Case Scenario
Male (54): Lab results and chronic disease management follow-up.
Diabetes background (HPI): Checks a.m. fasting blood sugars about three times per week. Results 140s-150s with one high reading of 200. Reports one episode of feeling “shaky.” Takes cholesterol medicine at bedtime nightly along with his blood pressure medicine.
Social history: Works as high school teacher, coaches football, and lives with his wife and two dogs. Denies tobacco use or history, denies recreational drugs, but drinks beer. Involved in his church, working with community outreach ministry.
Medical:
DM diagnosed 10 years ago
HTN diagnosed five years ago
Hyperlipidemia diagnosed seven years ago
OA bil knees diagnosed 12 years ago
Tension headaches diagnosed two years ago
Medications:
Metformin ER 500 mg 2 PO BID for diabetes
Januvia 100 mg QD for diabetes
Lisinopril 20 mg QD for HTN
Atorvastatin 20 mg q HS for cholesterol
Ibuprofen 200 mg 2-4 prn HA for knee pain
Vital Signs:
VS: BP 142/88, P 97, RR 18, Temp 98.8 (temporal) F, Ht 5’11”, Wt 240, BMI 33. 5
Labs (done 2 weeks before visit):
Total chol 225, trigs 210, non-HDL 193, HDL 32, LDL 170, VLDL 40
BMP glucose 142, rest in range
A1c 7.2
CBC normal
TSH 2.42
Questions
1. What else do you need to know about this patient’s chronic issues?
2. Are the chronic conditions managed appropriately according to current guidelines based on the information you have?
3.What is your plan for managing this patient, including education, health maintenance, medication, labs, referrals, and follow-up?
This benchmark assignment assesses the following programmatic competencies:
MSN Family Nurse Practitioner
7.1: Demonstrate advanced clinical and diagnostic reasoning in the diagnosis, management, and evaluation of illness and disease across the life span.
7.3: Prescribe appropriate pharmacologic and nonpharmacologic therapies in the management of illness, disease, or injuries.
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