solved: Mrs. Park is a 65-year-old white female with hx of HTN  who

  

Mrs. Park is a 65-year-old white female with hx of HTN  who presents for an annual physical. She is currently taking Lisinopril 10mg daily. NKDA  She is postmenopausal. Surgical history includes an appendectomy and cholecystectomy. She is married with two grown children and works part-time in retail. She has never smoked. States she drinks alcohol rarely. States she does not exercise on a regular basis.   Vitals Labs Blood pressure: 128/80Total cholesterol: 300Pulse: 80/regularTriglycerides: 182Resp.: 18LDL-C: 165Height: 5’4″HDL-C: 36Weight: 185 lbsCMP, CBC, and TSH WNL HbA1c: 5.0Physical Exam General AppearanceThe patient is groomed and dressed appropriately. The patient is alert and oriented. In no acute distress, well developed, and well nourished. The patient answers questions appropriately.HEENTNormocephalic. Bilateral ear canals clear. Bilateral tympanic membranes are pearly gray with good cone of light, no erythema/budging or retraction noted bilaterally, boney landmarks are visible. Pupils are equal, round, and reactive to light accommodation. Sclerae anicteric, conjunctiva pink/moist and without drainage.PERRLANo eye pain with movement. Oral mucosa is moist, pharyngeal without erythema, no edema, uvula is midline, and tonsils are 1+ bilaterally. No postnasal drainage noted. Nose is symmetrical. Nares patent bilaterally.NeckTrachea midline. No thyromegaly or jugular vein distention.RespiratoryCTA bilaterally, no wheezes, rhonchi, or rales. No cyanosis or clubbing of the fingers.Cardiovascular Apical pulse is palpable. The heart has a regular rate and rhythm. No gallops, rubs, or murmurs. S1 & S2 normal. No thrills or bruits present. No edema of the lower extremities.MusculoskeletalNo spinal tenderness, No paraspinal muscle tenderness. ROM WNL.Gastrointestinal Abdomen is soft. No tenderness or masses. Active bowel sounds in all quadrants.GenitourinaryNot examined.IntegumentarySkin is warm, dry, no rashes.NeurologicA/O x 3, no gross deficits.PsychiatricAlert and cooperative, normal affect, thoughts appear congruent and appropriate. Rubric  Hyperlipidemia Case Study CriteriaRatingsPts This criterion is linked to a Learning OutcomeTx Plan: Specific lipid lowering therapy 40 ptsFull Marks 0 ptsNo Marks 40 pts  This criterion is linked to a Learning OutcomeTx Plan: Dose & Frequency 10 ptsFull Marks 0 ptsNo Marks 10 pts  This criterion is linked to a Learning OutcomeTx Plan: Resources 10 ptsFull Marks 0 ptsNo Marks 10 pts  This criterion is linked to a Learning OutcomePatient Education: Lifestyle Recommendations 20 ptsFull Marks 0 ptsNo Marks 20 pts  This criterion is linked to a Learning OutcomePatient Education: Side effects 20 ptsFull Marks 0 ptsNo Marks 20 pts  Total Points: 100 Health Science Science Nursing NURS 5080 Share QuestionEmailCopy link Comments (0)