*Assignment3 L. P., age 23, is a Hispanic woman who graduated from college last year. She reports to the CNP in her local community mental health center. She began working as an accountant 1 month after graduating. Approximately 2 months ago, she moved into a two-bedroom apartment with another woman who works at the same accounting firm. She states that her roommate recommended that she see a doctor to find out if she has anemia or “some sort of fatigue syndrome.” She states that she has felt “restless” and “on edge” for most of the past 9 months. She becomes easily fatigued and irritable and has difficulty concentrating and falling asleep. She states that sometimes her mind “just goes blank,” and she is worried that her work performance is no longer excellent. She reports that all her life she had good grades in school and was very successful in everything she attempted. Although she has been “a worrier from the day I was born,” now she worries more than she ever has and feels nervous “all the time.” L. P. reports that she has a good relationship with her boyfriend but they do not get to see each other very often because he is attending graduate school 100 miles away. She reports having a satisfying sexual relationship with him. She denies having any problems with relationships with her parents, roommate, or peers. She denies having any financial worries unless she is fired from her job for poor work performance. She reports that she has always been healthy and has taken good care of herself. The only medication she takes is birth control pills, which she has taken for the past 4 years without any adverse effects. In a paper not to exceed six pages, excluding title and reference pages, submit your answers to the following in an MS Word document: 1. What is L. P.’s diagnosis? 2. List specific pharmacotherapeutic treatment goals for L. P. 3. Should the CNP order any labs for L. P. at this time? Why? 4. What drug therapy would the CNP likely prescribe? Why? 5. What are the parameters for monitoring the success of the therapy? 6. Describe specific patient monitoring based on the prescribed therapy. 7. List one or two adverse reactions for the selected agent that would cause the CNP to change therapy. 8. L. P. returns to see the CNP after six weeks, complaining of still feeling anxious and had heard of a medication called Klonopin that she would like to try; how should the CNP respond to her request? 9. What health promotion activities should be recommended for this patient? 10. What is L. P.’s long-term prognosis? *Assignment4 E. P., a 51-year-old Asian woman who is 68 inches tall and weighs 130 pounds, presents to the CNP in her family practice clinic, complaining of amenorrhea for the past 8 months. She wakes up at least 5 times a night with hot flashes and experiences them at least 10 times a day. She is very uncomfortable and sleep deprived. At the visit a Pap smear is done and a mammogram is negative. Her FSH level is 32 international units/mL. She has no family history of breast cancer, but her mother has osteoporosis. She reports that her friend has been on hormone therapy, has found it helpful, and recommended that the patient explore this option with her primary provider. She made the appointment with you to discuss this option. In a paper not to exceed six pages, excluding title and reference pages, submit your answers to the following in an MS Word document: 1. List specific goals for treatment of E. P.’s clinical presentation. 2. After discussion of her options, E. P. and the CNP decide that drug therapy would be her best option at this time. What drug therapy would the CNP likely prescribe? Why? For how long? 3. Should the CNP order any labs at this time? Why? 4. What are the parameters for monitoring success of the therapy? 5. Discuss patient education and counseling necessary in this situation. 6. List two adverse reactions of the prescribed therapy. 7. What would be the choice for second-line therapy if E. P. could not tolerate the treatment of choice and symptoms were still present? 8. What health promotion recommendations should be made? 9. Describe contraindications to menopausal hormone therapy. 10. What is E. P.’s long-term prognosis?
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