Construct your response as an abbreviated SOAP note (Subjective Objective Assessment Plan).
Structure your ‘P’ in the following format: [NOTE: if any of the 3 categories is not applicable to your plan please use the ‘heading’ and after the ‘:’ input N/A]
Support the interventions outlined in your ‘P’ in every discussion with scholarly resources. (Very important).
Include Labs that needs to be ordered.
Therapeutics: pharmacologic interventions, if any – new or revisions to existing; include considerations for OTC agents (pharmacologic and non-pharmacologic/alternative); [optional – any other therapies in lieu of pharmacologic intervention]
Educational: health information clients need to address their presenting problem(s); health information in support of any of the ‘therapeutics’ identified above; information about follow-up care where appropriate; provision of anticipatory guidance and counseling during the context of the office visit
Consultation/Collaboration: if appropriate – collaborative ‘Advanced Care Planning’ with the patient/patient’s care giver; if appropriate -placing the patient in a Transitional Care Model for appropriate pharmacologic and non-pharmacologic care; if appropriate – consult with or referral to another provider while the patient is still in the office; Identification of any future referral you would consider making

DB4 (A). Diabetes Management
Scenario:
You are seeing a 64-year-old Hispanic male for his diabetes management. He reports that his morning capillary blood sugar readings are ranging in the 150 to 190 range.
• Last month his Hgb A1C was 7.4
• He is on Metformin 1000mg twice a day and Glipizide 5mg daily.
• He walks a couple miles three to five times a week.
• A dietary review reveals that his daily total carbohydrate intake is in the range of 75 to 100 grams.
• Last eye exam did not reveal any problems. He wears reading glasses when needed.
• He does report some intermittent burning sensation in his feet.
• Ht 6’2”, Wt 200 lbs, BP 118/72, P 72, R 17
• Heart regular rhythm, without murmur or gallop
• Lungs clear
• Monifilament testing does not reveal any decreased sensation in the feet
Please develop a discussion that responds to each of the following prompts. Where appropriate your discussion needs to be supported by scholarly resources. Be sure to include in-text citations in the context of the discussion and provide a full reference citation at the end of the discussion.

DB4 (B). Treatment of Hypothyroidism
Scenario: You are evaluating a 53-year-old white female who wants to talk to you about lab work that she had done recently at “Any Lab Test Now”.
• She wanted to have lab work done because she was feeling tired and unmotivated. Additionally, she had put on about 15 pounds even though she has been teaching yoga 2-3 times a week for the last few years.
• The lab results reveal a TSH of 93.
• She reports her last menstrual period was about 3 years ago. She experienced some menopausal symptoms of hot flashes and night sweats. However, she states they weren’t too much of a problem and those resolved a couple years ago.
• She denies any difficulty swallowing or neck pain/tenderness.
• Constitutional exam: 5’5” tall, 154 pounds, BP 145/88, P 60, R 16, Temp 97.2
• Neck – nontender, mild goiter with right side of thyroid larger than the left side
• Heart – regular rhythm without murmur or gallop
• Lungs – clear
• Skin – dry on extremities with some flaking noted
• A slowness of the relaxation phase of the Achilles tendon reflex is noted
Please develop a discussion that responds to each of the following prompts. Where appropriate your discussion needs to be supported by scholarly resources. Be sure to include in-text citations in the context of the discussion and provide a full reference citation at the end of the discussion.

DB 5 (A). PUD and Anemia
Scenario: The family of a 62-year-old white female call your office and ask if you can see their family member. The person being requested to be seen is known to you for the last twenty years.
• She is your former supervisor and a fellow FNP.
• The family reports your colleague is demonstrating signs of dementia.
• They note that she has not been eating much for the past few weeks reporting she has a gnawing pain in her stomach. If she does eat she reports getting ‘full’ very quickly. She reports feeling mildly nauseous for the last few weeks.
• Your friend sustained a fall injury about 9 months ago from a ladder. She shattered some teeth and developed an infection. She is under the care of an oral surgeon.
• You have seen a few of her patients in your practice over the last couple weeks because ‘she is never in her office or available’ over the last few weeks.
• You reflect on your last few conversations with your colleague and think to yourself that you also thought she seemed ‘off her game’.
• You recommend her family take her to Urgent Care and you convince your colleague this is in her best interest.
• Labs drawn at Urgent Care reveal a Hgb of 8 and HCT of 24.
Please develop a discussion that responds to each of the following prompts. Where appropriate your discussion needs to be supported by scholarly resources. Be sure to include in-text citations in the context of the discussion and provide a full reference citation at the end of the discussion.

DB 5 (B). Anti-coagulant Therapy
Scenario: A 77-year-old white male comes into your office complaining of feeling dizzy, short of breath, easily fatigued and having a sensation of his heart ‘skipping beats’.
• He reports he has had these same symptoms numerous times over the last year or so, but they only lasted for about a day.
• He thought since he has been experiencing them now for about 3 days he should come in and get checked out.
• He was diagnosed with type 2 diabetes twenty years ago and hypertension fifteen years ago.
• Current medications include Lisinopril 20 mg daily and Metformin 1000 mg daily.