NUR 714
Clinical Application Assignment #2

1) Hypertension (25 points)

a. In non-black patients without concurrent disease, the Hypertension Guideline Management Algorithm indicates that first-line anti-hypertensive medication may include thiazide-type diuretics, OR ace inhibitors, OR angiotensin receptor blockers, OR calcium channelblockers used alone or in combination. (2.5 points)

True / False

If false, correct the statement so it is true.

b. In black patients without concurrent disease, the Hypertension Guideline Management Algorithm indicates that first-line anti-hypertensive medication may include thiazide-type diuretics, OR beta blockers used alone or in combination. (2.5 points)

True / False

If false, correct the statement so it is true.

c. JNC-8 recommendations regarding the use of Beta Blockers for the primary management of HTN is (10 points):

d. A 44 year old, Caucasian male has been diagnosed with hypertension. Lifestyle modifications for one month did not bring his BP to goal. Prescribe a medication for the patient utilizing JNC-8 guideline for Pharmacological Therapy (10 points):

Medication:

Sig:

Quantity:

Refills allowed:

(continued)
2) Dyslipidemia (25 points)

a) Counseling your patient with dyslipidemia about lifestyle modifications would include a diet that is: (2.5points)

b) Routine monitoring of liver enzymes during statin therapy is necessary. (2.5 points)

True / False

If false, correct the statement so it is true.

c) Your patient has been diagnosed with dyslipidemia. Lifestyle modifications for 2 months have not altered the patient’s lipid panel. Describe the patient education you will provide your patient regarding the need for pharmacological therapy: (10 points)

d) A 54 year old, Caucasian female has been diagnosed with dyslipidemia(non-diabetic; LDL 192) . Lifestyle modifications for two months did not change her lipid panel. She is very concerned about the cost of a medication for a chronic condition. Prescribe a medication for the patient (10 points):

Medication:

Sig:

Quantity:

Refills allowed:

(continued)

3) Acute Coronary Syndrome (25 points)

a. A diagnostic test that should be done promptly for a patient with chest pain is: (2.5 points)

a. 12-Lead Electrocardiogram
b. Echocardiogram
c. Lipid panel
d. Nuclear Scanning

b. The best laboratory tests to rule out MI is / are: (2.5 points)

a. ESR
b. Chemistry Profile
c. Cardiac specific troponin / enzymes

c. A 50 year old female patient presents with “heartburn” that she has had for one week. Identify 3 differential diagnosis of concern for this patient and provide rationale for why it is a differential to consider: (10 points)

d. Write a prescription for a patient with stable angina for Nitroglycerin to use as needed: (10 points)

Name: A.A.​​Male​​DOB: 1-23-1951​Date: May 27, 2015

Medication:

Sig:

Quantity:

Refills allowed:

(continued)

4) Putting it all together (25 points)

Patient:
65 year old female with complaints of “Heartburn” and severe “fatigue” for one week. Pain radiated to Right posterior shoulder. No nausea, shortness of breath, or sweating.
She was evaluated in the primary care clinic and eventually admitted to the hospital with chest pain. It was determined she did have a myocardial infarction. She was told her BP was consistently high while in the hospital and that her cholesterol was “too high”
The patient is now being seen by you in the primary care clinic.

Today:
BP: 160/96
Pain free

Identify the things you need to assure are in place as she returns to your care:

Medications (at least 3 things to consider; more if you think of them):

Lifestyle Education:

Hypertension
The newest EBP guidelines (JNC8) were released early in 2014. There are still many resources online that do not contain these new guidelines.

Dunphy (2015) 4th Edition: Chapter 10 Cardiovascular Problems – pg 435 – 449 (Hypertension)
Caboral-Stevens, M. F. & Rosario-Sim, M. (2014). Review of the Joint National Committee’s Recommendations in the Management of Hypertension. The Journal of Nurse Practitioners, 10, pp. 325-330.

2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults. Report from the Panel Members Appointed to the Eighth Joint National Committee (JNC8) [you do not need to read this in its entirety but it is a good reference to have]

Dyslipidemia

These are pretty new guidelines as well – with some significant changes from previous guidelines. I will review these in the lecture.

Dunphy (2015) 4th Edition: Chapter 10 Cardiovascular Problems – pg 449-454 (Dylipidemia)
Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Disease Risk in Adults: Synopsis of the 2013 American College of Cardiology/American Heart Association Cholesterol Guideline
2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults: A Report of the American College of Cardiology / American Heart Association Task Force on Practice Guidelines. (You do not need to read this article in its entirety but it is available for you if you’d like. I would like you to focus on pages: 13-15, 22-24, 27, 30, 42-48)
ASCVD Risk Calculator:

Instructions for Completing the Treatment Planning Assignment
There are a number of cases to choose from. First read through the cases and decide which one you want to
complete a treatment plan for. There is a sample treatment plan available for your review. Below is an
outline of each area of the treatment plan that you must complete. All treatment plans should include a
reference page with full references for any assessment instruments.
Short Term Objectives
These are goals or tasks you want to accomplish in the early stages of treatment with your client. Think
immediate goals such as establishing rapport. You should have at least 3 short term objectives.
Long Term Objectives
These will be more long term goals you hope to accomplish with your client. This might include decrease in
the severity of the presenting problem or a total cessation of the problem. You should have at least 3 long
term objectives.
Assessment
This section should include any and all instruments you might use to assess a client’s condition. This may
include assessments that you may not be able to perform yourself, due to the expertise required. In that case,
you would indicate the specialist who would conduct the assessment. For example, you may want to refer
your patient for a full physical examination and this would be done by a physician. You will need to research
instruments, standardized and validated, that may be used to assess your client’s condition. Be sure to use the
proper citation for the measure. All measures have an author.
Clinician
This section should describe the clinician in terms of gender, age, and therapeutic characteristics. In addition,
you should describe the clinician as having experience in the particular type of counseling/therapy that will
be conducted with the client. The clinician should also be familiar with treating the disorder.
Location
Where should the counseling take place? Inpatient? Outpatient? Private practice? Community Agency?
Perhaps several different locations for different therapeutic interventions should be recommended.
Interventions
This section should specifically describe the type of therapeutic interventions that are going to be employed.
For example, cognitive-behavioral therapy, relaxation training, exercise, journaling, etc. Be very specific
about the types of interventions that will be used. This is where you really need to cite the research literature
on what is effective for your client’s disorder.
Emphasis
Describe the nature of the counseling in terms of the approach used by the therapist. For example, terms such
as highly structured, directive, supportive, confrontative, educational, might be used.
2
Number of People
Will the treatment be individual or group or family? This is the section that will detail the number of people
(clients) involved in the treatment process.
Timing
This section will detail the frequency of the sessions (how often per week/month) and for approximately how
long. If there are expected changes in the frequency, this section will describe that as well.
Medication
If medication is deemed necessary for this condition, this section should describe any medications that are
commonly used. Brief description of the medication’s effect on the condition as well as any potential side
effects should be reviewed. This is another section of the paper where citation from the literature is
important.
Adjunct Services
If additional adjunct services are necessary for complete client care, they should be described in this section.
This might include, for example, referral to AA programs, support groups, residence in a group home.
Prognosis
In this section, you should describe the prognosis for this condition. You may use terms such as “good”,
“fair”, “uncertain” and make your prediction based on client characteristics (i.e. compliance with treatment,
premorbid functioning, support factors, etc). Be sure to state the prognosis for your particular case based on
characteristics of the client or their situation. Be specific about your case not just all people with this
disorder.
Diagnosis
Using the DSM 5, provide the code and full name of the disorder for the client. Remember to use all
categories of the DSM, including “Other conditions that may be a focus of clinical attention”.
APA Style References
A proper list in APA style of the all the work you cited in your treatment plan. This should include, at a
minimum, two research articles found in journals. Try to avoid reliance on websites and the text book.