Naproxen And Lodicane Patches Case Study

In order to progress further following discussion with Lisa under my mentor supervision as a CPNP V100 I made a prescribing decision based on the physical examination and the information provided I

Stonestreet. He was aware of the patient’s displeasure with her lack of progress and that she had often called the office on several occasions with complaints. He does note that she has history of alcohol abuse and often when she called she sounded intoxicated. Because of his concerns, he did have his medical assistant attend the patient’s visits along with him. He documented the patient’s behavior. He states that he did offer referral for second opinion to the patient on multiple occasions, but she refused because of transportation issues. Because of the patient’s concerns, Dr. Stonetreet stated that he went out of his way to be helpful and extra courteous to this patient. The patient did offer complaints to her family physician and Dr. Stonestreet also did follow up with the family physician and discuss the patient and her concerns about his behavior with them on the phone as well. The patient was welcomed back for further evaluation per Dr.

Scheduling attempted to schedule Pamela for the EGD that Dr. Piaseck approved, however, the patient is requesting a consult with a physician first.

Two pt verfier name and dob confirmed. Pt states she has hx of GERD and currently takinkg Rabeprazole 4 tabs per day with is more than the prescribed dose to controlled her symptoms. Pt is requesting Raberazole be increase or she be placed on Nexium. Pt states that she prefer Nexium and she is wiling to the pay for the co- pay. Informed the pt that will provide her with a handwritting script for Nexium. Pick up script at the front desk. Schedule the pt an appt to address GERD sx and treatment options. Pt agrees and verbalizes understanding to the

Telephone contact made to the patient. Two patient verifier completed. The patient states she started taking Hyzaar and Zantac approx 2 weeks. however, the patient states on this past Monday, Jan 11 two hours after she had taken her Zantac and Hyzaar her face, lips, and hands begin to swell and itch. The patient states that she took a Benadryl and used her Epi pen and that helped with her reaction. Due to her allergic reaction the patient states that she has stop taking the Hyzaar for her bp and the Zantac. Informed the patient that an appt with her provider is needed to discuss other bp treatment options and allergies. Apt was made. The patient instructed to monitor her bp twice a day, if she starts to feel dizzy, throbbing headahce, light

Two pt verifier name/dob confirmed. Per NP Robinson the mother of the pt was informed that her daughter vitamin D is low and a prescription has been ordered for vitamin D to be taken every week.Thyroid labs are normal range and the pelvic ultrasound is also is normal. MOP states that she is concern about her daughter because her cycle is irregular; she only had one menstrual cycle last year that lasted 7 days but denies menstrual cycle this year. Provided the MOP with an appt to address concerns with her pcm.

The patient came to the clinic today with no previous medical records. She was able to pull up her ultrasound for the provider to review on a personal medical app on her phone. A medical release was signed to retrieve her medical records from Texas. The patient has a current Pap 7/2017 that was noted by patient to be normal. Explained to the patient that we will obtain some blood for lab work to evaluate her hormone levels, electrolytes, and blood count. Will draw CBC with diff, CMP, Prolactin, LH, FSH, TSH, T3, and T4. Urine pregnancy test was negative. We will order a repeat pelvic ultrasound and a EMB was performed in the office. The results will be back within one week. The provider explained that the patient will need to return to the office after ultrasound, lab work, and EMB results are back to discuss results and plan of care. Explained that

DPLO received a prescription for patient Bob. The prescription is checked by an Order Entry Technician and a Pharmacist; no discrepancies were found. Bob is contacted for delivery. During the delivery call the Patient Access Coordinator reviews the prescription with the Bob for accuracy and schedules the delivery. Bob received his medication and starts therapy. A week later a DPLO nurse contacts Bob for an initial adherence call. During the call Bob reports chest pain. The nurse completes an ADE, faxed the physician, and schedules the next adherence call. Bob continued to receive the medication for 2 years from DPLO. During this time the Bob reported chest pain, blurred vision, numbness in arms and legs. After several reports of side effects,

Two pt verifier name and dob. Pt states that he was seen and tx in the clinic on yesterday for sinus infection and cold/flu like symptoms. Pt staes that he still feels "horrible" and he has a 102 temp. Pt denies n/v/d and states that he is tolerating food and liquids Pt denies new onset of symptoms.Ptwas informed that he is placed on an addtional 48hour of quarters, rest, hydrated, and take medications as directed to tx sinus infection, fever, and cold like symptoms. Pt was instructed if he symptoms do not improve within the next 48hours please go to the UC/ER. Pt agrees and verbalized

Telephone contact made to the pt. Two pt verifier name/dob confirmed. Informed pt this is a f/u call d/t recent hospitalization for veritigo and meningioma. At this the pt states that she is feeling "somewhat better." She denies epiosode of dizziness or nausea. Provided the pt with the number to the MRI department to schedule appt. Assist the pt with scheduling f/u in the clinic. Instructed the pt to take meds as prescribed; go to the ER if she starts having frequent episodes of dizziness, SOB, CP, epgastric pain, left shoulder pain that radiates down the arm and facial drooping. Pt agrees and verbalized understanding to the POC.

Follow up: keep future schedule appointment and return to MD office if symptoms worsen or does not

Telephone contact made to the patient. Two patient verifier used to confirm name and DOB. Per PA Alford, the patient was advised that her UA can back positive for a UTI. Informed the patient that antibiotic was ordered and is ready for pickup in the pharmacy. The patient states that she is prone to yeast infection when taking antibiotic and wish to be prescribe Diflucan to proprolatic treat possible of yeast infection. Also the patient is requested a refill on her Zyrtec because she has been double her dose due to the allergies response to the mountain cedar. Per PA Alford, the patient was informed that she have ordered the Diflucan and to take this med after the completion of her antibiotic. Also, the patient was informed that double the

For the DOS 6/17/2016-The patient was here for Colpo labs results.The visit never was on Hold

I first go on the computer to read the description of the appointment to see what the client is coming in for. The patient is a Toy Poodle mix named Bella Rose, the records read that she is due for her DA2PP and bordetella vaccines, and is being tested for heartworm, and is also coming in for a hand scaling. I took the patient’s record form and went out to the front to call the owner and the patient to come in. I showed them the way to the exam room and introduced myself. First thing I tell the client is “I see in our records that you Bella Rose is do for her Distemper and bordetella vaccine and she is here for a hand scaling!” she tells me yes and asked me if her rabies was also due. I check the computer to see when the last rabies vaccine was done and I told her that “No that the rabies vaccines is good for another two years”. I then said “Okay, I’m just going to ask you a few questions.” “Has Bella Rose been eating and drinking normally” she responds with a yes. I said “Okay, also has she been urinating and defecating normally, any diarrhea or vomiting?” She responds telling me no that she has been fine and she is acting normally. I told her “That’s great to hear.” “I’m just going to take Bella Rose to the back so we can get a fecal and check on her heart rate and temperature, pull blood for the heartworm test, and we will also do the hand scaling in the back.” “I’ll be back in a few.” She tells me okay great and hands Bella Rose over to

I returned to work today and I had the pleasure of caring for Mrs. Reyes again. After reviewing her chart, I noticed that she should be returning home soon. There was no better time than the present to begin talking to her about how she will manage herself at home. The first topic I wanted to discuss with her is, when she will take her Lasix. Before I went to see her, the PCA informs me that she took her vitals already, and reports them as 86/50 with a pulse of 52. If this was the case, I would hold her Digoxin and Lasix and inform the physician. I decided that I would prefer to retake her vitals since I was not there to witness the PCA doing so. I entered the room, foamed in, introduced myself and identified Mrs. Reyes. I then told her that I had to check her vital signs to ensure that they were within range to give her the morning medication. Luckily, her vitals were within range so I was able to administer both the digoxin and Lasix. I also figured that it would be best to talk about her Lasix when I administered it to her this morning. I explained that I was giving this medication to her in the morning so she did not have to get up all night to use the bathroom. I told her, she should continue to take her Lasix in the morning when she gets home as well. She told me that she will try her best to remember when she goes home. I told her that if she would like, I could provide her with a pill box that separates her medication by day and time of day as well.