The 42-year-old female patient presents for follow up on lab results from her annual physical exam completed a week ago. The lab results are as follows: Triglycerides 225, LDL 170, HDL 22, HgBA1c 8.3% Patient history reveals a 20 pack-a-year smoking history and type 2 diabetes. The last labs done 18 months ago were normal. What is this patient’s cardiovascular risk based on these lab results? Describe how the FNP would clinically manage and follow up this patient. List the pharmacological and non-pharmacological interventions.
A 66 year old male presents to your office complaining of shortness of breath for the past five days which has gotten progressively worse. His shortness of breath is worse when lying down and with exertion. He complains of a cough, especially at night. He also reports increased swelling in both legs bilaterally and mild substernal chest pressure. The patient has a history of diabetes, hypertension, and a prior myocardial infarction. His vital signs are: BP 208/102, HR 116, RR 28, T 98.4, 94% oxygen saturation. On exam you note rales in the lung bases bilaterally as well as 1+ pitting edema in the lower extremities bilaterally. The patient is sitting up and in no acute respiratory distress.
Provide the most likely diagnosis based on the HPI and PE. In addition, provide your interpretation of the cues found in the assessment. List at least 3 possible differential diagnoses and justify your rationale. Develop therapeutic plan options based on quality, evidence-based clinical guidelines.