Regis College School of Nursing, Sciences, and Health ProfessionsNU665BNeurology Case StudyAn 80-year-old male patient, Gene Upshaw, comes in to see the primary care NP complaining of feeling “lightheaded.” The patient lives with his wife and manages his own medications. He tells you that he went to the ER three days ago for evaluation. The ER diagnosed him with sinusitis and treated him with an antibiotic and sent him home. He tells you that he was at the gym earlier today and had to sit down because he got “lightheaded” and thought he was going to pass out while walking on the treadmill. After a short rest, the “dizziness went away.” When asked, he told you that he had similar episodes in the past when his “medications were adjusted.” Patient is also concerned with peripheral edema that worsened when his meds were adjusted by his cardiologist; he denies shortness of breath. Patient states feeling constipated and since being treated for the sinus infection has been having trouble urinating, telling you he feels like he “has to go but it just won’t come out.” During his review of systems, patient tells you that he is “not sleeping well” for the past three months and thinks this is about when his Wellbutrin was increased. He has no appetite and feels “jittery at times.” Review his medications, labs from ER, and physical exam findings. After reading that information, answer the questions about the patient.Medications per PatientLabs from ERPhysical Exam Findings:Ramipril 10mg po bid BUN – 40Laying – 142/72 – 76 Sitting – 120/66 – 72 Standing – 90/50 – 72 MVI 1 po qd Creat – 1.9RR – 18Benadryl 50mg po q 6 hrs prn Na – 135General—fatigued; pale-looking male; oriented to person, place, and time; able to provide historyNorvasc 10mg po qd K – 4Head—normocephalic, mild temporal wasting, no sinus tenderness or associated swelling Flomax 0.4mg po qd TSH – 10Eyes—sclera white, no erythema or drainageWellbutrin XL 300mg po qhsAlbumin – 2.9Ears—TM’s intact bilat with good color and position HCTZ 50mg po qhs T-protein – 5.8Nose—no nasal discharge Augmentin 875mg po bid x 10 days Cardiac—Irreg, irreg, murmur 3/6 Pseudoephedrine 60mg po q 4–6 hrs Resp—CTA, normal examLevoxyl 100mcg po qdMusculoskeletal—L Knee– crepitus noted, + boney deformity, R knee with midline scar ES APAP 1000mg po q 4 hrsAbd—+BS, soft, NTElavil 100mg po qhsNeuro—WNLAnswer these questions:1. Please reconcile the medication list by identifying concerns you have, including what could be contributing to his complaints and physical findings. 2. Formulate a problem list from this visit with a focused plan for each problem you identified; take into consideration the abnormal lab values. Please make sure you include all aspects of the plan as outlined in the rubric.3. Please provide a list of three of differential diagnoses for insomnia for the 80-year-old patient.4. Please provide a list three of differential diagnoses for dizziness for the 80-year-old patient.5. Polypharmacy in aging clients is a concern for all primary care providers. As a nurse practitioner, what can you do to safely monitor and promote safe prescribing for your patients in the future? List 5 items.