Joan is a 78 year old female who is scheduled with you today because

Joan is a 78-year-old female who is scheduled with you today because she needs refills for her blood pressure medication. When you look at her record, you notice that she has not been in for 14 months. You notice that there are a number of missed appointments on record, but that she has been calling in for refills for her meds. During the last call, the office nurse told her she would need to come in for a visit to obtain the refills. Her record indicates that her medications at her last visit included Lisinopril/hctz 10/12.5 and simvastatin 20mg daily.

She reports that she takes her blood pressure medication “most of the time” but doesn’t take the simvastatin regularly because her neighbor developed liver problems from it. She remembers in the past that she was told she has a “touch of sugar.” She feels good but she wants to get checked out and wants to “get her act together” and start taking care of herself because her brother, who is 48, just found out that he has “clogged arteries.” She would like some help with quitting smoking as well. She also tells you that she had a “little heart attack” when she was 72.

Her vital signs are: BP: 168/94, pulse: 84 and regular, resp: 18

Height: 5’9” Weight: 221lbs

1. What additional subjective information do you need to obtain? Be specific to her medical history and reason for presentation today.
2. What objective information do you need to obtain? Be specific to her medical history and reason for presentation today.
3. What labs/diagnostic tests are indicated and why? Include references for your rationales.You conduct the visit. The review of systems and physical exam, with the exception of her blood pressure and weight, are normal. The diagnostic tests and laboratory test you ordered were normal with the exception of the following:
   • EKG – Afib with a rate of 82
   • Fasting Lipids: Total cholesterol: 242, LDL: 176, HDL: 36, triglycerides: 250
   • Fasting glucose: 162
   • HgbA1c – 7.4
4. What is your complete diagnosis list for this patient?
5. How will you manage her blood pressure pharmacologically? Provide a rationale for your choice and include references.
6. How will you manage her cholesterol pharmacologically? Provide a rationale for your choice and include references.
7. What is Joan’s CHADS-Vasc score? What is her yearly risk for stroke? What treatment will you recommend based on her score and why? Remember to include references for your rationales.
8. Estimate Joan’s 10-year ASCVD.
9. During the follow up visit, you discuss her lab results and their implications. What will you tell her?

Please refer to the Grading Rubric for details on how this activity will be graded.

• S Question 1
• O Question 2, 3
• A Question 4
• P Question 5, 6, 7, 8, 9

Grading Rubric:

ote: Scholarly resources are defined as evidence-based practice, peer-reviewed journals; textbook (do not rely solely on your textbook as a reference); and National Standard Guidelines. Review assignment instructions, as this will provide any additional requirements that are not specifically listed on the rubric.

Clinical Case Study – 100 PointsCriteriaExemplary
Exceeds ExpectationsAdvanced
Meets ExpectationsIntermediate
Needs ImprovementNovice
InadequateTotal PointsSubjective DataIncludes all relevant subjective data necessary for differentiation of the client’s problem. Data is presented in systematic, organized manner consistently.

20 pointsIncludes most subjective data with omission of two minor details or one major detail. Most data is presented in systematic, organized manner.

17 pointsIncludes subjective data but omits four minor details or two major details. Some data is presented in a systematic, organized manner.

15 pointsOmits more than four minor details or more than two major details of the subjective data. Data is not presented in a systematic, organized manner.

Lacking most or all subjective data.

Submits assignment late.

13 points20Objective DataObjective data is complete and consistently presented in an organized manner.

20 pointsObjective data is complete and presented in an organized manner most of the time.

17 pointsObjective data is not complete or is not presented in an organized manner.

15 pointsObjective data is not complete and is not presented in an organized manner.

Lacking most or all objective data.

Submits assignment late.

13 points20AssessmentAssessment, including differential and/or diagnosis (if appropriate), is complete and appropriate to client Diagnostics are complete and appropriate to client.

20 pointsAssessment, including differential and/or diagnosis (if appropriate), is complete but some may not be appropriate for client.

17 pointsAssessment, including differential and/or diagnosis (if appropriate), is not complete but is appropriate.

15 pointsAssessment, including differential and/or diagnosis (if appropriate), is not complete or appropriate, or it is not evident.

Submits assignment late.

13 points20PlanPlan includes all relevant measures 95% to 100% Pharmacologic Non-pharmacologic Education Referral Follow-up.

20 pointsPlan includes all relevant measures 89% to 94% Pharmacologic Non-Pharmacologic Education Referral Follow-up.

17 pointsPlan includes four of the five relevant measures, but the four are complete.

15 pointsPlan is not complete and/or covers only three relevant measures.

Plan and relevant measures are not evident.

Submits assignment late.

13 points20Professional ApplicationCase incorporates four evidence-based practice articles.

10 pointsCase incorporates three evidence-based practice articles.

8 pointsDoes not include an evidence-based practice article but has two or more advanced practice articles.

7 pointsDoes not include evidence-based practice article but has one advanced practice article or does not include evidence-based practice article or advanced practice article.

6 points10Organization, APA, Grammar, and SpellingWell organized content that is clear and concise. Correct APA formatting with no errors.

The writer correctly identifies reading audience, as demonstrated by appropriate language (avoids jargon and simplifies complex concepts appropriately).

There are no spelling, punctuation, or word-usage errors.

10 pointsOrganized content that is informative and supportive of purpose. Correct and consistent APA formatting of references, and cites all references used. No more than one to two unique APA errors.

There are minimal to no grammar, punctuation, or word-usage errors.

8 pointsPoor organization and flow of ideas may distract from the content. Three to four unique APA formatting errors.

The writer occasionally uses awkward sentence construction or overuses/inappropriately uses complex sentence structure. Problems with word usage (evidence of incorrect use of thesaurus) and punctuation persist, often causing some difficulties with grammar. Some words, transitional phrases, and conjunctions are overused.

Multiple grammar, punctuation, or word usage errors.

7 pointsIllogical flow of ideas.

Many APA formatting errors, or no attempt to format in APA.

The writer struggles with limited vocabulary and has difficulty conveying meaning–noting just the broadest of meanings.

Grammar and punctuation are consistently incorrect. Spelling errors are numerous.

Submits assignment late.

6 points10Total Points100