Setting: large rural clinic; family practice clinic that employs physicians and nurse practitioners You open the chart to review for your next patient, and you see it is Larry M. Larry is a 60 year-old African American male with a history of hypertension. You note he is not due for a follow up at this time, so you look at the chief complaint. CC: chest pain three days ago You enter the room and introduce yourself. Larry M. is sitting in the chair. You ask what brings him in today. Larry M. smiles, shaking his head and says “My wife made me come, I feel fine.” Three days ago Larry M. felt short of breath, had this heavy feeling in his chest, and he got kind of nauseous and sweaty. It lasted only about 3 minutes, and it has not happened again, but he does feel a little more tired. “It could be that I have not worked out since it happened.” PMHx: Reports general health as good. He had been feeling great since starting to work out and lost weight. Had lots of energy and felt great until this episode three days ago. Now he is a little concerned because he feels a little more tired when he works out. Cardiovascular Part One He has not done as much strenuous running and has not worked out since the episode. Childhood/previous illnesses: chicken pox. Chronic illnesses:
Cardiovascular Part One
Hypertension- lifestyle changes recommended. Elevated cholesterol, lifestyle management was initiated. Surgeries: T and A, cholecystectomy, vasectomy Hospitalizations: None aside from surgeries listed above Immunizations: Does not receive the flu shot. Allergies: NKDA Blood transfusions: None Enjoys a beer or a glass of whiskey and the occasional cigar when playing poker with his buddies Current medications: None Social History: Married for 20 years, works as an architect. Family History: Parents are deceased. Father had lung cancer and mother died from complications of a stroke. Brother died at 44 from malignant melanoma. Other sister and brother are healthy. PE: Height: 5’8” weight: 220 pounds; BMI 33.5 vital signs: BP 146/90 P 70 Sao2 97% General: African American male in NAD. Alert, oriented, and cooperative. Pain: 0/10 at present Skin: Skin warm, dry, and intact. Skin color is light skinned brown, no cyanosis or pallor. HEENT: Head normo-cephalic. Hair thick and distribution even throughout scalp. Eyes: Sclera clear. Conjunctiva: white, PERRLA, EOMs intact. No AV nicking noted. Ears: Tympanic membranes gray and intact with light reflex noted. Pinna and tragus non-tender Nose: Nares patent without exudate. Sinuses non-tender to palpation, Right-sided Deviation Throat: Oropharynx moist, no lesions or exudate. Teeth in poor repair, gums reddened and receding, filled cavities noted. Tongue smooth, pink, no lesions, protrudes in midline. Neck supple. No cervical lymphadenopathy or tenderness noted. Thyroid midline, small and firm without palpable masses. Mild JVD in recumbent position Lungs: Lungs clear to auscultation bilaterally. Respirations unlabored. No rashes or vesicles noted on chest. CV: Heart S1 and S2 noted, RRR, no murmurs, noted. No parasternal lifts, heaves, and thrills. Peripheral pulses equally bilaterally. PMI 5th ICS displaced 4cm laterally. No edema in lower extremities. Abdomen: Abdomen round, soft, with bowel sounds noted in all four quadrants. No organomegaly noted. Labs from 3 months ago: Total Cholesterol: 230 Ldl 180 Hdl 38 · EKG In office TODAY: ST depression Click here to access the EKG (Links to an external site.)Links to an external site. Discussion Questions:
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Cardiovascular Part One
ADDITIONAL INSTRUCTIONS FOR THE CLASS
Discussion Questions (DQ)
- Initial responses to the DQ should address all components of the questions asked, include a minimum of one scholarly source, and be at least 250 words.
- Successful responses are substantive (i.e., add something new to the discussion, engage others in the discussion, well-developed idea) and include at least one scholarly source.
- One or two sentence responses, simple statements of agreement or “good post,” and responses that are off-topic will not count as substantive. Substantive responses should be at least 150 words.
- I encourage you to incorporate the readings from the week (as applicable) into your responses.
- Your initial responses to the mandatory DQ do not count toward participation and are graded separately.
- In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days, for a total of three replies.
- Participation posts do not require a scholarly source/citation (unless you cite someone else’s work).
- Part of your weekly participation includes viewing the weekly announcement and attesting to watching it in the comments. These announcements are made to ensure you understand everything that is due during the week.
APA Format and Writing Quality
- Familiarize yourself with APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for APA paper templates, citation examples, tips, etc. Points will be deducted for poor use of APA format or absence of APA format (if required).
- Cite all sources of information! When in doubt, cite the source. Paraphrasing also requires a citation.
- I highly recommend using the APA Publication Manual, 6th edition.
Use of Direct Quotes
- I discourage overutilization of direct quotes in DQs and assignments at the Masters’ level and deduct points accordingly.
- As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content.
- It is best to paraphrase content and cite your source.
- For assignments that need to be submitted to LopesWrite, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me.
- Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes.
- Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own?
- Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for tips on improving your paper and SI score.
- The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies.
- Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances.
- If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect.
- I do not accept assignments that are two or more weeks late unless we have worked out an extension.
- As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.
- Communication is so very important. There are multiple ways to communicate with me:
- Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class.
- Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.