Maria – discussion week 2 case2 (REPLY) Jack is a 54-year-old patient who has difficulty coming in for primary care visits. He sees cardiology, pulmonary clinic, and endocrine clinic for his comorbid conditions of diabetes mellitus, postcoronary artery bypass grafting (CABG) 2 years ago, and mild chronic obstructive pulmonary disease issues from a 30-pack year history of smoking. His last visit with you was over a year ago. Today, your registered nurse brings you a telephone triage call requesting a refill of his Crestor prescription, which was ordered by cardiology soon after his CABG. Per the electronic links to the cardiology service within your facility, the medication was due to be renewed about 2 months ago. His last lipid labs were a year ago and his last complete metabolic panel (CMP) was done at the same time. He was recently at the pulmonary clinic and his last recorded HgA1C was 9.0 from a visit to endocrine 4 months ago. A review of records include a prescription for his hypertension (Lisinopril 20 mg daily), metformin 1,000 mg twice a day for his diabetes, and no known medications for his pulmonary issues. The Crestor prescription appears to have multiple dosing levels over the past few refills. His last vital signs were blood pressure (BP) 170/110 mm Hg, pulse 88, and respirations 22. His body mass index is 30 and he indicates a pain level of four out of five. His pulse oximetry was 92% on room air. 1. How do you respond to this telephone request? Encourage the patient to be seen by us STAT due to multiple discrepancies in his prescribed medications and obvious non-compliance with a previous treatment plan. 2. What steps are required to get Jack’s therapeutic plan under control? Observe the pt’s level of health literacy to make sure that this patient understands the importance of following the treatment plan. Find out what was the main reason for treatment non-compliance and gather more information. It is important to provide extensive education about Mr. Jack’s disease process, as well as about drug therapy. He needs to be taught about the warning signs and symptoms of hypoglycemia and diabetes neuropathy. He needs to be stressed repeatedly as the adult learns to judge insulin needs with exercise stressors, other drug effects, and diet. Exercise and diet should always be emphasized as the mainstay of dealing with diabetes. Mr. Jack needs to be cautioned about the use of over-the-counter and herbal or alternative therapies. Mr. Jack needs to maintain and monitor for changes in response to metformin (Msn Rn, 2022). Fax over STAT requests for progress notes and any lab data to other medical providers that are involved in this patient’s treatment in order to complete the medication reconciliation. Assess and reevaluate current health condition: Head-to-toe, Chief complaint, Vs, BMI, PAIN, dietary approach, lifestyle. STAT referral: CMP, Liver and renal function, HgA1C, Chest XR, EKG. These studies will be super important in order to rule out a protentional risk of stroke, CAD, DVT=>PE, as well as diabetic neuropathy and nephropathy. Also, may selectively additional biological markers such as family history, high sensitivity C-reactive protein, ankle-brachial index, and coronary artery calcium score with the assessment tool to assist in predicting and evaluating risk (Leeuwen et al., 2016). Update medication prescription w/no additional refills until next pt’s follow-up appt for the further adjustment of a treatment plan based on a new finding. If the patient is still a current smoker, then a prescription for Wellbutrin may be made for smoking cessation, which is the most important step for the patient’s health improvement. 3. What is the role of the primary care provider (PCP) in this scenario? At this juncture, the primary care provider would serve as the main source of care for this patient as well as facilitate the delivery of consistent care guidelines. Also, become a milestone in professional medical collaboration, as well as condition management and prevention (The Importance of a Primary Care Provider, 2019). References: Leeuwen, A. M. van, Bladh, M. L., & Van Leeuwen, A. M. (2016). Textbook of Laboratory and Diagnostic Testing: Practical Application of Nursing Process at the Bedside. F. A. Davis Company. Msn Rn, K. A. M. (2022). Focus on Nursing pharmacology by Amy M. Karch MSN RN Sixth edition (Textbook ONLY, Paperback). In No Title. Acrimony Lounge. The importance of a primary care provider. (2019, September 18). Mayo Clinic Health System. Retrieved September 6, 2022, from https://www.mayoclinichealthsystem.org/hometown-health/speaking-of-health/the-importance-of-a-primary-care-provider
