Case and Discussion: Headache

A 35-year-old woman comes to your office to discuss her “bad headaches,” which started after having her first child 2 years ago. The headaches sometimes awaken her from sleep and at times can be disabling and occasionally require her to take Tylenol and rest in a dark room. Sometimes she vomits during an attack. Over the past 6 months, her headaches have become more severe and frequent, prompting her visit today.

What additional questions would you ask to learn more about her headaches?
How do you classify headaches?
How can you determine if this is an old headache or a new headache/s? Is this a chronic or episodic condition?
Can you make a definite diagnosis through an open-ended history followed by focused questions?
How can you use the patient history to distinguish between benign headaches and serious ones that require urgent attention?
What diagnostic tests do you want to include to help you with your diagnosis?
Create a differential diagnosis flow sheet for this patient for this patient and include the diagnostics related to the differentials.

Sample Solution

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Prescribing

Claudia (G2P2) is a 36-year-old mother who recently delivered a child 9 months ago. She has been using condoms for birth control for the last 7 months. Today she is requesting a more convenient method of birth control. She is not sure of her current pregnancy plans, however, she does not wish to discuss sterilization or an IUD. She has no religious contraindications for treatment.

PMH: positive for mild hypertension with first pregnancy, seasonal allergies.

Surgeries: Left inguinal hernia and tonsillectomy.

Family history: Mother-HTN; Father-Colon CA (both deceased)

Social History: Denies tobacco use, wine one to two glasses a week, denies recreational drugs, exercises twice a week.

Drug allergies-Sulfa causes a rash.

Current medications-MVI with Fe, Calcium chews, Allegra 10mg daily prn for allergies.

Vitals: Height 67 inches, weight 157 pounds, BP 110/75, P 70, R 16. PAP collected today, breast exam WNL, urine pregnancy negative.

Physical exam is normal.

What are your treatment goals for Claudia today?
What are two possible medications (in different classes) that you can recommend for Claudia? Please provide detailed rationale and mechanism of actions for each medication. Make sure that all recommendations are cited with guidelines or scholarly, peer-reviewed articles and always include medication, strength, dosage form, route, frequency and duration when making recommendations.
Pick of the medications from your response above and list five (5) patient-centered teaching points to communicate to the patient.
What would your contraceptive choice be if Claudia smoked 10-15 cigarettes per day? Explain your answer.

Sample Solution

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Communication Plan

Communication is vital to the success of your international virtual team during your Capstone simulation. Since you will be operating virtually, this first assignment, the communications plan, should provide specific details about what your goals are as a team, your team’s organizational structure, what you would like to accomplish and how, and how you are going to communicate with each other.
Successful communication is an ongoing process, not a one-time event.
How do you develop a plan for communication?

Sample Solution

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Social Security

Public surveys, such as this Gallup Poll https://news.gallup.com/poll/184580/americans-doubt-social-security-benefits.aspx, indicate that the majority of younger Americans think that Social Security is a “dead program.” Please review the required resources for this week and address the following:

In your informed opinion, why do so many young people have such a dim view?
What are at least two ways that the existing Social Security program could be altered to make it sustainable long in to the future?
What are some alternatives to the program as it is now? Should alternatives be considered? Why or why not?

Sample Solution

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