Susan Bridge is a 58-year-old Caucasian female who just recently moved into town and is seeing the NP today to establish care and go over her medication and treatment plan.   Susan checks her BP at home 3x a week and average home BP readings are 144/86 mmHg.   PMH: HTN dx. 5 years ago, Hyperlipidemia dx. 5 years ago. OB hx:  G:3, P: 3.  Gestational DM, preeclampsia, menopausal 1 year Family Hx:  Dad alive 88 y – DM type II, HTN, Hyperlipidemia, CVD with an MI at age 67.  Mom alive 85 y – DM type II, Hyperlipidemia, depression Medications: Lisinopril 10 mg/day, Atorvastatin 40 mg/day, multi-vitamin Social Hx:  non-smoker, ETOH wine 3 glasses/week, full-time work as an accountant, exercise – short walks 2-3 x a month.  Doesn’t have time to cook – eats fast-food 2-3x a week, eats soup from a can 3-4x a week.  Likes to reward herself on the end of the day with a couple of pieces of pie.   Lipid panel – 1 week ago while on statin therapy:   Total cholesterol 142 LDL 135 HDL 35 Non-HDL: 107 VS: BP: 158/84 mmHg.   RR: 16 HR:  88 Pulse-ox: 95% RA BMI:  29 Address each question separately:   1.  Identify risk factors. 2.  Address why these are risk factors. 3.  Is this patient at treatment goals for HTN?  4.  What should be the BP goal?  5.  What should the NP advice/prescribe to help the patient achieve her HTN goal?   6.  Why did you choose the treatment described in question #5?  

Untreated Obstructive Sleep Apnea (OSA) increases the risk for other health related conditions.  List three health related conditions:    

Ms. Gloria Briggs continued – see below her subjective and objective data points.   With findings of elevated brain natriuretic peptide and left ventricular dysfunction on echo (ejection fraction 38%), a diagnosis of HF with reduced ejection fraction (HFrEF) is confirmed. What is Gloria’s American College of Cardiology Foundation/American Heart Association (ACCF/AHA) stage and New York Heart Association (NYHA) class?   Ms. Gloria Briggs works as a librarian and presents with a 6-week history of fatigue and increasing shortness of breath. She believes that these symptoms are related to recent renovations at the library, which have reactivated her asthma; however, her nebulizer and inhaler have not relieved her symptoms. Gloria reports that her dyspnea is worse with ordinary activity and lying flat, but she is comfortable sitting. She has not experienced chest pain. She complains of her legs swelling and shoes “pinching.” She can no longer take her brisk lunchtime walk and has gained weight. Her history includes hypertension, type 2 diabetes (T2DM), and dyslipidemia; she is a nondrinker and quit smoking 7 years ago. Physical examination: o   Height: 5 ft 6 in; weight: 165 lbs. (body mass index [BMI]: 26.6 kg/m2) o   Blood pressure (treated): 140/92 mm Hg o   Heart rate: 116 bpm; respiratory rate: 22; temperature: 98.4°F o   1+ pitting edema ankles; S3 heart sound; bilateral rales at lung bases o   Mild cardiomegaly

You are following up on an anxious 80 y.o. woman who presented with multiple complaints. At your last visit 1 week ago, you performed a thorough examination and today you will review the test results with your patient.  The diagnostic tests include laboratory work, cardiac stress testing with echo, and PFT’s. When evaluating this woman and her test results, which one of the following is considered a normal finding for her age?

Case Study: Ms. Briggs a 64-year-old woman Ms. Gloria Briggs works as a librarian and presents with a 6-week history of fatigue and increasing shortness of breath. She believes that these symptoms are related to recent renovations at the library, which have reactivated her asthma; however, her nebulizer and inhaler have not relieved her symptoms. Gloria reports that her dyspnea is worse with ordinary activity and lying flat, but she is comfortable sitting. She has not experienced chest pain. She complains of her legs swelling and shoes “pinching.” She can no longer take her brisk lunchtime walk and has gained weight. Her history includes hypertension, type 2 diabetes (T2DM), and dyslipidemia; she is a nondrinker and quit smoking 7 years ago. Physical examination: o   Height: 5 ft 6 in; weight: 165 lb (body mass index [BMI]: 26.6 kg/m2) o   Blood pressure (treated): 140/92 mm Hg o   Heart rate: 116 bpm; respiratory rate: 22; temperature: 98.4°F o   1+ pitting edema ankles; S3 heart sound; bilateral rales at lung bases o   Mild cardiomegaly Laboratory findings: o   Random blood glucose: 125 mg/dL o   Lipids (treated): total cholesterol 200 mg/dL, low-density lipoprotein cholesterol 105 mg/dL Medications: o   Furosemide 20 mg/d; lisinopril 20 mg/d; simvastatin 20 mg/d, metformin 2000 mg/d, divided doses Electrocardiogram: o   No arrhythmias  After reviewing everything above you are pretty sure of Ms. Briggs current problem and her diagnosis, but you also know that this diagnosis has the following:  – select the correct answer.  

The 10-year ASCVD risk calculator – calculates the first “hard” ASCVD event (fatal and nonfatal MI or stroke).  The calculation takes into account race, sex, should be estimated by using the race- and sex-specific pooled cohort equation (PCE).  Adults are categorized as being low risk, borderline, intermediate, and high risk.  Match the risk categories below: 

Which of the following genes has the largest effect on statin response variability?

What do the 2019 American College of Cardiology (ACC)/American Heart Association (AHA) Guidelines on the Primary Prevention of Cardiovascular Disease recommend for assessment of atherosclerotic cardiovascular disease (ASCVD) Risk?

Accounts whose balances at the end of the accounting period are NOT carried over to the next accounting period.

The difference between footings in a T account will give the accountant the: