case study: Mr. X is a 63-year-old, married, African American male who presents to the primary care office where you are working as a masters prepared nurse. He is relatively new to your practice. Until recently, he had not received primary healthcare for some time due to a lack of health insurance. He lives with his wife and three children. He works for the U.S. Postal Service as a mail clerk. He does not smoke and he consumes alcohol only on rare social occasions. He walks daily for his job and claims to eat healthily, though he admits to eating a lot of red meat, canned foods, and soda. When asked, Mr. X admits he is under a fair amount of stress at home and work. Previous blood pressure readings taken over the past two weeks were: 176/108 mm Hg in the right and left arms, while seated and supine, during his first office visit; and 172/110 mm Hg in both arms, while seated and standing, during his second encounter. Today, he reports that he has occasional episodes of exertional chest pain and has been taking sublingual nitroglycerin prn for relief. He states, “I seem to be getting these episodes more frequently over the past month or so.” He also describes a remote history of migraine headaches but in recent months only suffers with one about two to three times per month.
Medications: naproxen 440mg daily prn, Tylenol 625mg daily prn, multivitamin
Drug Allergies: NKDA
Past Medical History (PMH): migraines, basal cell carcinoma
Past Surgical History (PSH): laparoscopic cholecystectomy (2006); basal cell carcinoma excision on back
(2011)
Family History (FH): Mother: alive at 84, hypertension (HTN). Father: deceased at 78 from myocardial infarction (MI), HTN, type 2 diabetes (T2DM), hyperlipidemia. 4 siblings: one brother and one sister with HTN, others healthy as far as he knows
Assignment
You will analyze a progressive scenario that is revealed throughout the course in multiple parts. After all of the data has been revealed, you will develop a collaborative care plan for the client in the scenario. The objective is to apply theory to practice, demonstrating the application of pathophysiology and pharmacology to clinical decision making in the development of the plan of care for the client. You will need to use scholarly, peer-reviewed references, and current clinical guidelines to support your analysis.
1. Overview: Provide a brief overview of the scenario. Who is the client in the scenario? What is the client’s medical history? Are there any deviations from
normal in the client’s body systems?
2. Subjective Data: Interpret the subjective data provided in the scenario. Support your interpretation with current research and clinical guidelines, such as
the JNC 8. This interpretation will lay the groundwork for the appropriate pharmacological care for the client.
3. Objective Data: Interpret the objective data provided in the scenario. Support your interpretation with current research and clinical guidelines, such as
the JNC 8. This interpretation will lay the groundwork for the appropriate pharmacological care for the client.
4. Analysis: Based on your interpretation of the client’s subjective and objective data, analyze the socioeconomic, cultural, or demographic considerations
in the scenario. How will these considerations help you determine safe and appropriate pharmacotherapeutics for the client?
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