B.J., a 70-year-old Caucasian female has been seen in the clinic several times over the last 3 years. However, she missed her last annual appointment-last appointment was 18 months ago and today you are the nurse practitioner seeing her. She arrived to the clinic alone and states she is â€œhere for my check-upâ€.
The patient reports that â€œmy feet just burn and tingle all the time and it is so much worse at night that I can hardly sleep at allâ€. She also indicates that â€œI need some new pillows; I use 3 of them now to just get comfortable at night to sleep. Those pillows help me catch my breath so I can sleep betterâ€. She also reports dyspnea just walking to the bathroom, but it only happens when her legs are â€œswole upâ€ and also states, â€œthe coughing also keeps me up at nightâ€. To be honest, â€œIâ€™m just tired in general whether my feet are â€œswoleâ€ or notâ€. She also indicates that she cannot see well, especially at night. She also reported that at her last visit to the clinic, she was told that she had a â€œheart beat problemâ€ and that she is supposed to be taking aspirin every day. She said she thinks all of her â€œheart painsâ€ went away after she started taking the aspirin and â€œputting that pill under the tongueâ€. One of her concerns she has today is that since her husband died last year, she tells you, â€œI just donâ€™t like doing things that I liked to do before my husband died. We used to like to do all sorts of stuff, but anymoreâ€¦.I just feel blue all the timeâ€.
Chronic back pain
Previous history of MI in 2010
Coreg 6.25 mg PO BID
Colace 100 mg PO BID
Glucotrol XL 10 mg PO daily
Lantus insulin 20 units at HS
K-dur 20 mEq PO QD
Furosemide 40 mg PO QD
L-Thyroxine 112 mcg PO QD
2010-Left Anterior Descending (LAD) cardiac stent placement
She receives an annual flu shot. Last flu shot was this year
Has never had a Pneumovax
Has not had a Td in over 20 years
Has not had the herpes zoster vaccine
Has not seen a dentist in over 15 years, the time she got her dentures
Last colorectal screening was 11 years ago
Last mammogram was 5 years ago
Has never had a DEXA/Bone Density Test
Last dilated eye exam was 4 years ago
Labs from last yearâ€™s visit: Hgb 12.2, Hct 37%, Hgb A1C 8.2%, K+ 4.2,
Na+140,Cholesterol 186, Triglycerides 188, HDL 37, LDL 98, TSH 3.7,
She graduated from high school, and thought about college, but got married right away and then had kids a short time later. Her two sons and their wives live with her, take her to church and to the local senior center; they do all the cleaning, run errands, and do grocery shopping.
Both parents are deceased. Father died of a heart attack; mother died of natural causes. She had one brother who died of a heart attack 20 years ago at the age of 52.
Patient is a current tobacco user and has smoked 1 pack of cigarettes daily for the last 50 years and reports having no desire to quit. She uses occasional chew. She drinks one 4 ounce glass of red wine daily.
Discussion Part One: