Advance Pharm.docx - Week2:DiscussionPartOne No unread...

Info icon This preview shows pages 1–4. Sign up to view the full content.

View Full Document Right Arrow Icon
Week 2: Discussion Part One No unread replies. 50 50 replies. Cynthia is a 65-year-old African American female who presents to the clinic for a check- up. Her last examination was ~5 years ago. She has no specific, significant, or urgent complaint. She explains that her only issues are thirst, fatigue, and leg numbness and tingling, which is beginning to occur more often. You decide to do a physical exam, as well as draw labs and receive the following results: Social history: no smoking or alcohol consumption. Physical examination: GEN: well nourished, slightly obese female VS: BP 180/103 HR 73 RR 13 T 98.4 Weight 90 kg, Height 5’6” HEENT: PERRLA COR: RRR, NMRG CHEST: CTA NEURO: monofilament test shows decreased peripheral sensation EXT: normal Laboratory (fasting): Na 139 mEq/L K 3.8 mEq/L ALT 34 U/L Ca 9.1 mg/dL CL 102 mmol/L HCO3 22 mEq/L AST 39 U/L TP 6 g/dL BUN 33 mg/dL SCr 2.0 mg/dL Alb 4.1 g/dL Cholesterol 254 mg/dL BG 300 mg/dL TSH 0.12 U/mL UA: SG 1.013 mg/24h, pH 6.5, +++ protein What are the major problems in this patient, and what diagnoses do these values indicate?
Image of page 1

Info icon This preview has intentionally blurred sections. Sign up to view the full version.

View Full Document Right Arrow Icon
Additionally, what is your assessment and pharmacological plan for each of these problems including the medication, dose, and mechanism of action? Dr. Woodward and class, Cynthia, a 65-year-old African American female, presents to the clinic for a check-up. Last known check-up was approximately five years ago. She reports excessive thirst, fatigue, and leg numbness and tingling, with increasing frequency. Physical examination and lab show the following: VS: BP 180/103, HR 73, RR 13, T 98.4 Weight 90 kg/198lbs/bmi 32.0, Height 5’6” HEENT: PERRLA COR: RRR, NMRG CHEST: CTA NEURO: monofilament test shows decreased peripheral sensation EXT: normal Laboratory (fasting): Na 139 mEq/L Normal range: 136-145 mEq/L K: 3.8 mEq/L 3.5-5.0 mEq/L ALT: 34 U/L 0-35 U/L LOW Ca: 9.1 mg/dL 9-10.5 mg/dL CL 102 mmol/L 98-106 mmol/L HCO3 22 mEq/L 23-28 mEq/L LOW AST 39 U/L 0-35 U/L HIGH TP 6 g/dL 6-7.8 g/dL BUN 33 mg/dL 8-20 mg/dL HIGH SCr 2.0 mg/dL 0.7-1.3 mg/dL HIGH Alb 4.1 g/dL 3.5-5-5 g/dL
Image of page 2
Cholesterol 254 mg/dL 150-199 mg/dL HIGH BG 300 mg/dL 70-105 mg/dL HIGH TSH 0.12 uU/mL 0.5-5.0 uU/mL LOW UA: SG 1.013 mg/24h 1.002-1.030 mg/24h pH 6.5 5.0-7.0 pr +++ negative Abnormal *lab values vary per facility ( (Links to an external site.)Links to an external site. ) It is a good thing that Cynthia came in for a check-up rather than waiting until her symptoms became bothersome because she has some concerning things going on with her. Hypertension: Cynthia presents with an extremely elevated blood pressure of 180/103. Hypertension is categorized as primary, which has an unknown etiology in 95% of cases, or secondary to other causes (Edmunds, 2013, p. 226). Although an exact reason for the hypertension may not always be identifiable; there are a number of mechanisms that have been identified that lead to the development of hypertension. It just isn’t always understood why this process occurs. “Involved mechanisms include elevated peripheral resistance, alteration in the cell membrane related to elevated lipids, endothelial dysfunction, changes in sodium or calcium levels, and hyperinsulinemia” (Edmunds, 2013, p.226). Other causes include: 1) sympathetic nervous system
Image of page 3

Info icon This preview has intentionally blurred sections. Sign up to view the full version.

View Full Document Right Arrow Icon
Image of page 4
This is the end of the preview. Sign up to access the rest of the document.

{[ snackBarMessage ]}

What students are saying

  • Left Quote Icon

    As a current student on this bumpy collegiate pathway, I stumbled upon Course Hero, where I can find study resources for nearly all my courses, get online help from tutors 24/7, and even share my old projects, papers, and lecture notes with other students.

    Student Picture

    Kiran Temple University Fox School of Business ‘17, Course Hero Intern

  • Left Quote Icon

    I cannot even describe how much Course Hero helped me this summer. It’s truly become something I can always rely on and help me. In the end, I was not only able to survive summer classes, but I was able to thrive thanks to Course Hero.

    Student Picture

    Dana University of Pennsylvania ‘17, Course Hero Intern

  • Left Quote Icon

    The ability to access any university’s resources through Course Hero proved invaluable in my case. I was behind on Tulane coursework and actually used UCLA’s materials to help me move forward and get everything together on time.

    Student Picture

    Jill Tulane University ‘16, Course Hero Intern