PRAC 6540 FINAL EXAM PREP ADVANCED PRACTICE CARE OF OLDER ADULTS ANSWERED 2026/2027 (4pages)

Select a patient from your clinical experience that presents with significant comorbidities. This should not be a patient with a single, straightforward condition, such as an ear infection, nor should it be a wellness visit. Create a focused SOAP note for this patient using the template in the Resources. Patient: J.D., 65-year-old male Chief complaint: Shortness of breath and chest pain Subjective: The patient reports experiencing shortness of breath and chest pain for the past two days. He says the pain is sharp and radiates to his left arm and jaw. He rates the pain as 8/10 on a numerical scale. He also reports feeling fatigued, dizzy, and nauseous. He denies any fever, cough, or other symptoms. He has a history of hypertension, diabetes, and hyperlipidemia. He takes lisinopril, metformin, and atorvastatin daily. He smokes half a pack of cigarettes per day and drinks occasionally. He works as a truck driver and has a sedentary lifestyle. He has no known allergies. Objective: Vital signs: BP 180/100 mmHg, HR 110 bpm, RR 24 breaths/min, SpO2 94% on room air, Temp 36.8°C. Physical exam: HEENT: PERRLA, EOMI, no scleral icterus or conjunctival pallor, moist mucous membranes, no oral lesions, no lymphadenopathy. Chest: Decreased breath sounds bilaterally, no crackles or wheezes. Heart: Tachycardic, regular rhythm, no murmurs or gallops. Abdomen: Soft, non-tender, non-distended, normoactive bowel sounds, no organomegaly or masses. Extremities: No edema, cyanosis, or clubbing. Pulses 2+ and symmetric in all four extremities. Skin: Warm and dry, no rashes or lesions. Assessment: Acute coronary syndrome (ACS) with possible myocardial infarction (MI). Differential diagnoses include pulmonary embolism (PE), aortic dissection, pericarditis, and musculoskeletal pain. Plan: The patient was given aspirin 325 mg and nitroglycerin 0.4 mg sublingually in the clinic and was transferred to the emergency department for further evaluation and management. He will undergo an electrocardiogram (ECG), cardiac enzymes, chest X-ray, and other relevant tests to confirm the diagnosis and assess the severity of his condition. He will be admitted to the cardiac care unit (CCU) for monitoring and treatment. He will receive oxygen therapy, intravenous fluids, morphine for pain relief, heparin for anticoagulation, beta-blockers for blood pressure control, and other medications as indicated. He will be counseled on smoking cessation, diet modification, exercise promotion, and medication adherence. He will be referred to a cardiologist for follow-up care and possible coronary angiography and revascularization. What area of the heart is considered the “pacemaker of the heart”? The sinoatrial node When reviewing the chest X-ray, a review of the bony structures of the clavicle, ribs, and spine can indicate which of the following pathologies if present? Lytic lesions Alignment of the spinous processes—indication of compression fractures