NR 601 Week 5 iHuman Virtual Patient Attempt 402080 - Heather Nardone

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; mild eosinophilia (6%) and basophilia (5%) TSH 1.5 (normal)/ Free T4 0.8 ( low-normal): euthyroid UA: Normal, no proteinuria, hematuria, or glycosuria ECG: Normal sinus rhythm, no conduction abnormalities Management Plan 1. Diagnostic Test Order ApoB and Lp(a): Rationale- The necrotic core of atherosclerotic plaques is characterized by the accumulation of dead cells and cholesterol crystallization. LDL particles, which encourage LDL retention and the release of bioactive lipid products that cause inflammatory responses in vascular cells, as well as adaptive immune responses. Resident and recruited macrophages take up modified LDL, resulting in foam cell formation and ultimately cell death due to inadequate cellular lipid handling (Borén et al., 2025). AST/ALT: Rationale- Our findings imply that the AST/ALT ratio could be a practical, affordable, and useful tool for assessing the risk of atherosclerosis and could assist in identifying triglycerides while raising high-density lipoprotein (HDL, or "good") cholesterol levels (Preventing High Cholesterol, 2024). 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 intake to only one drink per day (Preventing High Cholesterol, 2024). Importance of medication adherence and periodic monitoring of labs. 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). Education on statin side effects and when to report symptoms. 5. Follow Up Follow up in 3 months and repeat lipid measurements every three to twelve months as needed, and four to twelve weeks after starting a statin or adjusting the dosage (Feingold, 2025). Annual monitoring of thyroid function and HbA1c Continue home blood pressure monitoring Reassess cardiovascular risk annually