Reference no: EM133384745

Mr. Joseph Jones, a 69-year-old retired male, presents for an initial visit at your primary care clinic. He recently moved to the area from out of state and seeks to establish care. He complains of general fatigue for 4 days, shortness of breath with exertion, and abdominal discomfort. Mr. Jones's past medical history includes hypertension for 5 years. He denies a history of surgery. His current daily medications are Losartan 100 mg by mouth, ASA 81 mg by mouth and hydrochlorothiazide 25 mg by mouth. Mr. Jones states he is not allergic to any medication and he does not take any herbal or OTC medicines.

Vital signs: body temperature 97.9. BP 159/100 mmHg left arm sitting. Irregular pulse rate at 95 beats/min. RR 22. Ht. 6ft. 0in. Wt. 235 lbs.

Physical exam: Well developed, well hydrated, slight facial pallor. No acute distress. Alert, oriented X 4. Heart sounds S1, S2, S3 gallop. Bilateral lower extremity pitting edema.

Discussion Questions:

1. What additional assessment areas should be included in the physical exam?

2. What additional data from the history and components of the physical examination would you do before making a diagnosis and treatment decision?

3. What diagnostic and lab tests will you order?

4. Any imaging tests?

5. Based on the information given, what would be your three priority differential diagnoses? What is the top diagnosis?

6. What health promotion strategies are especially important for this patient?

7. Do you think this case might be beyond the scope of practice for an APRN?

8. Would you do a referral for this patient? If so, referral to what specialty (specialties)?