HPI: Fredrick Irving is a 45-year-old African American male who comes in for follow-up of his hypertension and follow-up from a visit to the emergency department for a DVT. The patient was due back for a follow-up 1 month after starting his BP medication 6 months ago, but he reports that he was too busy to come in. He states that he was having leg pain and swelling of his left calf after a long flight and took himself to ER for evaluation last week where he was diagnosed with DVT and was told to follow up with his PCP. He states that he is supposed to take Xarelto 15 mg twice a day for the next two weeks for the total of 3 weeks to treat the DVT. When the medication runs out, he was told that he should get a new prescription for Xarelto from his PCP. He is concerned about the SEs of the medication. He denies chest pain, shortness of breath, edema, change in eating habits or activity patterns, sputum production, postnasal drip, or runny nose.

Medical history: None reported.

Family history: Mr. Irving’s mother died at age 65 from a stroke, HTN, DM. His father died at age 55 from a heart attack. Mr. Irving’s two brothers are living in good health, although one has high cholesterol.

Medications: Lisinopril 10 mg qd started 6 months ago; Xarelto 15mg twice a day started 7 days ago.

Allergies: None reported.

Social history: He is a divorced father of one, and he teaches sixth grade. Patient does not smoke or drink.

Physical examination: This is a w/n, w/d African American male with good eye contact, appropriate speech and mannerisms, appropriately dressed and who states he wants to be seen for control of his blood pressure. His left calf is still swollen and mildly tender but no warmth or pain noted. He does not have any other noticeable rash or excessive dryness of his skin.

Vital signs: Ht 6 ft, Wt 265 lb, BP 148/110, P80 & regular

Abbreviated exam: Chest CTA, cardiac NSR without murmurs, abd soft, nontender, liver nonpalpable, nontender, no peripheral edema noted.

Labs:
TSH: 2 (0.5–4.5)
Free T4: 1.2 (0.8–1.7)
Free T3: 3 (2.0–4.8)
Creatinine: 2.1 (0.8–1.4)
BUN: 22 (7–20)
CMP is otherwise normal.
CBC is normal.
Total cholesterol: 228
Triglyceride: 208
HDL: 40
LDL: 168
VLDL: 60

Radiology: No tests were performed.

Assignment Instructions
Based on the information provided above, complete the patient’s write-up by giving your diagnosis, justifying your diagnosis with a full written assessment, and delineating your treatment plan.

Write a 1,400-word assessment and treatment plan for Mr. Irving.

Discuss the following in your assessment and treatment plan:

• Identify which drugs and/or devices you would furnish/prescribe pursuant to standardized procedures and in conformance with applicable laws, codes and/or regulations, including knowledge of pharmacy rules and regulations, health and safety code and Federal Register (consider the rules and regulations of your state or the state in which you plan to practice.)
• Based on the health assessment of the client, identify the appropriate therapeutic regimen, including drugs and/or devices using the latest guidelines.
• What is your diagnosis?
• Evaluate the response and compliance of the client to the drugs and/or devices prescribed and implement appropriate action by identifying necessary patient monitoring (before and after drug regimen) and education strategies (i.e. medications including: name of medication/s, frequency/time of doses, correct dosage/s to take, how to take the medication/s i.e., with or without food, what to do if a dose of a medication is missed, side effects to expect, and adverse event/s to report to the prescriber, how the medication interacts with drugs of choice and alternatives, and involve the client and family in the decision-making process) and clinical endpoints for drugs and/or device therapies.
• Use knowledge of pharmacokinetics and pharmacodynamics to identify the indication, rationale, mechanism of action for drugs to observe, and to understand the effects of drugs and/or devices on a client; and to predict the client’s response.
• Justify correct dosages, dosage forms, routes, and frequency of administration based on relevant individual client parameters.
• Evaluate possible uses of vitamins and herbal supplements as they relate to disease prevention and management.
• What specific conditions relative to pharmacokinetics should be considered, based on the client’s symptomatology, health status, lifestyle, genetics, ethnicity, nutrition, culture, socioeconomic status, etc.?

Include a minimum of 5 peer-reviewed, evidence-based articles referenced and formatted according to APA guidelines.

Fill out the blank prescription form below to complete the activity.

Submit Fredrick Irving’s assessment and treatment plan and his written prescription(s).