work

Mr. B is a 75-year-old, white, male

Source: Self, reliable source

Subjective:

Chief complaint: “I feel winded.”  

HPI:  Patient states he has been feeling short of breath with exertion for years now. However, over the past year he feels he has been worsening. He decided to come in today as he experienced shortness of breath mowing his lawn yesterday and had to take two breaks. He has a cough, generally productive. He denies any chills or fever. He denies any chest pain or lower extremity swelling. He denies any nausea or vomiting. He has not taken anything OTC for his symptoms.

Allergies: NKA

Current Mediations:

Lisinopril, 20 mg, daily

Propranolol ER, 120 mg, daily

Simvastatin, 40 mg, daily

Aspirin, 81 mg, daily

Tamsulosin, 0.4 mg, daily

Sertraline, 100 mg, daily

Omeprazole, 20 mg, daily

Metformin, 1000 mg, BID

Glimepiride, 4 mg, daily

Insulin glargine, 10 units, nightly                                                                                                                      

Pertinent History: Hypertension, hyperlipidemia, diabetes mellitus, benign prostatic hyperplasia, anxiety, gastritis, obesity, nicotine dependence

Health Maintenance. Immunizations: Immunizations up to date, to include PPSV-23. He has refused recommended yearly low dose CT screens (candidate given at least 30 pack-year-smoking history).

Family History:

            Father – Congestive heart failure, hypertension, hyperlipidemia (deceased age 81)

            Mother – atrial fibrillation (deceased age 79)

Social History: Patient lives with his wife. He smokes 1ppd (40 pack year history). He drinks “a beer or two a day” and denies drug use.

ROS: Incorporated into HPI

Objective:

VS – BP: 118/68, HR: 86, RR: 16, Temp 97.6, oxygenation 100%, weight: 340 lbs, height: 64 inches.

Mr. B is alert, awake, oriented x 3.  Patient is clean and dressed appropriate for age.

Cardiac: No cardiomegaly or thrills; regular rate and rhythm, no murmur or gallop. No peripheral edema or jugular vein distention

Respiratory: Clear to auscultation, but decreased breath sounds

Chest x-ray shows no consolidation or masses

ECG shows sinus rhythm

Spirometry shows FEV1/FVC < 0.7 and FEV1 of 65% predicted

Assessment:

Diagnosis: Moderate chronic obstructive pulmonary disorder, ICD-10: J44.9

Please answer the following:

  1. Utilizing the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines mentioned in your lecture, what is your prescribed treatment plan (include specific dosage, frequency)? Why did you choose this treatment plan? In your answer, please describe, briefly, the pharmacodynamics (1 point) and pharmacokinetics (1 point) of your treatment choice and how they influenced your choice. Please describe how the patient comorbidities influenced your choice as well (1 point).  Are there any medical interactions to your choice (1 point)? 
  2. Document the education you would provide for this patient, specific to the prescribed medication(s). Please include information pertinent to the patient (2 points) and common potential adverse effects for each prescribed medication (2 points)

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