Akron School of Practical Nursing Chronic Diseases Discussion Post
Description
Case Study Scenario
Jack is a 54-year-old patient who has difficulty coming in for primary care visits. He seen in a cardiology clinic, a pulmonology clinic, and an endocrinology clinic for his comorbid conditions of postcoronary artery bypass grafting (CABG) 2 years ago, Type 2 diabetes mellitus, and mild chronic obstructive pulmonary disease from a 30 pack year history of smoking. His last visit with you was over a year ago. Today, your registered nurse brings you a telephone triage call requesting a refill of his Crestor prescription, which was ordered by cardiology soon after his CABG. Per the electronic links to the cardiology service within your facility, the medication was due to be renewed about 2 months ago. His last lipid labs were a year ago and his last complete metabolic panel (CMP) was done at the same time. He was recently at the pulmonary clinic and his last recorded HgA1C was 9.0 from a visit to endocrine 4 months ago.
Review of records include a prescription for Lisinopril 20 mg PO daily for his hypertension, metformin 1,000 mg PO twice a day for his diabetes, and no known medications for his pulmonary issues. The Crestor prescription for hyperlipidemia appears to have multiple dosing levels over the past few refills.
His last vital signs were blood pressure (BP) 170/110 mm Hg, pulse 88, and respirations 22. His body mass index is 30 and he indicates a pain level of four out of five. His pulse oximetry was 92% on room air.
For the Discussion (Include the corresponding number below as you respond in your initial post):
1. How do you respond to this telephonic request?
2. What steps non-pharmacologic and pharmacologic are required to get Jacks therapeutic plan under control?
3. Give the rationale why you chose certain treatment plans and not others.
4. Provide the follow up plan for the patient and why you made the decision. Consider continuity of care and timing of visits as well as outlining specific considerations and their priority for each of the specialists this patient sees.
5. Post and reply using the discussion board rubric guidelines. Discuss with other students (nicely) the treatment plan they provided, explain why your plan is appropriate (provide evidence). Just posting good plan to another student is NOT acceptable. Your posts must be substantive, having substance and involving matters of major or practical importance to all concerned.
6. Copy and paste your discussion board posts into a word document and place in the Dropbox by the close of the discuss. The Dropbox will check for originality and plagiarism.
References must include your textbook assignment readings (chapters on HTN, DM, HLD, COPD) and the four articles posted in course contents: Whitson & Boyd (2021) Managing multiple comorbidities, Holstein (2018) Managing chronic disease in affordable primary care, Jin, Bratzke, & Bauman (2021) Helping persons with multiple chronic conditions overcome barriers to self-management, and Diggins (2019) Deprescribing polypharmacy management in older adults with comorbidities
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