NR 508 Week 2 TD and Quiz
, NR 508 Week 2 TD and Quiz
PART 1: (Ch 17, 18, 21, 24, 52, 53)
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 (regular rate & rhythm), NMRG (No
murmur (valve), rub (friction/fluid around
pericardium), gallop (valve))
CHEST: CTA
NEURO: monofilament test shows decreased
peripheral sensation
EXT: normal
Laboratory (fasting):
Na 139 mEq/L N (135-145)
K 3.8 mEq/L N (3.5-5)
ALT 34 U/L N (0-40)
Ca 9.1 mg/dL N (8.6-10)
CL 102 mmol/L N (95-105)
HCO3 22 mEq/L N (22-28)
AST 39 U/L N (0-40)
TP 6 g/dL T. Pro?? N (5.6-8.4)
BUN 33 mg/dL H (8-21)
SCr 2.0 mg/dL H (0.5-1.5)
Alb 4.1 g/dL N (3.2-4.8)
Cholesterol 254 mg/dL H (<200)
BG 300 mg/dL H
, TSH 0.12 mU/mL L (0.4-4.8)
UA: SG 1.013 mg/24h (N), pH 6.5 (N), +++ protein
(from DM and hyperthyroidism)
UR SG 1.002 – 1.030, pH 4.6-7.9
What are the major problems in this patient, and what diagnoses do
these values indicate? HTN, DM, Hyperlipidemia, Diabetic peripheral
neuropathy, Hyperthyroidism, proteinuria?
Additionally, what is your assessment and pharmacological plan for
each of these problems including the medication, dose, and mechanism
of action?
Cynthia, a 55-year-old African American female, presents to the office with
complaints of polydipsia, fatigue, and frequent leg numbness and tingling.
Upon examination, Cynthia is found to have a BMI of 32, elevated blood
pressure, and decreased peripheral sensation. Based on her physical exam,
blood and urine lab work are ordered. Cynthia’s lab work and the physical
exam reveal a number of issues including chronic kidney disease (CKD),
hypertension (HTN) secondary to CKD, hyperthyroidism, diabetes mellitus
type 2 (DM2) that is uncontrolled, diabetic peripheral neuropathy,
hyperlipidemia, proteinuria, fatigue, polydipsia, and obesity. Cynthia’s major
problems along with the pharmacological plan will be addressed below.
Chronic kidney disease, stage 3B (calculated GFR of 30mL/min/1.73 m2,
Calculated creatinine clearance (CrCl) = 26-32 mL/min): Angiotensin-
converting enzyme (ACE) inhibitors aid renal functions in hypertensive
patients by way of angiotensin II and autoregulation of the glomerular
filtration rate (GFR) (Mann & Hilgers, 2017). Angiotensin II causes
constriction at the afferent and efferent arterioles and causes a beneficial
increase in the efferent resistance (Mann & Hilgers, 2017). This is beneficial
because it causes an increase or stabilization in intraglomerular pressure,
which helps maintain or increase the GFR (Mann & Hilgers, 2017). Using an
ACE inhibitor to lower hypertension in patients with renal disease will also
reduce or regulate intraglomerular pressure (Mann & Hilgers, 2017).
An ACE inhibitor will be ordered to aid in renal function as well as for her
HTN.
, NR 508 Week 2 TD and Quiz
PART 1: (Ch 17, 18, 21, 24, 52, 53)
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 (regular rate & rhythm), NMRG (No
murmur (valve), rub (friction/fluid around
pericardium), gallop (valve))
CHEST: CTA
NEURO: monofilament test shows decreased
peripheral sensation
EXT: normal
Laboratory (fasting):
Na 139 mEq/L N (135-145)
K 3.8 mEq/L N (3.5-5)
ALT 34 U/L N (0-40)
Ca 9.1 mg/dL N (8.6-10)
CL 102 mmol/L N (95-105)
HCO3 22 mEq/L N (22-28)
AST 39 U/L N (0-40)
TP 6 g/dL T. Pro?? N (5.6-8.4)
BUN 33 mg/dL H (8-21)
SCr 2.0 mg/dL H (0.5-1.5)
Alb 4.1 g/dL N (3.2-4.8)
Cholesterol 254 mg/dL H (<200)
BG 300 mg/dL H
, TSH 0.12 mU/mL L (0.4-4.8)
UA: SG 1.013 mg/24h (N), pH 6.5 (N), +++ protein
(from DM and hyperthyroidism)
UR SG 1.002 – 1.030, pH 4.6-7.9
What are the major problems in this patient, and what diagnoses do
these values indicate? HTN, DM, Hyperlipidemia, Diabetic peripheral
neuropathy, Hyperthyroidism, proteinuria?
Additionally, what is your assessment and pharmacological plan for
each of these problems including the medication, dose, and mechanism
of action?
Cynthia, a 55-year-old African American female, presents to the office with
complaints of polydipsia, fatigue, and frequent leg numbness and tingling.
Upon examination, Cynthia is found to have a BMI of 32, elevated blood
pressure, and decreased peripheral sensation. Based on her physical exam,
blood and urine lab work are ordered. Cynthia’s lab work and the physical
exam reveal a number of issues including chronic kidney disease (CKD),
hypertension (HTN) secondary to CKD, hyperthyroidism, diabetes mellitus
type 2 (DM2) that is uncontrolled, diabetic peripheral neuropathy,
hyperlipidemia, proteinuria, fatigue, polydipsia, and obesity. Cynthia’s major
problems along with the pharmacological plan will be addressed below.
Chronic kidney disease, stage 3B (calculated GFR of 30mL/min/1.73 m2,
Calculated creatinine clearance (CrCl) = 26-32 mL/min): Angiotensin-
converting enzyme (ACE) inhibitors aid renal functions in hypertensive
patients by way of angiotensin II and autoregulation of the glomerular
filtration rate (GFR) (Mann & Hilgers, 2017). Angiotensin II causes
constriction at the afferent and efferent arterioles and causes a beneficial
increase in the efferent resistance (Mann & Hilgers, 2017). This is beneficial
because it causes an increase or stabilization in intraglomerular pressure,
which helps maintain or increase the GFR (Mann & Hilgers, 2017). Using an
ACE inhibitor to lower hypertension in patients with renal disease will also
reduce or regulate intraglomerular pressure (Mann & Hilgers, 2017).
An ACE inhibitor will be ordered to aid in renal function as well as for her
HTN.
