Appropriate Prescribing
Pertinent Positives
The patient’s BMI is within the normal range, and she is not overweight or obese. She does not have headaches yet. The dizziness was transient, with no incidences of falls or vertigo.
Pertinent Negatives
The patient is hypertensive with a previous reading of 189/112 and is currently elevated at 129/86. There is also a history of HTN and CAD in the family.
Missing Information
Information that would prove useful includes whether she had skipped any meals on the day of the incident; if she had stayed too long in the sun; whether she had experienced any appetite loss; if there was any edema in the lower extremities, or whether there was chest pain along with the dizziness.
List of Differential Diagnosis and Actual Diagnosis
Cardiomyopathy: Symptoms include but are not limited to dizziness; lightheadedness; trouble breathing or shortness of breath, especially with physical exertion; fatigue; and swelling in the extremities and ankles (Maron, 2018).
Iron deficiency Anemia: This is the second most common cause of anemia among older adults. The leading reasons for this deficiency include blood loss, medications, nutritional deficiencies, poor absorption, and cancer therapies (Auberach & Spivak, 2019).
A transient ischemic attack (TIA): This is a short-duration stroke that happens when some part of the brain does not receive blood because of a blockage. The symptoms do not last for long (Amarenco et al., 2016).
Given the provided patient information, the priority diagnosis is cardiomyopathy.
Plan for the Priority Diagnosis
The objectives for treating cardiomyopathy include: curtailing the worsening of the disease; managing any conditions that may contribute to or cause the disease; reducing the risk and complications of a sudden cardiac arrest, and control of the symptoms to allow a person to live as normally as possible (Bakalakos, Ritsatos, & Anastasakis, 2018).
The patient will be put on ACE inhibitors to help lower the blood pressure. She will be advised to go for regular checkups. Additionally, the patient will be advised to change her diet to healthier options that reduce sodium and sugar intake, take plenty of fluids and exercise more regularly (Bakalakos et al., 2018).
References
Amarenco, P., Lavallée, P. C., Labreuche, J., Albers, G. W., Bornstein, N. M., Canhão, P., & Molina, C. (2016). One-year risk of stroke after transient ischemic attack or minor stroke. New England journal of medicine, 374(16), 1533-1542.
Auerbach, M., & Spivak, J. (2019). Treatment of iron deficiency in the elderly: a new paradigm. Clinics in geriatric medicine, 35(3), 307-317.
Bakalakos, A., Ritsatos, K., & Anastasakis, A. (2018). Current perspectives on the diagnosis and management of dilated cardiomyopathy Beyond heart failure: a Cardiomyopathy Clinic Doctor’s point of view. Hellenic Journal of Cardiology, 59(5), 254-261.
Maron, B. J. (2018). Clinical course and management of hypertrophic cardiomyopathy. New England Journal of Medicine, 379(7), 655-668.
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Question 
Appropriate Prescribing
NU 627 DT 4 Instructions
Unit 4 Discussion – Appropriate Prescribing
Instructions
It is anticipated that the initial discussion response should be in the range of 250-300 words. Response posts must demonstrate topic knowledge and scholarly engagement with peers. This is not the only criteria utilized for evaluation; substantive content is imperative. All questions in the topic must be addressed. Please proofread your response carefully for grammar and spelling. Do not upload any attachments. All responses need to be supported by a minimum of one scholarly resource. Journals and websites must be cited appropriately. Citation and reference must adhere to APA format.
Appropriate Prescribing
Discussion Prompt
Week 4 you are learning many concepts, the one we will be focusing on with this discussion board is appropriate prescribing of medication to the older adult. As Nurse Practitioner, we have the responsibility of deciding if a medication is warranted, which drug is the best to prescribe and how much/often. It is also our responsibility to educate on the side effects of the medication and when to seek medical attention if it should occur. Finally, it is our responsibility to determine the effectiveness of our treatment that was prescribed, for example, is the patient’s glucose stable on Glucophage 500 mg BID PO or do we need to titrate up or down.
Initial Post Instructions:
- Please critically evaluate the subjective and objective information provided to you in the attached file below.
The first part of the discussion board is to identify all pertinent positive and, negative information and list missing information. - Then create a differential diagnosis list with at least 3 possibly actual diagnosis based on your findings.
Second part is to create a plan utilizing clinical practice guidelines for the priority diagnosis. - Be sure to utilize template, in-text citations and provide full reference citation at the end of the discussion.