Instructions: Pick one case scenario to discuss in your initial post. For your peer responses, 150 words and 1 reference, please reply to the case scenario you did not choose for the initial post. You are expected to respond to two different peers.

Case Scenario 1: A 67-year-old female with PMH of CVA, DM, HTN, Obstructive Sleep Apnea (OSA), and Venous Stasis who presents with a complaint of chest pain x 1 day. She described the pain as constant chest tightness and poking to the midsternum, radiating to the back, associated with SOB, cough, and nausea. The chest pain is worse when breathing in and out. Her initial vital signs are HR 89, BP 170/100, RR 18, and O2 sats 98% on room air.

Answer the following questions:

1. Subjective:
   • What pertinent questions will you ask to describe the patient’s chief complaints?
   • What are the risk factors of this patient?
2. Objective:
   • How do you differentiate the clinical signs and symptoms of Stable Angina, Unstable Angina, NSTEMI, and STEMI?
     

     Stable Angina	Unstable Angina	NSTEMI	STEMI

   • What are the gold diagnostics tests to rule in or out?
3. Assessment and Plan:
   • Give at least 3 differential diagnoses and provide a rationale.
   • Complete the table below to differentiate the classifications of hypertension according to the 2017 American College of Cardiology/American Heart Association (ACC/AHA) Clinical Guidelines.
     

     Classification	Systolic BP	Diastolic BP
     Normal
     Prehypertension
     Hypertension
     Stage 1
     Stage 2

   • A HEART Score assesses the patient’s 6-week risk of a major adverse cardiac event (MACE). What would be your disposition if the patient’s HEART Score is 7?
4. Plan:
   • What is the gold standard treatment for the patient’s final diagnosis?

Case Scenario 2: A 75-year-old male patient with PMH of CAD, HTN, HLD, and GERD who presents with left swelling x 2 months. He also endorses occasional “throbbing pain” to his left leg associated with some pallor, cool to touch, and low-grade fever. The patient denies recent injury, fall, surgery, or long-distance travel.

1. Subjective:
   • What are the pertinent questions that you would be asking when obtaining HPI?
   • What are the risk factors of this patient?
2. Objective:
   • When doing a physical exam, what are the clinical signs and symptoms you will be concerned about related to the patient presenting symptoms?
   • What is the gold standard tests that you would be ordering?
3. Diagnosis:
   • What would be your interpretation if you ordered for Ankle Brachial Index and the result came back an ABI of 0.20?
     

     Ankle Brachial Index (ABI)
     ABI Scoring	Interpretation
     0.91 – 1.30
     0.70 – 0.90
     0.40 – 0.69
     <0.40
     >1.30

   • Give at least 3 differential diagnoses and provide a rationale.
4. Plan:
   • What is the gold standard treatment specific for the patient’s final diagnosis? – Revascularization interventions – Medications – Supportive measures
   • What is your disposition? – Admit vs. discharge? Why?