A patient, Wanda Pence, presented with recurrent chest pain with changing frequency and pattern with dx unstable angina.
Access i-Human Patients® through the access link near the top of the main course content page.
This case study asks you to consider how best to collaborate with other professionals and specialists to optimize the treatment plan for the patient.
First, watch the Wk 5 – Video in this week’s Learning Activities folder. Then, read the case study below.
Case Study — Wanda Pence
A patient, Wanda Pence, presented with recurrent chest pain with changing frequency and pattern with dx unstable angina.
Ms. Pence was admitted for cardiac catheterization, which revealed a 95% mid-right coronary lesion, a 45% occlusion of the proximal left anterior descending coronary artery, and a 20% occlusion of the left circumflex. A drug-eluting stent was placed in the right coronary artery to relieve the obstruction, resulting in nearly normal blood flow. Clopidogrel was added to her admission regimen, and her statin dose was increased to further decrease her serum LDL level. She was discharged within 48 hours and has a f/u appointment with her cardiologist in 2 weeks.
Ms. Pence is seeing you, the FNP in the primary care clinic, one week after her hospital discharge. She informs you she just got laid off from her job, lost her health insurance, and is very anxious about her ability to f/u with the cardiologist. She verbalizes that she will buy the baby aspirin 81mg daily over the counter but will stop the other meds (atorvastatin 40mg daily, metoprolol ER 25mg daily, and clopidogrel 75mg daily) until she can get find another job with insurance. As the FNP, you know that Ms. Pence’s intention to stop her medications is not a safe option with her recent stent placement.
Write a 750- to 1,000- word reflection regarding your patient encounter with Wanda Pence in which you:
Formulate a final diagnosis(es) and ICD-10 from the information provided in the scenario taking into consideration her medical and social determinants of health issues. Provide a rationale for the inclusion of each diagnosis.
Discuss best practices for Mrs. Pence to continue her medications after her drug-eluting stent placement based on a current evidence-based practice journal article.
Outline a detailed collaboration plan, including the identification of resources (such as sliding scale clinics and pharmacological discounts), for uninsured patients within your community that will help Ms. Pence continue her medications.
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