Category: Nursing

To Prepare:
Review the Resources and identify a clinical issue of interest that can form the basis of a clinical inquiry.
Develop a PICO(T) question to address the clinical issue of interest you identified in Module 2 for the Assignment. This PICOT question will remain the same for the entire course.
Use the key words from the PICO(T) question you developed and search at least four different databases in the Walden Library. Identify at least four relevant systematic reviews or other filtered high-level evidence, which includes meta-analyses, critically-appraised topics (evidence syntheses), critically-appraised individual articles (article synopses). The evidence will not necessarily address all the elements of your PICO(T) question, so select the most important concepts to search and find the best evidence available.
Reflect on the process of creating a PICO(T) question and searching for peer-reviewed research.
The Assignment (Evidence-Based Project)
Part 2: Advanced Levels of Clinical Inquiry and Systematic Reviews
Create a 6- to 7-slide PowerPoint presentation in which you do the following:
Identify and briefly describe your chosen clinical issue of interest.
Describe how you developed a PICO(T) question focused on your chosen clinical issue of interest.
Identify the four research databases that you used to conduct your search for the peer-reviewed articles you selected.
Provide APA citations of the four relevant peer-reviewed articles at the systematic-reviews level related to your research question. If there are no systematic review level articles or meta-analysis on your topic, then use the highest level of evidence peer reviewed article.
Describe the levels of evidence in each of the four peer-reviewed articles you selected, including an explanation of the strengths of using systematic reviews for clinical research. Be specific and provide examples.
Resources.
Melnyk, B. M., & Fineout-Overholt, E. (2023). Evidence-based practice in nursing & healthcare: A guide to best practice (5th ed.). Wolters Kluwer.
Chapter 2, “Asking Compelling Clinical Questions” (pp. 37–60)
Chapter 3, “Finding Relevant Evidence to Answer Clinical Questions” (pp. 62–104)
Davies, K. S. (2011). Formulating the evidence based practice question: A review of the frameworksLinks to an external site. for LIS professionals. Evidence Based Library and Information Practice, 6(2), 75–80.
Library of Congress. (n.d.). Search/browse help – Boolean operators and nestingLinks to an external site.. Retrieved September 19, 2018, from https://catalog.loc.gov/vwebv/ui/en_US/htdocs/help/searchBoolean.html
Stillwell, S. B., Fineout-Overholt, E., Melnyk, B. M., & Williamson, K. M. (2010). Evidence-based practice, step by step: Asking the clinical question: A key step in evidence-based practice.Links to an external site. American Journal of Nursing, 110(3), 58–61.
Melnyk, B. M., Fineout-Overholt, E., Stillwell, S. B., & Williamson, K. M. (2009).Evidence-based practice: Step by step: Igniting a spirit of inquiryLinks to an external site..Links to an external site. American Journal of Nursing, 109(11), 49–52. doi:10.1097/01.NAJ.0000363354.53883.58
Stillwell, S.B., Fineout-Overhold, E., Melnyk, B.M., & Williamson, K.M. (2010). Evidence-based practice step-by-step: Searching for evidence.Links to an external site. American Journal of Nursing, 110(5), 41-47.
Walden University Library. (n.d.-a). Databases A-Z: NursingLinks to an external site.. Retrieved September 6, 2019, from https://academicguides.waldenu.edu/az.php?s=19981
Walden University Library. (n.d.-c).Evidence-based practice research: CINAHL search helpLinks to an external site.. Retrieved September 6, 2019, from https://academicguides.waldenu.edu/library/healthevidence/cinahlsearchhelp
Walden University Library. (n.d.-d). Evidence-based practice research: Joanna Briggs Institute search helpLinks to an external site.. Retrieved September 6, 2019, from https://academicguides.waldenu.edu/library/healthevidence/jbisearchhelp
Walden University Library. (n.d.-e). Evidence-based practice research: MEDLINE search helpLinks to an external site.. Retrieved September 6, 2019, from https://academicguides.waldenu.edu/library/healthevidence/medlinesearchhelp
Walden University Library. (n.d.-f). Keyword searching: Finding articles on your topic: Boolean termsLinks to an external site.. Retrieved September 19, 2018, from http://academicguides.waldenu.edu/library/keyword/boolean
Walden University Library. (n.d.-g). Keyword searching: Finding articles on your topic: Introduction to keyword searchingLinks to an external site.. Retrieved September 19, 2018, from http://academicguides.waldenu.edu/library/keyword/searching-basics 
Walden University Library. (n.d.-h). Quick Answers: How do I find a systematic review article related to health, medicine, or nursing?Links to an external site. Retrieved September 6, 2019, from https://academicanswers.waldenu.edu/faq/72670
Walden University Library. (n.d.-i). Systematic review.Links to an external site. Retrieved January 22, 2020, from https://academicguides.waldenu.edu/library/healthevidence/types#s-lg-box-1520654

please reply to post: Sepsis
My clinical issue of interest is Sepsis in Intensive Care Units (ICU). My PICOT question will encompass the methodology and efficacy of current Sepsis protocols in the ICU. Sepsis can arise from many causes, such as central line infection, urinary tract infection, or pneumonia. The Center for Disease Control and Prevention (CDC) states, “Infections that lead to sepsis most often start in the lung, urinary tract, skin, or gastrointestinal tract” (The Center for Disease Control and Prevention [CDC], 2023). When bacteria from these infections become systemic and enter the bloodstream, it can create a systemic inflammatory response (SIRS) that can cause organ damage if left untreated.
Search Results
Many studies resulted when I searched for “sepsis” in the various search engines. However, a large portion of these studies were either observational studies or systematic reviews. The results began to be more targeted when I started to hone in on more specific sepsis-related topics, i.e., trending lactate levels or fluid resuscitation for sepsis—looking for more specific results generated more original studies that explore sepsis.
Strategies for a More Effective Search
Strategies I will use to find more original research will be to explore concise topics. CINAHL and MEDLINE both offer multiple search engine bars. I will use this when exploring my PICOT question because I can search for sepsis, but the article must also include lactate levels and fluid resuscitation. CINAHL by EBSCOhost also provides specifiers to limit results on the home page- one can choose peer-reviewed articles, full text, and adult (EBSCOhost, n.d.). MEDLINE is affiliated with the National Library of Medicine and contains many articles focusing on biomedicine (EBSCOhost, n.d.). Within the MEDLINE search engine, there is an option to choose databases. As I research, I plan to switch between databases to find the most pertinent information for my PICOT question.

Dysfunctional/Abnormal Uterine Bleeding (DUB/AUB)
Scenario:
A 29-year-old patient presents in the clinic with bleeding in between menses. The onset of
menarche was age 14 and she has had regular monthly menses. For the past 2 months, she has
been spotting between menses. She is not on any hormonal birth control, and she uses condoms
occasionally to prevent pregnancy and STIs. She is currently with a new partner of 6 months, and
she hasn’t been tested for STIs with this partner. She is in the clinic because she is concerned
about why she has been spotting in between menses. She is considering possibly regulating her
menses. Upon history taking and physical exam, you do not notice anything abnormal. You
suspect this is a case of dysfunctional uterine bleeding.
Based on your working diagnosis, patient’s HPI, and your physical assessment, create a 3- to 5-
minute video and a 2- to 4-page write-up discussing the following information:
• Definition of DUB/AUB: What is this condition? Why is this important to address?
• Prevalence and risk factors
• DUB/AUB can be a risk of developing what types of health complications?
• Presentation
• Pathophysiology
• Physical assessment and testing to confirm diagnosis
• Provide at least one differential diagnosis and an exam and/or lab test to rule out this
diagnosis.
• If a patient is hesitant about taking medication or intervening now, how long can she
continue to “watchfully observe” her situation before an intervention must occur?
• Treatment or management of dysfunctional uterine bleeding for a patient who is currently
not planning a pregnancy
• Treatment or management of dysfunctional uterine bleeding for a patient who is currently
planning a pregnancy
Your video can be informative while your write-up will be more detailed. Be creative with the
video. There are many ways to complete this portion of the assignment.
Below are some examples of potential ideas to help you brainstorm:
• Create an explainer video with animations and voiceover using Biteable, Canva,
Powtoon, Animaker, or any other software platform.
• Create a voiceover PowerPoint presentation or use Panopto to record your screen while
you present your slides and your narration.
Your write-up and your video must include at least two scholarly sources that are not from your
textbook nor any standard government or medical websites.
• Scholarly sources must be peer-reviewed articles.
• Do not write this paper in a SOAP format.
• You don’t need to rewrite the prompt in your paper.
• Be sure you use APA Style and include headings and subheadings and an introduction
and conclusion.
• Reference and use in-text citations properly according to APA Style.
• Be sure to include a title page and a reference list for the write-up and the video

Develop an intervention (your capstone project), as a solution to the patient, family, or population problem you’ve defined. Submit the proposed intervention to the faculty for review and approval. This solution needs to be implemented (shared) with your patient, family, or group. You are not to share your intervention with your patient, family, or group or move on to Assessment 5 before your faculty reviews/approves the solution you submit in Assessment 4. In a separate written deliverable, write a 5–7 page analysis of your intervention.

DNP Project Evaluating the Effectiveness of Patient Centered Type 2 Diabetes Prevenetion Program
Using the MEAL plan, write a short paragraph that explains the differences between a QI/PI project and a research study.
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Introduction
In this assessment, you will write a short paragraph that explains the differences between a quality improvement or performance improvement (QI/PI) project and a research study, using the MEAL plan format.
Note: The assessments in this course must be completed in the order presented; subsequent assessments should be built on both your earlier work and your instructor’s feedback on earlier assessments. If you choose to submit assessments prematurely, without considering and integrating your instructor’s feedback, your assessment may be returned ungraded, resulting in your loss of an assessment attempt.
Scholarly writing and the application of nursing research are two vital skills that you will use often as you progress through your doctoral program. In this assessment, you will construct a well-developed paragraph that differentiates between a quality or performance improvement (QI/PI) project and a research study. This paragraph will also provide you an opportunity to review the basics of academic writing, organization, and sentence structure.
Demonstration of Proficiency
By successfully completing this assessment, you will demonstrate your proficiency in the course competencies through the following assessment scoring guide criteria:
Competency 3: Address assessment purpose in a well-organized text, incorporating appropriate evidence and tone in grammatically sound sentences.
Differentiate a QI/PI project from a research study.
Compose a passage with appropriate structure as shown in the MEAL plan.
Produce text with minimal grammar, usage, spelling, and mechanical errors.
Instructions
Review the resources provided in Assessment 3. Use them to help you describe the differences between a QI/PI project and a research study.
Choose a project idea that might serve as a potential DNP project. Describe how the focus of the project would be a QI/PI project rather than a research study.
Construct a well-developed and well-organized paragraph using the MEAL Plan.
Label the parts of the paragraph appropriately by placing the letters M, E, A, and L before their respective parts.
The paragraph should start with a non-referenced topic sentence that captures the main point of the paragraph. Subsequent sentences should support or explain the topic sentence.
The paragraph should be in your own words and should not include direct quotes.
The paragraph should be no more than 250 words.
This skill will be important for you to master before you create your project charter, which must be written professionally, yet succinctly.
Grading Criteria
Your summary will be graded using the following scoring guide criteria:
Differentiate a QI/PI project from a research study.
Compose a passage with appropriate structure as shown in the MEAL plan.
Produce text with minimal grammar, usage, spelling, and mechanical errors.
MEAL Plan
Reading, Writing, and Critical Thinking
Writing academic text can’t be done without first locating, reading, and analyzing other academic texts to use as resources. The Reverse Outline and the MEAL Plan are useful during the entire process. By incorporating critical thinking methods into a system of reading academic texts and your own writing, these tools will be invaluable to you as you build your academic writing skills.
Key Elements
Academic writing is focused on a main point or thesis. The main point or thesis is often found at the very beginning of an academic text, such as in the introduction or abstract. Everything after the thesis statement provides additional information or evidence to support the thesis, often referred to as supporting evidence or details.
In order to strongly and effectively support a thesis statement, a writer must focus on how to organize ideas and to develop key points.
Using the MEAL plan and practicing reverse outlining will help you organize ideas and develop key points in your academic writing. Both practices can be useful at multiple stages of the writing process.
MEAL Plan
MEAL stands for: main idea, evidence or examples, analysis, and link. This guide is a helpful tool when you are first constructing paragraphs and essays and when you are revising your work.
How the MEAL plan relates to essays and paragraphs
Essay Paragraph
Introduction/Thesis Statement Topic Sentence/Main Idea
Body Evidence/Analysis
Conclusion Link/Transition to Next Paragraph
Main Idea
Every paragraph should have one main idea. An essay or piece of writing similarly focuses on one topic. If you find that your paragraphs have more than one main idea, separate your paragraphs so that each has only one main point. The idea behind a paragraph is to introduce an idea and expand upon it. If you veer off into a new topic, begin a new paragraph.
Evidence
Your main idea needs support, either in the form of evidence that supports your argument or examples that explain your idea. If you don’t have any evidence or examples to support your main idea, your idea may not be strong enough to warrant a complete paragraph. In this case, re-evaluate your idea and see whether you need even to keep it in the paper.
This goes the same for writing an essay. The evidence should support the main argument of the writing assignment. If it does not, your writing may lack focus and need to be revised.
Analysis
Analysis is the heart of academic writing. While your readers want to see evidence or examples of your idea, the real “meat” of your idea is your interpretation (analysis) of your evidence or examples:
How you break down the ideas or evidence.
Compare ideas.
Compile your ideas to build a persuasive case.
Demonstrate the strengths and weaknesses of the evidence.
Analysis is always needed for any type of evidence or example you use to support your main point. Whether you include the evidence as a paraphrase, summary, or direct quotation your analysis is critical. It demonstrates how the evidence helps you make your case. Think about how each source fits into the context of your main idea in the paragraph and in the overall thesis of your essay.
Link or Transition
Links help your reader to see how your paragraphs fit together. When you end a paragraph, try to link it to something else in your paper, such as your thesis or argument, the previous paragraph or main idea, or the following paragraph. Creating links will help your reader understand the logic and organization of your paper, as well as the logic and organization of your argument or main points.
Key words that function as links include:
however
so
thus
still
despite
nonetheless
although
Reverse Outline
Reverse outlining is a great tool to use to figure out where your draft needs work. One of the most important parts of the writing process is revision, the stage where you rework your draft’s global concerns focus, clarity, organization, and persuasiveness.
What is Reverse Outlining?
You’re probably familiar with the concept of outlining as a prewriting strategy—when you outline, you write down all the sections and subsections of your paper in an organized, numbered hierarchy, which you can then use as a blueprint in producing your first draft.
When you create a reverse outline, you do the same thing, only backwards: you start with an existing draft, and try to create an outline that represents its sections and its major points. Doing so allows you to see where your organization doesn’t make sense, where you have unexplained “leaps” in your logic, and where you haven’t constructed effective paragraphs.
How to Create a Reverse Outline
There are a couple of ways to create a reverse outline:
Create a sequential outline.
Make a table.
How to Create a Sequential Outline
Look at your current draft and read each paragraph carefully—and separately—for purpose and content.
Write in the margins of your draft what you see as the main point in your paragraph. If your paragraph seems to have two main points, write them both in the margin of the paper.
Transfer these “main points” into an outline format on a separate sheet of paper.
Examine your outline for several important things:
Fluidity of development: Ask yourself, do my points follow logically from each other? Could I make the flow smoother by moving certain paragraphs to different places in my argument?
Separation of points: Do any of my paragraphs make more than one point? If so, how do I separate them into different paragraphs? Do the paragraphs belong near each other? Or should they be separated to improve the flow of my argument?
Inclusion of important elements: Does my essay miss any significant points or connections that are necessary for its development? Where should I put these “missing links”?
And finally, make revisions as necessary, first with the outline, and then with the draft.
How to Create a Table
To use the tabling approach to reverse outlining:
Number your draft’s paragraphs from beginning to end.
Use the following table (or draw columns on a separate sheet) to record what each paragraph “does” and “says.”
In the “does” column, write down the paragraph’s function, the job it is supposed to do in your draft (“proves that some evidence indicates heightened self-esteem among home-schooled pre-teen girls;” “creates a logical transition from discussion of self-esteem to discussion of body image”).
In the “says” column, write down each paragraph’s main point(s). As with the sequential outlining approach, you’ll want to keep an eye out for paragraphs that have more than one main point and paragraphs whose “says” don’t seem to match their “does;” that is, paragraphs that are not functioning in the way you intended them to function.
When you’re done, check your paper’s organization and logical flow by reading the “does” column in order from top to bottom. Are the points presented in the most logical order? Do you see gaps in reasoning, or places where you suddenly switch tracks without explanation or transitions? Also, how can you revise paragraphs so that what they say makes them do what they’re supposed to do more effectively?
The Template
Paragraph Number Does Says
Example of a Table
Paragraph Number Does Says
1 Introduction Teachers must balance different methods with the rise of technology in the classroom.
2 Evidence Many elementary students are now required to use e-reader software on the iPad for reading assignments in order to track their progress.
Using the Tools
Using the Reverse Outline and MEAL Plans for reading and writing will add more time to the earlier stages of your academic writing, so be sure to budget time to use these tools to their full potential.
You will find, however, that spending this extra time at the beginning of writing will pay off down the road. Research shows that the more you use these tools when reading and writing, the more proficient you become.
Writers note that after using these tools to write a few papers, they find the process to actually be faster and more concise because they generate first drafts rapidly, without worrying that everything is right. They know that they have two tools to help them effectively organize and develop their drafts and put their ideas into the academic format that those reading and assessing their writing will expect.

Assignment: APA Paper
Topic: The Role of Nursing Interventions in the Management of Postoperative Pain in Surgical Patients
Objective:
The purpose of this assignment is to enhance your understanding of postoperative pain management in surgical patients and to further develop your skills in writing a scholarly paper following APA 7th edition guidelines.
Instructions:
Title Page:
Include the title of your paper, your name, the institution’s name, the course name, the instructor’s name, and the due date, all centered and double-spaced.
Follow the APA 7th edition format for the title page.
Abstract: Not Required
Introduction:
Introduce the topic of postoperative pain management.
Provide background information on the importance of effective pain management in surgical patients.
State the purpose of your paper.
Current Best Practices:
Conduct a search for and review current best practices in postoperative pain management.
Summarize key findings from at least three peer-reviewed nursing or medical journals published within the last five years.
Discuss various nursing interventions used in the management of postoperative pain.
Nursing Interventions:
Describe specific nursing interventions (can be from your best practice research) that can be used to manage postoperative pain, such as pharmacologic and non-pharmacologic methods.
Explain the rationale behind each intervention.
Provide examples of how these interventions can be implemented in a clinical setting.
Implications:
Discuss the implications of effective pain management on patient outcomes, including physical and psychological aspects.
Explore the role of the nurse in advocating for optimal pain management.
Address potential barriers to effective pain management and strategies to overcome them.
Conclusion:
Summarize the key points discussed in the paper.
Emphasize the importance of nursing interventions in the management of postoperative pain.
References:
Include a reference list in APA 7th edition format.
Ensure all sources cited in the paper are included in the reference list.
Use at least three credible sources, including peer-reviewed journal articles, books, and reputable websites.
Formatting:
The paper should be a minimum of 3 pages in length, excluding the title and reference pages.
Use 1-inch margins on all sides, double spacing, and a readable font such as 12-point Times New Roman.
Include page numbers in the upper right-hand corner.
Use headings and subheadings to organize the content clearly.
Evaluation Criteria:
Your paper will be evaluated based on the following criteria:
Adherence to APA 7th edition formatting guidelines.
Depth and relevance of the literature review.
Clarity and comprehensiveness of the description of nursing interventions.
Quality and relevance of the case study analysis.
Coherence and logical flow of the discussion and conclusion.
Proper citation and referencing of sources.
Grammar, spelling, and overall presentation.
By completing this assignment, you will enhance your understanding of postoperative pain management and develop your ability to write scholarly papers that adhere to professional standards.

Your submission must be your original work. No more than a combined total of 30% of a submission and no more than a 10% match to any one individual source can be directly quoted or closely paraphrased from sources, even if cited correctly. The similarity report that is provided when you submit your task can be used as a guide.
You must use the rubric to direct the creation of your submission because it provides detailed criteria that will be used to evaluate your work. Each requirement below may be evaluated by more than one rubric aspect. The rubric aspect titles may contain hyperlinks to relevant portions of the course.
Tasks may not be submitted as cloud links, such as links to Google Docs, Google Slides, OneDrive, etc., unless specified in the task requirements. All other submissions must be file types that are uploaded and submitted as attachments (e.g., .docx, .pdf, .ppt).
Note: You may use the attached “Professional Development Plan Template” in the Supporting Documents section to complete this task.
A. Develop your five-year professional development plan by doing the following:
1. Discuss each of the goals in your professional development plan for attaining professional experience, academics, certificates or certifications, leadership development, or other important aspects of your career by including the following:
• one-year (short-term) goals
• three-year (intermediate) goals
• five-year (long-term) goals
2. Discuss the requirements needed to maintain your current certificates or certifications.
3. Discuss the requirements needed to earn and maintain desired future certificates or certifications.
Note: If your organization does not require additional certificates or certifications, provide an explanation in part A3.
4. Discuss the requirements needed to achieve your desired education.
5. Discuss the requirements needed to achieve your desired work experience.
6. Discuss how your professional development plan will allow you the opportunity to be a change agent within your professional practice, including specific examples.
B. Discuss the importance of each certificate obtained in this course:
• American Museum of Natural History (AMNH)
• End-of-Life Nursing Education Consortium (ELNEC)
• One of the following additional certificates of your choice:
• Institute of Healthcare Improvement (IHI)
• How Nurses Can Help Prevent Child Maltreatment
• Sexual Orientation and Gender Identity Nursing Education (SOGI Nursing)
• Caring Science, Mindful Practice
1. Explain how you plan to use each certificate discussed in part B within your professional practice, including specific examples.
2. Explain how each certificate discussed in part B support your professional development plan, including specific examples.
3. Submit a copy of your completed additional certificate discussed in part B by scanning it in either a JPEG, PNG, BMP, or PDF file.
a. Explain why you chose the additional certificate.
C. Acknowledge sources, using in-text citations and references, for content that is quoted, paraphrased, or summarized.
D. Demonstrate professional communication in the content and presentation of your submission.
File Restrictions
File name may contain only letters, numbers, spaces, and these symbols: ! – _ . * ‘ ( )
File size limit: 200 MB
File types allowed: doc, docx, rtf, xls, xlsx, ppt, pptx, odt, pdf,

Provide an initial workup of Chapter Two and the project direction. Solidify your project topic and begin to think about strategies for conducting your inquiry. As you reflect on your immersion activities and feedback, you received during the first week, and potential project question that you would like to focus on for your project.
At this point, it is important to avoid firmly attaching yourself to specific details as there will still be considerable revisions based on the new knowledge you will obtain over the next few weeks.
The second chapter is a review of the literature, which attempts to sketch a wider pattern of similar scholarly activities, discussing prior studies and fitting the present project into a broader scheme. This is the most time-consuming and a key chapter for the rest of the project. 
The literature review should be comprehensive and scholarly. You will complete an exhaustive review of the literature. You should have approximately thirty-five (35) references in this chapter that support your project.
Chapter Two defines what the current literature is on your topic and how you are filling a gap or adding to the body of knowledge. Do not let yourself get behind.

John is a 24-year-old who presents to urgent care with a 2 week history of cough and congestion. He says it started out as a “normal cold” and it will not go away. He has a productive cough of green mucous and has green nasal discharge. He says that he has had a low-grade temperature for the past 2 days. John reports an intermittent frontal headache with this cold. He is otherwise healthy, with no known drug allergies.
The patient’s assessment is as follows:
Vital signs are stable and temperature is 99.9°F. Tympanic membranes (TMs) are clear bilaterally, pharynx is pink with no exudate, he has greenish postnasal drainage, turbinates’ are swollen and red, there is tenderness when frontal sinuses palpated, there is no cervical adenopathy, and lungs are clear.
Answer the following questions. What medications do you anticipate being prescribed/recommended and why?
What patient education would you anticipate giving the patient regarding the medications you chose?

Case studies are a useful way for you to apply your knowledge of pharmacokinetics and pharmacodynamic aspects of pharmacology to specific patient cases and health histories.
For this Assignment, you evaluate drug treatment plans for patients with various disorders and justify drug therapy plans based on patient history and diagnosis.
CASE STUDY
NURS 6521, Week 4 Assignment
Directions: For each of the scenarios below, answer the questions below using your required learning resources, clinical practice guidelines, medscape and JNC 8. Explain the problem and explain how you would address the problem. When recommending medications, write out a complete prescription for each medication. What order would you send to a pharmacy? Include drug, dose, route, frequency, special instructions, # dispensed (days supply), refills, etc. Also state if you would continue, discontinue or taper the patient’s current medications. Use at least 3 sources for each scenario and cite sources using APA format.
• Sara is a 45-year-old female presenting for her annual exam. Her blood pressure today is 160/90 HR 84 RR 16. Her height is 64 inches and her weight is 195. Her last visit to the clinic 3 months ago shows a BP of 156/92. She is currently taking ibuprofen 600 mg tid for back pain. She has no known allergies. What is the goal for her blood pressure? What medication would you prescribe to treat her blood pressure? What education would you prescribe?
• Monty is a 52-year-old male following up on his labs that were drawn last week. He smokes 1 pack per day. He is currently on Lisinopril 20 mg po daily. He is allergic to penicillin. Fasting lipid profile shows total cholesterol 266, LDL cholesterol 180, HDL cholesterol 40, and Triglycerides 185. What treatment plan would you implement for Monty’s lipid profile? What is the goal Total Cholesterol (TC), HDL-C, and LDL-C level for Monty? How would you monitor the effectiveness of your treatment plan? How many risk factors for coronary artery disease does this patient have? Identify them specifically.
• Beatrice is a 17-year-old female diagnosed with mild persistent asthma since age 7. During her visit today, she reports having to use her albuterol MDI 3 to 4 days per week over the past 2 months. Over the past week she has been using albuterol at least once per day. She reports being awakened by a cough three nights during the last month. She is becoming more short of breath with exercise. She also has a fluticasone MDI, which she uses “most days of the week.” Her current medications include: Flovent HFA 44 mcg, two puffs BID, Proventil HFA two puffs Q 4–6 H PRN shortness of breath, Yaz one PO daily, Propranolol 80 mg PO BID. What treatment plan would you implement for this patient? What medication changes would you make? How would you monitor the effectiveness of this plan?
• Daute is a 56-year-old man seeking evaluation for increasing shortness of breath. He noticed difficulty catching his breath about 3 years ago. Physical activity increases his symptoms. He avoids activity as much as possible to prevent any SOB. His previous physician had placed him on salmeterol/fluticasone (Advair Diskus) one inhalation twice daily 2 years ago. He thinks his physician initiated the medication for the shortness of breath, but he is not entirely sure. He did not refill the prescription and has not been taking it. Pertinent history – Chronic bronchitis X 8 years with one exacerbation in last 12 months of treatment with oral antibiotics. He has a 40-pack-year smoking history. What treatment plan would you implement for this patient? What medication(s) would you prescribe? How would you monitor the effectiveness of this plan?