NURS – 6521C Advanced Pharmacology

NURS – 6521C Advanced Pharmacology: By the conclusion of this course, you should be able to: Evaluate the impact of patient factors on pharmacokinetic and pharmacodynamic processes…

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NURS – 6521C Advanced Pharmacology

Paper details

Course Learning Outcomes

By the conclusion of this course, you should be able to:

• Evaluate the impact of patient factors on pharmacokinetic and pharmacodynamic processes
• Analyze pharmacotherapeutic treatments for body system disorders and the effects they have on patient outcomes
• Analyze factors that impact patient drug therapy plans
• Evaluate the impact of drug therapy on patient health outcomes
• Apply decision-making strategies for the appropriate use of drugs based on classifications, indications, patient factors, and pathophysiology
• Evaluate the ethical and legal implications of prescribing drugs

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Solution

Comprehensive SOAP

Patient Initials: CJ Age: 53 Gender: Male
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SUBJECTIVE DATA:

Chief Complaint (CC): Generalized body rash and multiple joint pains
History of Present Illness (HPI): The patient CJ is a 53-year-old male. The patient presented at the clinic with complaint of a rash on his back. The rashes began a week ago and is progressing to the arms and thighs. CJ complains of discomfort in the affected areas. He also complains of pain in the knee joint and on both of the ankles which limits his movement.

The patient has rates the pain at 4 out of 10 on the pain scale 0-10. The pain has a past medical history included asthma, hypertension and diabetes mellitus, and has not made any recent adjustments to his medications.

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Medications:
Metformin 1 g bd
Gliclazide 160 mg bd
Amlodipine 10 mg daily
Albuterol Inhaler
Allergies: Has no known drug interactions, no seasonal or environmental allergies
Past Medical History (PMH):
Hypertension for four years
Diabetes Mellitus
Past Surgical History (PSH):
No surgical history
Sexual/Reproductive History: If applicable,
Heterosexual
Personal/Social History:
The patient is a nonsmoker. No blood tests. Occasional drinks on weekends and on occasions. Had some sunburn in the past

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Immunization History:
Pneumovax-Unknown
Significant Family History: Family history of Hypertension, Obesity and diabetes
Lifestyle: Lives with family, wife and two children (19 years old and 16 years old).

Review of Systems:

General: + fatigue, rashes and joint pain for 7 days, itchiness and discomfort
CARDIOVASCULAR/PERIPHERAL VASCULAR: SOB, fatigue and chest pain, no weakness, no PND
GI: denies abdominal pain, nausea or vomiting, diarrhea, and constipation. No melena, no hemorrhoids
GU:  No urinary symptoms and no dysplasia was found
MS: Joint pain and stiffness, weakness
Psych: Denies history of anxiety or depression, no suicidal or homicidal history
Neuro: Denies headaches or imbalance, dizziness, syncope, paralysis
HEME: rashes on back, thighs and right arm, itching,
Endo: No endocrine symptoms or hormone therapies
Allergic/ Immunologic: Has no known immune deficiencies

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OBJECTIVE DATA:

Physical Exam:

Vital signs: Vital Signs: Temp 97.6; BP 119/85; RR 16; P 93; HT 5’11”; WT 189lbs
General: Awake, well-groomed and well-nourished. Denies fever, chills, fatigue,
Nausea, and vomiting.
HEENT: No changes in vision or hearing. Has had no recent ear infections, drainage or pain. Patient does not have a history recent sinus infection. Denies loss of taste, no difficulty in chewing and no swallowing and tooth/ gum pain or bleeding.
Neck: Denies pain on neck
Chest/Lungs: SOB, chest pain
Heart/Peripheral Vascular: SOB, no murmur, gallops, heaves, or thrills.
Abdomen: Bowel sounds present in all four quadrants, No masses palpated.
No lesions observed
Musculoskeletal: Joint pain, right knee, both ankles
Neurological: Alert and oriented to person, place, and time. CN II-X intact.
Skin: rashes on back, thighs and right arm, itching,

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LAB/DIAGNOSTIC TESTS/EKG:

No diagnostic studies performed.

Clinical appearance is sufficient for distinctive diagnosis.

Differential Diagnosis:

• Guttate Psoriasis (Confirmed). Characterized by multiple skin eruptions, less than 1cm in diameter, scaly tear drops (Shahid et al., 2013). May be present in patients with no preexisting psoriasis. Disease progression is mild, covers about 3% of the skin. The drop like lesions coupled with clinical examination to confirm diagnosis.
• Plaque Psoriasis (Refuted) characterized by scaling and induration, scalp involvement, nail involvement, and a family history of psoriasis. Clinical diagnosis, and covers up to 80% of total body surface (Bélanger et al., 2016). Differentiated by the size of plaque, more common type of psoriasis.
• Diabetic dermopathy (refuted). Begins as dull red scaly papules or plaques and later develop into bilateral asymmetrical circumscribed shallow pigmented scars and/or brownish macular lesions with a fine scale. Differentiated by size as in diabetic dermopathy the lesions usually are greater than 4 cm in size compared to lesions less than 1 cm in the patient (Ball et al., 2019).

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ASSESSMENT: • Guttate Psoriasis

References

• Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to physical examination: An interprofessional approach (9th Ed.). St. Louis, MO: Elsevier Mosby.
• Bélanger, A., de Oliveira, C. P., Maheux, M., & Pouliot, R. (2016). Plaque psoriasis: understanding risk factors of this inflammatory skin pathology. Journal of Cosmetics, Dermatological Sciences and Applications, 6(02), 67features of varicella-zoster virus infection. Viruses, 10(11), 609.
• Shahid, N., Bawany, M. Z., Rafiq, E., & Sodeman, T. (2013). Guttate psoriasis: a rare cause of diffuse rash. British Journal of Medical Practitioners, 6(4), 47-49.

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