NR 601 Week 5 iHuman Virtual Patient Attempt 3746307 - Lisa Jones

Management Plan by Briayanna Nordwick on case Lisa Jones - Chamberlain Management Plan 1. Diagnostic Tests Completed: Lipid panel, HbA1c, CMP, CBC, TSH/Free T4, 12-lead ECG Fasting Lip Panel: Elevated total cholesterol (255 mg/dL) and LDL (190 mg/dL), HDL 45mg/dL, triglyceride 100 mg/dL: abnormal HbA1c: 5.3% CMP: Normal electrolytes, renal, and liver function CBC with differential: Normal TSH 1.5 (normal)/ Free T4 0.8 ( low-normal): euthyroid ECG: Normal sinus rhythm, no conduction abnormalities Additional recommended: ApoB and Lp(a) – to assess cardiovascular risk and LDL particle burden (Borén et al., 2025) Baseline liver function (AST/ALT) – already normal; monitor for statin therapy ASCVD 10-year risk score – fundamental guidelines that physicians should follow when choosing which patients to treat and how severely to treat hypercholesterolemia to reduce the risk of ASCVD (Feingold, 2025) 2. Medications Prescription: New Prescription: Atorvastatin 40 mg PO daily at bedtime Dispense: 90 tablets, 1 refill Rationale: LDL >190 mg/dL; evidence-based intervention to reduce ASCVD risk (Feingold, 2025) Levothyroxine 75 mcg PO daily - continue; TSH and Free T4 normal. 3. Consults / Referrals Nutritionist: Dietary counseling (DASH or Mediterranean diet) Cardiology: If ASCVD risk high or familial hypercholesterolemia suspected Sleep medicine: Only if symptoms of obstructive sleep apnea develop 4. Client Education Limit saturated/trans fats, added sugars, and sodium; increase fiber-rich foods Choose low saturated fat, trans fat, sodium, and added sugars instead of high saturated fat (Preventing High Cholesterol, 2024). (found in avocados, vegetable oils like olive oil, and nuts), and fiber (found in oatmeal and black, pinto, kidney, lima, and other beans). These foods may help prevent and manage high levels of LDL ("bad") cholesterol and triglycerides while raising high-density lipoprotein (HDL, or "good") cholesterol levels (Preventing High Cholesterol, 2024). Increase physical activity (moderate-intensity exercise 150 min/week) The Surgeon General advises adults to engage in moderate-intensity physical activity, like brisk walking or cycling, for two hours and thirty minutes each week (Preventing High Cholesterol, 2024). Limit alcohol to ≤1 drink/day (Preventing High Cholesterol, 2024). Explain ASCVD risk and importance of LDL control Educate patients on what it means to have an elevated LDL and ASCVD risk. Achieving optimal LDL levels requires the use of statin therapy, which is particularly crucial for four high-risk groups: patients with diabetes mellitus, those with a history of familial hypercholesterolemia, those with a known history of atherosclerotic disease, and those with an ASCVD risk of greater than 7.5% (Su et al., 2021b).