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103 The Family Nurse Practitioner: Clinical Case Studies, Second Edition. Edited by Leslie Neal-Boylan. © 2021 John Wiley & Sons Ltd. Published 2021 by John Wiley & Sons Ltd. SUBJECTIVE James is a 5‐year‐old male who presents to his pediatrician after being seen in the emergency room 2 days prior for hives and trouble ... | Leslie Neal-Boylan - The Family Nurse Practitioner.pdf |
104 The School-Aged Child Elimination: James has no history of constipation and no history of urinary tract infection (UTI). Sleep: James has an inconsistent bedtime routine, but generally goes to bed around 8 p. m. on school nights and wakes up at approximately 6 a. m. On the weekends, he is often up until 10 p. m. bu... | Leslie Neal-Boylan - The Family Nurse Practitioner.pdf |
Food Allergies 105 How can the provider help the school manage a child with food allergies? If this family does not have insurance, what is the expected out‐of‐pocket expense for an Epi Pen? Likely more than one will be needed, so how can a family navigate this barrier? What is the essential information that all caregi... | Leslie Neal-Boylan - The Family Nurse Practitioner.pdf |
107 The Family Nurse Practitioner: Clinical Case Studies, Second Edition. Edited by Leslie Neal-Boylan. © 2021 John Wiley & Sons Ltd. Published 2021 by John Wiley & Sons Ltd. SUBJECTIVE Tamika, a 12‐year‐old girl, came to the community health clinic with her mother, who had requested an urgent appointment to discuss a ... | Leslie Neal-Boylan - The Family Nurse Practitioner.pdf |
108 The School-Aged Child Social history: Tamika is in sixth grade. She is seldom absent and frequently makes the honor roll. She says she likes school but notes that she is shy and has few friends. She does not take part in any extracurricular activities and spends her after‐school time helping her grandmother cook or... | Leslie Neal-Boylan - The Family Nurse Practitioner.pdf |
Obesity 109 What is the most likely differential diagnosis and why? ___Sleep apnea___Obesity___Insulin resistance___Type 2 diabetes___Exercise intolerance___Psychosocial issues Are any referrals needed at this time?Can the school be of assistance?What community resources are available to this family?What type of nutrit... | Leslie Neal-Boylan - The Family Nurse Practitioner.pdf |
Section 5The Adolescent Case 5. 1 Drug Use 113 By Anna Goddard, Ph D, APRN, CPNP‐ PC Case 5. 2 Weight Loss 115 By Anna Goddard, Ph D, APRN, CPNP‐ PC Case 5. 3 Menstrual Cramps 119 By Vera Borkowski, MSN, APRN, FNP ‐C Case 5. 4 Missed Periods 121 By Vera Borkowski, MSN, APRN, FNP ‐C Case 5. 5 Birth Contr ol Decision‐Mak... | Leslie Neal-Boylan - The Family Nurse Practitioner.pdf |
113 The Family Nurse Practitioner: Clinical Case Studies, Second Edition. Edited by Leslie Neal-Boylan. © 2021 John Wiley & Sons Ltd. Published 2021 by John Wiley & Sons Ltd. SUBJECTIVE Natalie is a 17 year‐old female who presents to the school‐based health center (SBHC) for the fourth time in 1 week with nonspecific c... | Leslie Neal-Boylan - The Family Nurse Practitioner.pdf |
114 The Adolescent Review of systems: Natalie denies problems with weight gain or weight loss, fever, night sweats, or pain. She has no difficulty in hearing, runny nose, post‐nasal drip, or ear pain. She denies history of cardiovascular issues, shortness of breath, night sweats, prolonged cough, wheezing, or gastro-in... | Leslie Neal-Boylan - The Family Nurse Practitioner.pdf |
115 The Family Nurse Practitioner: Clinical Case Studies, Second Edition. Edited by Leslie Neal-Boylan. © 2021 John Wiley & Sons Ltd. Published 2021 by John Wiley & Sons Ltd. SUBJECTIVE Roseanne is a 15‐year‐old female who presents to the adolescent clinic with her mother for her annual wellness examination. Her mother... | Leslie Neal-Boylan - The Family Nurse Practitioner.pdf |
116 The Adolescent Allergies: NKDA; no allergies to foods or environment. General: Denies fever, chills, or malaise. Denies restriction in food or decreased appetite. Skin, hair, nails: No pigment changes, no current rashes although occasional tinea from tumbling on gymnastic mats; occasional bruises from cheerleading ... | Leslie Neal-Boylan - The Family Nurse Practitioner.pdf |
Weight Loss 117 CRITICAL THINKING What are the top differential diagnoses in this case and why? ___Eating disorder___Excessive exercise___Malnutrition___Malabsorption___Thyroid disorder___Anxiety___Female athlete triad What are the diagnostic tests required in this case and why? __Urine pregnancy test___Glucose___Urina... | Leslie Neal-Boylan - The Family Nurse Practitioner.pdf |
119 The Family Nurse Practitioner: Clinical Case Studies, Second Edition. Edited by Leslie Neal-Boylan. © 2021 John Wiley & Sons Ltd. Published 2021 by John Wiley & Sons Ltd. SUBJECTIVE Khaleesi is a 16‐year‐old who comes to the school‐based health center (SBHC) after she just got her period in school. She is requestin... | Leslie Neal-Boylan - The Family Nurse Practitioner.pdf |
120 The Adolescent Cardiac: RRR, S1 S2 normal with no murmurs, rubs, or gallops. Breast: Tanner V symmetrical. Abdomen: Bowel sounds present, abdomen soft, nontender, nondistended with no hepatosplenomegaly. Genitourinary: Pubic hair; Tanner V normal female; + menses. CRITICAL THINKING What is the most likely different... | Leslie Neal-Boylan - The Family Nurse Practitioner.pdf |
121 The Family Nurse Practitioner: Clinical Case Studies, Second Edition. Edited by Leslie Neal-Boylan. © 2021 John Wiley & Sons Ltd. Published 2021 by John Wiley & Sons Ltd. SUBJECTIVE Genevieve is a 17‐year‐old female who came to the clinic requesting a pregnancy test “because I haven't gotten my period and it is 3 w... | Leslie Neal-Boylan - The Family Nurse Practitioner.pdf |
122 The Adolescent Cardiac: RRR, S1 S2 normal with no murmurs, rubs, or gallops. Breast: Tanner V symmetrical. Abdomen: Bowel sounds present, abdomen soft, nontender, nondistended, with no hepatospleno-megaly. Exam limited by adipose habitus. Genitourinary: Pubic hair normal; Tanner V normal female; mucosa pale and pin... | Leslie Neal-Boylan - The Family Nurse Practitioner.pdf |
123 The Family Nurse Practitioner: Clinical Case Studies, Second Edition. Edited by Leslie Neal-Boylan. © 2021 John Wiley & Sons Ltd. Published 2021 by John Wiley & Sons Ltd. SUBJECTIVE Lauren is a 17‐year‐old female who presents alone to the primary care office to discuss birth control options. She has been in a relat... | Leslie Neal-Boylan - The Family Nurse Practitioner.pdf |
124 The Adolescent Breast: Tanner V breast development noted. Not palpated at time of visit; at last annual physical exam had normal breast exam with no masses. Gastrointestinal: Bowel sounds normoactive in all four quadrants. Soft, nontender, nondistended, with no hepatosplenomegaly. Genitourinary: External exam with ... | Leslie Neal-Boylan - The Family Nurse Practitioner.pdf |
125 The Family Nurse Practitioner: Clinical Case Studies, Second Edition. Edited by Leslie Neal-Boylan. © 2021 John Wiley & Sons Ltd. Published 2021 by John Wiley & Sons Ltd. SUBJECTIVE Nora, an 18‐ year‐ old college student known to this family practice office, presents with a com-plaint of “some spotting since my las... | Leslie Neal-Boylan - The Family Nurse Practitioner.pdf |
126 The Adolescent OBJECTIVE General: Anxious 18‐year‐old female in no acute distress. Well groomed with good hygiene. Cooperative. Vital signs: Height: 5 ft 4 inches; weight: 112 lbs; BMI: 21. 2; temperature: 97. 8°F; B/P: 118/72; HR: 98. Respiratory: Normal respiratory effort, CTA bilaterally. Cardiac: Regular rate, ... | Leslie Neal-Boylan - The Family Nurse Practitioner.pdf |
127 The Family Nurse Practitioner: Clinical Case Studies, Second Edition. Edited by Leslie Neal-Boylan. © 2021 John Wiley & Sons Ltd. Published 2021 by John Wiley & Sons Ltd. SUBJECTIVE Michelle, a 17‐year‐old Caucasian female, presents to a primary care practice where she has been a patient since 5 years of age. She i... | Leslie Neal-Boylan - The Family Nurse Practitioner.pdf |
128 The Adolescent has recently told a few other students about identifying as a boy, noting “it's hard to be different in this area. ” Medications: No regular medications. Allergies: Seasonal (spring) allergies. NKDA. OBJECTIVE General: Alert, pleasant adolescent; well groomed with good hygiene. Cooperative with good ... | Leslie Neal-Boylan - The Family Nurse Practitioner.pdf |
129 The Family Nurse Practitioner: Clinical Case Studies, Second Edition. Edited by Leslie Neal-Boylan. © 2021 John Wiley & Sons Ltd. Published 2021 by John Wiley & Sons Ltd. SUBJECTIVE Peter is a 16‐year‐old male who presents to your pediatric primary care office with complaints of right knee pain and swelling for 1 w... | Leslie Neal-Boylan - The Family Nurse Practitioner.pdf |
130 The Adolescent OBJECTIVE Vital signs: Weight: 140 lbs; height: 68 inches; BMI: 21. 3; temperature: 100. 4°F; HR: 76; RR: 16; B/P: 108/72. General: Alert, tired appearing but in no acute distress. HEENT: Head is normocephalic and atraumatic. Scleras are clear. PERRLA bilaterally. Normal fundi exam bilaterally. Otosc... | Leslie Neal-Boylan - The Family Nurse Practitioner.pdf |
Knee Pain 131 What is the most likely differential diagnosis and why? ___Infectious cause (septic arthritis, osteomyelitis, Lyme arthritis)___Autoimmune diseases (juvenile idiopathic arthritis, systemic lupus erythematous)___Trauma/Injury___Malignancy (tumor secondary to osteosarcoma, lymphoma, neuroblastoma) What is t... | Leslie Neal-Boylan - The Family Nurse Practitioner.pdf |
Section 6 Women's Health Case 6. 1 Preconception Planning 135 By Sara Smoller, RN, MSN, ANP-BC Case 6. 2 Bleeding in the First Trimester of Pregnancy 137 By Meredith Scannell, Ph D, MSN, MPH, CNM, CEN, SANE-A Case 6. 3 Night Sweats 139 By Ivy M. Alexander, Ph D, APRN, ANP-BC, F AANP, FAAN and Annette Jakubisin-Konicki,... | Leslie Neal-Boylan - The Family Nurse Practitioner.pdf |
134 Women' s Health Case 6. 12 Muscle Tenderness 165 By Leslie Neal-Boylan, Ph D, APRN, CRRN, FAAN, F ARN Case 6. 13 Insomnia 169 By Leslie Neal-Boylan, Ph D, APRN, CRRN, FAAN, F ARN | Leslie Neal-Boylan - The Family Nurse Practitioner.pdf |
135 The Family Nurse Practitioner: Clinical Case Studies, Second Edition. Edited by Leslie Neal-Boylan. © 2021 John Wiley & Sons Ltd. Published 2021 by John Wiley & Sons Ltd. SUBJECTIVE Delilah is a 28‐year‐old female who presents to discuss her plans to conceive. She is in a monog-amous relationship with her husband. ... | Leslie Neal-Boylan - The Family Nurse Practitioner.pdf |
136 Women' s Health OBJECTIVE Vital signs: Temperature 97. 6°F (orally); BP 118/72; pulse 72 and regular. She is 5 ft 5 inches tall and 183 pounds. General: Delilah is pleasant and cooperative and is sitting comfortably in the exam room. Eyes: PERRL. No injection or icterus. Mouth: No lesions or exudates. Neck: Thyroid... | Leslie Neal-Boylan - The Family Nurse Practitioner.pdf |
137 The Family Nurse Practitioner: Clinical Case Studies, Second Edition. Edited by Leslie Neal-Boylan. © 2021 John Wiley & Sons Ltd. Published 2021 by John Wiley & Sons Ltd. SUBJECTIVE Tasha is a 44‐year‐old female who presents with a sudden onset of heavy vaginal bleeding. She reports that the bleeding started 2 days... | Leslie Neal-Boylan - The Family Nurse Practitioner.pdf |
138 Women' s Health Genitourinary: Tasha denies any dysuria, frequency, or incontinence. Medications: Tasha take no prescribed medication; over‐the‐counter medications include multi-vitamin QD, Vitamin D 200IU QD, fish oil 1,200 mg QD, ibuprofen 600 mg, as needed for pain. Allergies: Shellfish (rash), IV contrast (rash... | Leslie Neal-Boylan - The Family Nurse Practitioner.pdf |
139 The Family Nurse Practitioner: Clinical Case Studies, Second Edition. Edited by Leslie Neal-Boylan. © 2021 John Wiley & Sons Ltd. Published 2021 by John Wiley & Sons Ltd. SUBJECTIVE Susan is a 50‐year‐old Black female who presents for her annual physical with a complaint of hot flashes and night sweats. Susan repor... | Leslie Neal-Boylan - The Family Nurse Practitioner.pdf |
140 Women' s Health Diet: Her 24‐hour diet recall reveals a bagel with cream cheese and coffee (black) for breakfast, salad with cottage cheese for lunch, grilled fish with potatoes and salad for dinner, and no snacks. She reports that she eats out about once per week and enjoys dessert on occasion. Substance use: Susa... | Leslie Neal-Boylan - The Family Nurse Practitioner.pdf |
Night Sweats 141 smell, taste, or swallowing. She reports some increased dry eye symptoms and finds that she needs to use eye lubricating drops, especially when she is doing a lot of work on the computer. She has seasonal allergies and experiences sneezing, rhinorrhea, and itchy eyes year round and especially in the ea... | Leslie Neal-Boylan - The Family Nurse Practitioner.pdf |
142 Women' s Health finished and I am left feeling a bit frustrated. ” She denies dyspareunia. She reports their usual sexual practices include cuddling and kissing, then foreplay that includes genital manipulation, and then vaginal intercourse with penile penetration. They have used OTC lubricants recently, due to her... | Leslie Neal-Boylan - The Family Nurse Practitioner.pdf |
Night Sweats 143 Gynecological: Vaginal mucosa slightly dry, rugae present; uterus firm and anteverted, nontender, without palpable masses; adnexa nontender, without palpable masses bilaterally; no lesions noted. Rectal: No lesions or masses noted; + external hemorrhoids; nontender; + normal sphincter tone. Extremities... | Leslie Neal-Boylan - The Family Nurse Practitioner.pdf |
145 The Family Nurse Practitioner: Clinical Case Studies, Second Edition. Edited by Leslie Neal-Boylan. © 2021 John Wiley & Sons Ltd. Published 2021 by John Wiley & Sons Ltd. SUBJECTIVE Shanae is a 32‐year‐old female who presents with lower abdominal pain and fever. Fevers at home range between 99. 4°F to a maximum of ... | Leslie Neal-Boylan - The Family Nurse Practitioner.pdf |
146 Women' s Health Safety: Shanae reports feeling safe at home and in her current relationship. She says that the rela-tionship with her husband was beginning to feel unsafe due to constant fighting. Since the sepa-ration, she has had no safety concerns and in the process of finalizing a divorce. Medications: Ibuprofe... | Leslie Neal-Boylan - The Family Nurse Practitioner.pdf |
147 The Family Nurse Practitioner: Clinical Case Studies, Second Edition. Edited by Leslie Neal-Boylan. © 2021 John Wiley & Sons Ltd. Published 2021 by John Wiley & Sons Ltd. SUBJECTIVE Martha is a 24‐year‐old female who reports vaginal itching for 3 days. She says that she can barely focus on other things because of t... | Leslie Neal-Boylan - The Family Nurse Practitioner.pdf |
148 Women' s Health Throat: No swelling or exudates. Cardiac: Regular rate and rhythm. Respiratory: Lungs are clear bilaterally. Abdomen: Soft, nontender, nondistended, and without organomegaly. Pelvic exam: Inguinal lymph nodes are without swelling or tenderness; vaginal mucosa is moist, pink, and mildly swollen. Ther... | Leslie Neal-Boylan - The Family Nurse Practitioner.pdf |
149 The Family Nurse Practitioner: Clinical Case Studies, Second Edition. Edited by Leslie Neal-Boylan. © 2021 John Wiley & Sons Ltd. Published 2021 by John Wiley & Sons Ltd. SUBJECTIVE Jill is a 26‐year‐old female who presents today for evaluation of redness, swelling, and pain in her right breast. Three months ago sh... | Leslie Neal-Boylan - The Family Nurse Practitioner.pdf |
150 Women' s Health OBJECTIVE General: Pleasant young woman, who appears mildly unwell, in moderate discomfort; rates pain 4/10 located in R breast. Vital signs: Temperature: 100. 4°F; P: 90; BP: 100/60. Cardiac: Rate 96 and regular, no murmurs heard on auscultation. Respiratory: Rate 16 breaths per minute, lungs clear... | Leslie Neal-Boylan - The Family Nurse Practitioner.pdf |
151 The Family Nurse Practitioner: Clinical Case Studies, Second Edition. Edited by Leslie Neal-Boylan. © 2021 John Wiley & Sons Ltd. Published 2021 by John Wiley & Sons Ltd. SUBJECTIVE Aiyata is a 22‐year‐old female who presents requesting treatment for sexually transmitted infec-tion. She reports she recently graduat... | Leslie Neal-Boylan - The Family Nurse Practitioner.pdf |
152 Women' s Health OBJECTIVE General: Ayita is sad appearing, talking softly, answering questions appropriately. Vital signs: Temperature: 98. 6°F; BP: 120/74; HR: 99; RR: 18. Skin: Abrasion on left knee and left elbow. Neurologic: Alert and oriented × 3HEENT:Head: Nontender, without masses, hair normally distributed.... | Leslie Neal-Boylan - The Family Nurse Practitioner.pdf |
Sexual Assault 153 ___Transvaginal ultrasound ___Abdominal ultrasound What are the concerns at this point?What is the plan of treatment?What are the plans for referral and follow‐up care?What health education should be provided to this patient?Are there any standardized guidelines that should be used to assess or treat... | Leslie Neal-Boylan - The Family Nurse Practitioner.pdf |
155 The Family Nurse Practitioner: Clinical Case Studies, Second Edition. Edited by Leslie Neal-Boylan. © 2021 John Wiley & Sons Ltd. Published 2021 by John Wiley & Sons Ltd. SUBJECTIVE Rachel is a 17‐year‐old Caucasian female who presents with complaints of decreased appetite, fatigue, nausea, and intermittent abdomin... | Leslie Neal-Boylan - The Family Nurse Practitioner.pdf |
156 Women' s Health Abdomen: Soft with mild tenderness to palpation (TTP) in the RUQ with a positive Murphy's sign. There is no CVA tenderness. Genitourinary: A urine dipstick reveals positive protein. A urine HCG is negative. Rachel is diagnosed at this first visit with possible cholecystitis and is given Antivert 12.... | Leslie Neal-Boylan - The Family Nurse Practitioner.pdf |
157 The Family Nurse Practitioner: Clinical Case Studies, Second Edition. Edited by Leslie Neal-Boylan. © 2021 John Wiley & Sons Ltd. Published 2021 by John Wiley & Sons Ltd. SUBJECTIVE Susan is a 42‐year‐old female who presents with a report of burning pain on urination for the past 2 days. She has been urinating freq... | Leslie Neal-Boylan - The Family Nurse Practitioner.pdf |
158 Women' s Health Back: There is no CVAT. Cardiac: RRR S1/S2; without murmurs, clicks, gallops, or rubs. Abdomen: Soft, nontender, nondistended, without organomegaly. Bowel sounds are active in all 4 quadrants. Reproductive: Pelvic exam reveals no inguinal lymphadenopathy; moist pink vaginal mucosa, negative chandeli... | Leslie Neal-Boylan - The Family Nurse Practitioner.pdf |
159 The Family Nurse Practitioner: Clinical Case Studies, Second Edition. Edited by Leslie Neal-Boylan. © 2021 John Wiley & Sons Ltd. Published 2021 by John Wiley & Sons Ltd. SUBJECTIVE Sophia is a 35‐year‐old Latina woman who presents with a complaint of headaches that have been occurring more frequently over the past... | Leslie Neal-Boylan - The Family Nurse Practitioner.pdf |
160 Women' s Health OBJECTIVE General: Sophia is well groomed. Her manner and speech are appropriate and she is articulate. She is in no apparent distress during the visit. Vital signs: The patient is afebrile. Her blood pressure is 140/90 (which she says is higher than her normal blood pressure). Pulse is 86, and resp... | Leslie Neal-Boylan - The Family Nurse Practitioner.pdf |
161 The Family Nurse Practitioner: Clinical Case Studies, Second Edition. Edited by Leslie Neal-Boylan. © 2021 John Wiley & Sons Ltd. Published 2021 by John Wiley & Sons Ltd. SUBJECTIVE Aliyah is a 22‐year‐old African American female who presents with profound fatigue, sore hands and wrists, and frequent episodes of or... | Leslie Neal-Boylan - The Family Nurse Practitioner.pdf |
162 Women' s Health HEENT: Mild alopecia is noted. TMs are clear and intact. PERRLA; EOMs are intact; sclera and conjunctiva are clear. Aphthous ulcers are noted in the mouth and nose. Dentition is grossly intact. There is mild bilateral anterior cervical lymphadenopathy. Cardiac: RRR S1/S2; without murmurs, clicks, ga... | Leslie Neal-Boylan - The Family Nurse Practitioner.pdf |
Fatigue and Joint Pain 163 __Antiphospholipid antibodies (lupus anticoagulant [LA], Ig G and Ig M anticardiolipin [a CL] antibodies; and Ig G and Ig M anti‐beta2‐glycoprotein [GP] I) __Urine pr otein‐to‐creatinine ratio What is the plan of treatment? What is the plan for referrals and follow‐up?Are there other manifest... | Leslie Neal-Boylan - The Family Nurse Practitioner.pdf |
165 The Family Nurse Practitioner: Clinical Case Studies, Second Edition. Edited by Leslie Neal-Boylan. © 2021 John Wiley & Sons Ltd. Published 2021 by John Wiley & Sons Ltd. SUBJECTIVE Zelda is a 32‐year‐old female who reports tenderness when anyone or anything touches her. She has experienced these myalgias throughou... | Leslie Neal-Boylan - The Family Nurse Practitioner.pdf |
166 Women' s Health OBJECTIVE Height: 5 ft 3 inches; weight: 150 lbs; temperature: 98. 7°F oral. HR is 68 and regular. RR is 12 and regular. BP is 124/70. General: Teary, appears anxious. HEENT: Head: Normocephalic, mild tenderness to palpation (TTP) of occiput. Eyes: PERRLA, EOMs intact. Nose: No polyps, no erythema. ... | Leslie Neal-Boylan - The Family Nurse Practitioner.pdf |
Muscle Tenderness 167 __HCG __Urine dipstick__None What is the plan of treatment? What is the plan for referrals and follow‐up? | Leslie Neal-Boylan - The Family Nurse Practitioner.pdf |
169 The Family Nurse Practitioner: Clinical Case Studies, Second Edition. Edited by Leslie Neal-Boylan. © 2021 John Wiley & Sons Ltd. Published 2021 by John Wiley & Sons Ltd. SUBJECTIVE Iris, a 48‐year‐old Asian female, presents with a report of insomnia and impaired concentration. She has not slept through the night f... | Leslie Neal-Boylan - The Family Nurse Practitioner.pdf |
170 Women' s Health HEENT: Hair is shiny and soft. No exophthalmos is observed. There is no lid lag or retraction. Sclerae are clear and conjunctivae are without injection. PERRLA and EOMs are intact. CNs II-XII are grossly intact. There is no cervical lymphadenopathy. Trachea is midline. The thyroid is mildly palpable... | Leslie Neal-Boylan - The Family Nurse Practitioner.pdf |
Insomnia 171 What is a likely diagnosis if this patient returns with severe tachycardia, confusion, vomiting, diarrhea, high fever, and dehydration? What if this patient's lab results return and the TSH is low with normal results for free T4 and T3?Would the plan be any different if Iris were unemployed?Are there any s... | Leslie Neal-Boylan - The Family Nurse Practitioner.pdf |
Men's Health Case 7. 1 Fatigue 175 By Leslie Neal‐Boylan, Ph D, APRN, CRRN, FAAN, F ARN Case 7. 2 Testicular Pain 179 By Leslie Neal‐Boylan, Ph D, APRN, CRRN, FAAN, F ARN Case 7. 3 Prostate Changes 181 By Clara Gona, Ph D, FNP‐BC, RNSection 7 | Leslie Neal-Boylan - The Family Nurse Practitioner.pdf |
175 The Family Nurse Practitioner: Clinical Case Studies, Second Edition. Edited by Leslie Neal-Boylan. © 2021 John Wiley & Sons Ltd. Published 2021 by John Wiley & Sons Ltd. SUBJECTIVE Fred, a 62‐year‐old male, presents to the primary care clinic with the chief complaint of fatigue. Upon further questioning, he also r... | Leslie Neal-Boylan - The Family Nurse Practitioner.pdf |
176 Men's Health Baby aspirin, 81 mg daily Micardis, 40/12. 5 daily Actos, 30 mg daily Allergies: Fred has no known drug, food, or environmental allergies; and his immunizations are up to date. OBJECTIVE Vital signs: T: 98°F; P: 72; RR: 20; B/P: 138/90. His weight is 312 lbs, and his height is 58 inches. General: He ha... | Leslie Neal-Boylan - The Family Nurse Practitioner.pdf |
Fatigue 177 What is the plan of treatment? What is the plan for referrals and follow‐up?What would be relative and absolute contraindications to the treatment plan of testosterone therapy? Are there standardized guidelines that would help in this case? NOTE: The author would like to acknowledge the contributions of Ger... | Leslie Neal-Boylan - The Family Nurse Practitioner.pdf |
179 The Family Nurse Practitioner: Clinical Case Studies, Second Edition. Edited by Leslie Neal-Boylan. © 2021 John Wiley & Sons Ltd. Published 2021 by John Wiley & Sons Ltd. SUBJECTIVE Richard is a 45‐year‐old male who is an established patient. He arrives at the primary care office with the chief complaint of “extrem... | Leslie Neal-Boylan - The Family Nurse Practitioner.pdf |
180 Men's Health OBJECTIVE General: Visibly grimacing and teary eyed, not smiling. His skin is flushed. Vital Signs: T: 98. 2°F; P: 80; BP: 136/84; RR: 18. Respiratory: CTA bilaterally. Cardiac: RRR: S1/S2; no murmurs, clicks, gallops, or rubs. Genitourinary: Scrotal exam reveals obvious edema and redness of the right ... | Leslie Neal-Boylan - The Family Nurse Practitioner.pdf |
181 The Family Nurse Practitioner: Clinical Case Studies, Second Edition. Edited by Leslie Neal-Boylan. © 2021 John Wiley & Sons Ltd. Published 2021 by John Wiley & Sons Ltd. SUBJECTIVE Stanley is a 64‐year‐old Black male who has been at the clinic regularly for health maintenance. He had an unremarkable physical exam ... | Leslie Neal-Boylan - The Family Nurse Practitioner.pdf |
182 Men's Health OBJECTIVE General: Stanley is sitting in a chair, in no acute distress. Vital signs: Weight is 175 lbs; height is 5 ft 10 inches; oral temperature is 98. 5°F; BP is 125/80; heart rate is 74; respirations are 14. Cardiac: Regular rate and rhythm, no murmurs. Pulmonary: Clear to auscultation in all areas... | Leslie Neal-Boylan - The Family Nurse Practitioner.pdf |
General Adult Health Case 8. 1 Substance Use Disorder (SUD) 185 By Jason R. Lucey, DNP, FNP‐BC Case 8. 2 Foot Ulcer 187 By Susan M. Jussaume, MSN, APRN, FNP‐BC, AHN‐BC Case 8. 3 Abdominal Pain and Weight Gain 191 By Leslie Neal‐Boylan, Ph D, APRN, CRRN, FAAN, F ARN Case 8. 4 Burning Leg Pain 195 By Antonia Makosky, DNP... | Leslie Neal-Boylan - The Family Nurse Practitioner.pdf |
184 General Adult Health Case 8. 12 Fatigue, Confusion, and Weight Loss 213 By Leslie Neal‐Boylan, Ph D, APRN, CRRN, FAAN, F ARN Case 8. 13 Hand Numbness 217 By Leslie Neal‐Boylan, Ph D, APRN, CRRN, FAAN, F ARN Case 8. 14 Chronic Diarrhea 221 By Clara M. Gona, Ph D, FNP‐BC, RN, and Leslie Neal‐Boylan, Ph D, APRN, CRRN,... | Leslie Neal-Boylan - The Family Nurse Practitioner.pdf |
185 The Family Nurse Practitioner: Clinical Case Studies, Second Edition. Edited by Leslie Neal-Boylan. © 2021 John Wiley & Sons Ltd. Published 2021 by John Wiley & Sons Ltd. SUBJECTIVE Chan Ming, a 26‐year‐old woman, presents with her partner requesting assistance to “get off pills. ” She reports a gradual progression... | Leslie Neal-Boylan - The Family Nurse Practitioner.pdf |
186 General Adult Health OBJECTIVE General: Chan Ming appears restless, irritable, and mildly diaphoretic. Vital signs: Heart rate is 105 beats per minute. Blood pressure is 136/88 mm HG. Respiratory rate is nonlabored and 20 breaths per minute. Temperature is 98. 7° F. Skin: Mild diaphoresis (clammy skin) is present. ... | Leslie Neal-Boylan - The Family Nurse Practitioner.pdf |
187 The Family Nurse Practitioner: Clinical Case Studies, Second Edition. Edited by Leslie Neal-Boylan. © 2021 John Wiley & Sons Ltd. Published 2021 by John Wiley & Sons Ltd. SUBJECTIVE George is a 62‐year‐old gentleman presenting to primary care with complaints of newly developed right great toe pain with redness, swe... | Leslie Neal-Boylan - The Family Nurse Practitioner.pdf |
188 General Adult Health at age 48; diabetes mellitus Type 2, diagnosed at age 50; peripheral vascular disease, diagnosed at age 53; sleep apnea, diagnosed at age 53; heart disease (peripheral arterial disease and mild aortic stenosis), diagnosed at age 60. Social history: George is 62 years old, married for 42 years, ... | Leslie Neal-Boylan - The Family Nurse Practitioner.pdf |
Foot Ulcer 189 Integumentary: Intact without rashes or lesions; warm and dry. There are scattered varicosities on the legs bilaterally. There is brownish discoloration to the skin of the lower legs bilaterally, predominantly over the shins and dorsum aspects of the feet. There is no edema. Right great toe: Plantar aspe... | Leslie Neal-Boylan - The Family Nurse Practitioner.pdf |
190 General Adult Health Are there any standardized guidelines to consider? What health education should be provided to the patient?What complicating factors specific to this case should be considered?What collaborative assessment and care might the patient require? Include your rationale. ___Referral to a wound specia... | Leslie Neal-Boylan - The Family Nurse Practitioner.pdf |
191 The Family Nurse Practitioner: Clinical Case Studies, Second Edition. Edited by Leslie Neal-Boylan. © 2021 John Wiley & Sons Ltd. Published 2021 by John Wiley & Sons Ltd. SUBJECTIVE Annette, a 28‐year‐old female, presents to the primary care practice for an initial visit. She presents with two major concerns. First... | Leslie Neal-Boylan - The Family Nurse Practitioner.pdf |
192 General Adult Health part‐time student finishing a bachelor's degree in science at a state college. She has a network of friends and family and her hobbies include traveling and theater. She is currently in a sexual rela-tionship with 1 partner and does not practice any form of contraception. Her LMP was 2 months a... | Leslie Neal-Boylan - The Family Nurse Practitioner.pdf |
Abdominal Pain and Weight Gain 193 ___Urinalysis ___Transvaginal ultrasound___Abdominal ultrasound___CBC with differential___Metabolic panel___Prolactin level___DHEA What are the most likely differential diagnoses and why? ___Gastroesophageal reflux disease (GERD)___Cholecystitis___Helicobacter pylori infection/peptic ... | Leslie Neal-Boylan - The Family Nurse Practitioner.pdf |
195 The Family Nurse Practitioner: Clinical Case Studies, Second Edition. Edited by Leslie Neal-Boylan. © 2021 John Wiley & Sons Ltd. Published 2021 by John Wiley & Sons Ltd. SUBJECTIVE Robert is a 74‐year‐old gentleman who resides in an assisted living facility. He was referred today by the visiting nurse for evaluati... | Leslie Neal-Boylan - The Family Nurse Practitioner.pdf |
196 General Adult Health OBJECTIVE General: Unshaven. Well developed, well nourished. Afebrile and in no distress. Vital Signs: BP: 138/64; heart rate: 68 and regular; RR: 18 and regular; Temp: 97. 7°F; Sp O2: 100%. Skin: Tattoos are noted on upper and lower extremities. Lower extremities are almost hairless on the low... | Leslie Neal-Boylan - The Family Nurse Practitioner.pdf |
197 The Family Nurse Practitioner: Clinical Case Studies, Second Edition. Edited by Leslie Neal-Boylan. © 2021 John Wiley & Sons Ltd. Published 2021 by John Wiley & Sons Ltd. SUBJECTIVE Janis, a 59‐year‐old female, presents with tachypnea, dyspnea on exertion, and mild chest discom-fort. She was diagnosed with emphysem... | Leslie Neal-Boylan - The Family Nurse Practitioner.pdf |
198 General Adult Health HEENT: Negative. Cardiovascular: RRR: S1/S2; no murmurs, clips, rubs, or gallops. No peripheral edema. Posterior tibial and dorsalis pedis pulses 2+/4. Respiratory: Lungs have diffuse expiratory wheezing and crackles in the right upper lobe. Tenderness to palpation along intercostal spaces on r... | Leslie Neal-Boylan - The Family Nurse Practitioner.pdf |
199 The Family Nurse Practitioner: Clinical Case Studies, Second Edition. Edited by Leslie Neal-Boylan. © 2021 John Wiley & Sons Ltd. Published 2021 by John Wiley & Sons Ltd. SUBJECTIVE Meredith is a 63‐year‐old female who presents with worsening epigastric pain. She describes it as burning pain that starts over the st... | Leslie Neal-Boylan - The Family Nurse Practitioner.pdf |
200 General Adult Health HEENT: Unremarkable except for some moderate erythema in the posterior pharynx and some dental erosion. Her teeth are stained, as well. There are no abscesses. Neck: There is no cervical lymphadenopathy, and the thyroid is nonpalpable. Carotids are +2 without bruits. Cardiac: Regular rate and r... | Leslie Neal-Boylan - The Family Nurse Practitioner.pdf |
201 The Family Nurse Practitioner: Clinical Case Studies, Second Edition. Edited by Leslie Neal-Boylan. © 2021 John Wiley & Sons Ltd. Published 2021 by John Wiley & Sons Ltd. SUBJECTIVE Zachary, a 60‐year‐old man, presents to the primary care office with sharp chest pain relieved by leaning forward. Zachary reports tha... | Leslie Neal-Boylan - The Family Nurse Practitioner.pdf |
202 General Adult Health HEENT: Negative. Cardiovascular: He has 6‐cm jugular venous distention at 90 degrees. Heart tones: S1/S2 strong, with audible pericardial friction rub; no murmurs. He has trace ankle edema. Pedal and posterior tibial pulses are 1+/4. Respiratory: CTA bilaterally. An ECG is obtained (Figure 8. 7... | Leslie Neal-Boylan - The Family Nurse Practitioner.pdf |
Chest Pain and Dyspnea without Radiation 203 ___Urinalysis ___Sedimentation rate___Serial troponins (stat, 12 and 24 hours)___Cardiac catherization___Chest X‐ray___Cardiac MRI What is the most likely differential diagnosis and why? ___Acute myocardial infarction (MI)___Pericarditis___Infectious cardiomyopathy What is t... | Leslie Neal-Boylan - The Family Nurse Practitioner.pdf |
205 The Family Nurse Practitioner: Clinical Case Studies, Second Edition. Edited by Leslie Neal-Boylan. © 2021 John Wiley & Sons Ltd. Published 2021 by John Wiley & Sons Ltd. SUBJECTIVE Oliver, a 48‐year‐old male, presents to the office with mild‐to‐moderate chest pressure with radi-ation to his back. Oliver reports th... | Leslie Neal-Boylan - The Family Nurse Practitioner.pdf |
206 General Adult Health Cardiovascular: His heart tones are muffled with an S3 gallop. His hands and feet are cool on palpation. Radial pulses are 2+. Pedal and posterior tibial pulses are 1+. He has jugular vein dis-tention of 5 cm with head of bed at 90 degrees. He has no carotid bruits, heaves, or thrusts. His PMI ... | Leslie Neal-Boylan - The Family Nurse Practitioner.pdf |
207 The Family Nurse Practitioner: Clinical Case Studies, Second Edition. Edited by Leslie Neal-Boylan. © 2021 John Wiley & Sons Ltd. Published 2021 by John Wiley & Sons Ltd. SUBJECTIVE Alice, a 42‐year‐old female, presents with a persistent dry cough and joint tenderness. She was treated for an upper respiratory infec... | Leslie Neal-Boylan - The Family Nurse Practitioner.pdf |
208 General Adult Health Cardiovascular Heart tones bounding; no thrills, rubs, or murmurs. No peripheral edema. All pulses 3+/4. Respiratory: Bronchovesicular breath sounds audible over anterior chest; posterior breath sounds diminished. Course crackles audible in posterior bases. Harsh, nonproductive cough is evident... | Leslie Neal-Boylan - The Family Nurse Practitioner.pdf |
209 The Family Nurse Practitioner: Clinical Case Studies, Second Edition. Edited by Leslie Neal-Boylan. © 2021 John Wiley & Sons Ltd. Published 2021 by John Wiley & Sons Ltd. SUBJECTIVE Andrew is a 42‐year‐old African American male who presents with BP 168/92 and morning head-aches. Andrew reports headaches upon arisin... | Leslie Neal-Boylan - The Family Nurse Practitioner.pdf |
210 General Adult Health OBJECTIVE General: Patient appears older than his stated age; frowning. Vital signs: BP on arrival is 188/110. After 20 minutes, repeat BP is 180/90. P: 94; R: 20; T: 98. 2°F. HEENT: Cranial nerves intact. EENT exam negative. Neck: No lymphadenopathy. Skin: Skin warm and dry. Respiratory: Lung ... | Leslie Neal-Boylan - The Family Nurse Practitioner.pdf |
211 The Family Nurse Practitioner: Clinical Case Studies, Second Edition. Edited by Leslie Neal-Boylan. © 2021 John Wiley & Sons Ltd. Published 2021 by John Wiley & Sons Ltd. SUBJECTIVE Henry, a 32‐year‐old male, presents with a report of facial pain for 5 days. He reports that he has a headache, especially when he ben... | Leslie Neal-Boylan - The Family Nurse Practitioner.pdf |
212 General Adult Health indicate an absence of light. There is cobblestoning in the throat, but no erythema. Tonsils are +2. There are no exudates. Neck: There is no lymphadenopathy, and the thyroid is nonpalpable. Cardiac: RRR, S1/S2; no murmurs, clicks, gallops, or rubs. Respiratory: Clear to auscultation. CRITICAL ... | Leslie Neal-Boylan - The Family Nurse Practitioner.pdf |
213 The Family Nurse Practitioner: Clinical Case Studies, Second Edition. Edited by Leslie Neal-Boylan. © 2021 John Wiley & Sons Ltd. Published 2021 by John Wiley & Sons Ltd. SUBJECTIVE Maryanne, a 78‐year‐old female widow, presents to the primary care clinic with the chief complaint of feeling very tired lately. She a... | Leslie Neal-Boylan - The Family Nurse Practitioner.pdf |
214 General Adult Health HEENT: Denies any dizziness or blurry vision. No headaches except for + right ear pain. Sometimes has difficulty swallowing. Cardiovascular: Denies chest pain or palpitations. Respiratory: Occasional cough and has noticed more shortness of breath recently. Sleeps on 2 pillows. Gastrointestinal:... | Leslie Neal-Boylan - The Family Nurse Practitioner.pdf |
Fatigue, Confusion, and Weight Loss 215 Cardiovascular: Heart regular rate and rhythm. PMI is at 5th intercostal space left sternal border; + systolic murmur II/VI. Pulses positive all extremities. There is bilateral lower leg edema; chronic lymphedema; no ulcerations; skin intact; no hair growth; no pitting. Respirato... | Leslie Neal-Boylan - The Family Nurse Practitioner.pdf |
217 The Family Nurse Practitioner: Clinical Case Studies, Second Edition. Edited by Leslie Neal-Boylan. © 2021 John Wiley & Sons Ltd. Published 2021 by John Wiley & Sons Ltd. SUBJECTIVE Timothy is a right‐hand dominant, 45‐year‐old Caucasian male. He presents with a complaint of intermittent “right‐hand numbness. ” He ... | Leslie Neal-Boylan - The Family Nurse Practitioner.pdf |
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