 46-year-old hispanic female presents to the GI clinic for complaint of recurrent H. Pylori infection. She was treated about 2 ½ months ago with H. Pylori triple therapy and failed treatment. She has pmhx of dyspepsia, GERD. She also indicates that she has noticed that her symptoms of dyspepsia are worsening for past 2 months. She has associated her symptoms with nausea, upset stomach with all foods. Denies associated symptoms of hematochezia, melena, hemoptysis, abdominal pain, fever, chills, pain or any other symptoms. PMH: H. Pylori infection gastritis Diabetes Mellitus, type 2 Surgeries: None Allergies: NKDA Vaccination History: She receives an annual flu shot. Last flu shot was this year Social history: High school graduate, married and no children. He frequently eats out in restaurants. He drinks one 4-ounce glass of red wine daily. He is a former smoker that stopped 3 years ago. Family history: Both parents are alive. Father has history of DM type 2, Tinea Pedis. mother alive and has history of atopic dermatitis, tinea corporis and tinea pedis. ROS: Constitutional: Negative for fever. Negative for chills. Respiratory: No Shortness of breath. No Orthopnea Cardiovascular: No edema. No palpitations. Gastrointestinal: No vomiting. +Dyspepsia. + Nausea. No constipation. No melena. No abdominal pain. Skin: No lesions. No rash. No itching. Psychiatric: No anxiety. No depression. Physical examination: Vital Signs Height: 5 feet 5 inches Weight: 140 pounds BMI: 31 obesity, BP 110/70 T 98.0 po P 80 R 22, non-labored HEENT: Normocephalic/Atraumatic, PERRL, EOMI; No teeth loss seen. Gums no redness. NECK: Neck supple, no palpable masses, no lymphadenopathy, no thyroid enlargement. LUNGS: Lungs clear bilaterally. Equal breath sounds. Symmetrical respiration. No respiratory distress. HEART: Normal S1 with S2 during expiration. Pulses are 2+ in upper extremities. No edema. ABDOMEN: No abdominal distention. Nontender. Bowel sounds + x 4 quadrants. No organomegaly. Normal contour; No palpable masses. GENITOURINARY: No CVA tenderness bilaterally. GU exam deferred. MUSCULOSKELETAL: Slow gait but steady. No Kyphosis. SKIN: Dry. Intact. PSYCH: Normal affect. Cooperative. Labs day of visit:: Hgb 15.2, Hct 40%, K+ 4.0, Na+137, Serum Creatinine normal 1.0, AST/ALT normal. TSH 3.7 normal, glucose 98 normal A: Primary Diagnosis: Recurrent H. Pylori infection gastritis Secondary Diagnoses: Dyspepsia Differential Diagnosis: Peptic Ulcer Disease Previous medication plan:two months ago and failed. Clar.

Education

Pedis.
mother alive and has history of atopic dermatitis, tinea corporis
and tinea pedis.
ROS:
Constitutional: Negative for fever. Negative for chills.
Respiratory: No Shortness of breath. No Orthopnea
Cardiovascular: No edema. No palpitations.
Gastrointestinal: No vomiting. +Dyspepsia. + Nausea. No
constipation. No melena. No abdominal pain.
Skin: No lesions. No rash. No itching.
Psychiatric: No anxiety. No depression.
Physical examination:
Vital Signs
Height: 5 feet 5 inches Weight: 140 pounds BMI: 31 obesity, BP
110/70 T 98.0 po P 80 R 22, non-labored
HEENT: Normocephalic/Atraumatic, PERRL, EOMI; No teeth
loss seen. Gums no redness.
NECK: Neck supple, no palpable masses, no lymphadenopathy,
no thyroid enlargement.
LUNGS: Lungs clear bilaterally. Equal breath sounds.
Symmetrical respiration. No respiratory distress.
HEART: Normal S1 with S2 during expiration. Pulses are 2+ in
upper extremities. No edema.
ABDOMEN: No abdominal distention. Nontender. Bowel
sounds + x 4 quadrants. No organomegaly. Normal contour; No
palpable masses.
GENITOURINARY: No CVA tenderness bilaterally. GU exam
deferred.
MUSCULOSKELETAL: Slow gait but steady. No Kyphosis.
SKIN: Dry. Intact.
PSYCH: Normal affect. Cooperative.
Labs day of visit:: Hgb 15.2, Hct 40%, K+ 4.0, Na+137, Serum
Creatinine normal 1.0, AST/ALT normal. TSH 3.7 normal,
glucose 98 normal
A:
Primary Diagnosis: Recurrent H. Pylori infection gastritis

Secondary Diagnoses:
Dyspepsia
Differential Diagnosis:
Peptic Ulcer Disease
Previous medication plan:two months ago and failed.
Clarithromycin 500 mg po BID for 2 weeks
Omeprazole 40 mg po BID for 2 weeks and then po daily.
Cipro 500 mg po BID for 2 weeks
Plan: Tests
Pt had EGD done 2 weeks ago that showed H. Pylori positive
gastritis in biopsy results.
Urea breath test 8 weeks after treat with H. Pylori medications.
Pt needs to stop PPI’s 2 weeks prior to Urea Breath test.
Labs: No new labs are needed.
Referrals: may refer based on effect of medication therapy
given for 2 weeks.
Follow up: return to office in 8 weeks to reevaluate her
symptoms.

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Pharma Case Study week 8 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 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 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. GENITOURINARY: No CVA tenderness bilaterally. GU exam deferred. MUSCULOSKELETAL: + Heberden's nodes at the DIP joints, hands. + Crepitus, bil ...

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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 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 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. GENITOURINARY : No CVA tenderness bilaterally. GU exam deferred. MUSCULOSKELETAL : + Heberden's nodes at the DIP joints, hands. + Crepitus, bilateral .

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Digital Clinical Experience: Comprehensive (Head-to-Toe) Physical Assessment Week 9 SOAP NOTE Doris Ofodile Walden University Nurs 6512 Advanced Health Assessment & Diagnostic Reasoning Dr Kristin Curcio July 31st, 2022 Patient Initials: T.J Age: 28 Gender: Female SUBJECTIVE DATA: Chief Complaint (CC): " I came in because I'm required to have a recent physical exam for the health insurance at my new job" History of Present Illness (HPI): Miss Jones is currently employed by Smith, Steven, Stewart, Silver & Company. Before she begins work, a pre-employment physical must be completed. Despite having a history of type 2 diabetes, in which she is able to control it by taking metformin, dieting, and doing physical activity. For the past 4-5 months, she has been compliant with metformin. By eating yogurt, Metformin has no longer caused any side effects for her. The last time she saw a doctor was for her gynecology appointment four months ago in which the doctor prescribed oral birth control pills to her after she was diagnosed with the polycystic ovarian syndrome. Although, according to her, she is in good health and does not have any acute health issues, or stressful events, and is looking forward to starting her new job. Medications: Metformin 850mg PO BID, the last dose taken this morning. Fluticasone propionate (Flovent) was 110 milligrams twice daily.( taken last in Albuterol (Proventil) 90mcg 2 puffs every four hours PRN.( taken three months ) Drospirenone/ethinyl estradiol (dosage unknown). It was taken this morning. Tylenol 500 mg PO PRN for headache, medication was taken last week. Ibuprofen 600mg PO TID PRN to alleviate period cramps, was taken six weeks ago. Zantac was taken for GERD (completed) Tetracycline was taken because of acne (completed) Allergies: Miss Jones is allergic to penicillin which causes an allergic reaction characterized by hives and a rash. She is also allergic to cats and dust which triggers an asthma attack causing her to itch, wheeze and sneeze. She denies allergic reactions to latex and foods. Past Medical History (PMH): During her second and a half years of life, Miss Jones was diagnosed with asthma. Her medication regimen includes Proventil and Flovent. A diagnosis of diabetes was made at the age of twenty-four. Metformin is the medication she uses to manage her diabetes, but she had trouble complying because she had side effects like gassiness, which was later relieved with yogurt. As a result, she is better able to monitor her blood sugar levels daily, which last read at 90. The patient also reports losing 10 pounds in four months. Also, she reported that she slipped and hit her right foot, resulting in a healed wound. At the age of 28, she was diagnosed with the polycystic ovarian syndrome which she manages by taking birth control pills. Miss Jone’s menstrual cycle flows for five days and is regular. No Sexually transmitted diseases or pregnancies have been reported. At 38.

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