Discussion Board

  Chief complaint: “I’m near for a medication satisfy accordingly I ran out of my medicines”. HPI:  Mrs. Allen is a 68-year-old African American who presents to the clinic for direction satisfys. The enduring indicates that she has noticed failure of inhalation which established about 3 months ago. The SOB gets worse delay toil, in-particular when she is walking steadfast, and it is grounded when she is hanging. She reports that she is so bothered by failure of inhalation that wakes her up anew during her slumber. Her symptoms of failure of inhalation instruct succeeding sitting vertical on 3 pillows. She so has inferior leg edema pitting 1+ which established 2 weeks ago. She indicates that she frequently feels vain headed at times delay intermittent syncope episodes occasion going up a fvain of stairs, but it instructs succeeding sitting down to peace. She has not adept any aggravate the contrary medications at abode. She established portico her medications, but failed to satisfy the directions accordingly she cannot give the medications as she simply works part-time and lives singular. In analysis, she reports that she does not contemplate portico all these medications would acceleration her plight anyway. PMH: Primary Hypertension, Previous narrative of MI 1 year ago Surgeries: 1 year ago-Left Anterior Descending (LAD) cardiac stent placement Allergies: Penicillin Vaccination History:  Up-to-date Social narrative: High develop disequalize married and no manifestation. Drinks one 4-ounce glass of red wine daily. She is a anterior smoker and stopped 5 years ago. Family narrative: Both parents are existing. Father has narrative of MI and valvular interior complaint; mother existing and cardiac narrative is unrecognized. He has one twin who is existing and has narrative of MI 5 years ago at age 52. ROS: Constitutional: Lightheaded and half-hearted delay toil. Respiratory: Failure of inhalation delay toil. + Orthopnea. Cardiovascular: + 2 pitting leg edema for 3 weeks. Psychiatric: Non-contributory. Physical examination: Vital Signs: Height: 5 feet 1 inches Weight: 175 pounds BMI: 32, Obese, BP 160/92, T 98.0, P 111,  R 22 and non-labored HEENT: Normocephalic/Atraumatic, Bilateral cataracts; PERRLA, EOMI; Teeth inviolate. Negative for gum complaint. NECK: Neck compliant, no corporal masses, no lymphadenopathy, no thyroid expansion. LUNGS: + Mild Crackles on inspiratory exhibition not defecation delay cough. Equal inhalation sounds. Symmetrical respiration. No respiratory worry. HEART: Normal S1 delay S2 during dulness. An S4 is distinguished at the apex; + systolic whisper distinguished at the direct preferable sternal band delayout radiation to the carotids. Pulses are 2+ in preferable extremities and 2+ in pedal pulses bilaterally. 2+ pitting edema to her knees distinguished bilaterally. ABDOMEN: No abdominal distention. Nontender. Bowel sounds + x 4 quadrants. No organomegaly. Normal contour; No corporal masses. GENITOURINARY: No CVA pity bilaterally. GU exam plentiful. MUSCULOSKELETAL: + Heberden's nodes at the DIP joints, hands. + Crepitus, bilateral knees. Slow degree but equable. No Kyphosis. PSYCH: Normal seek. Cooperative. SKIN: No rashes. Positive for dry bark. Labs: Hgb 13.2, Hct 38%, K+ 4.0, Na+137, Cholesterol 228, Triglycerides 187, HDL 37, LDL 190, TSH 3.7, glucose 98. A: Primary Diagnosis: Congestive Interior Failure (CHF) Secondary Diagnoses: Primary Hypertension, Obesity, Osteoarthritis (OA) Differential Diagnosis: Peripheral Vascular Complaint (PVD) Plan: Medications: Tylenol 650 mg PO Q4 hours as insufficiencyed for arthritis pain Labs: UA; Brain natriuretic peptide (BNP); LFTs and TSH; 12-lead EKG, Chest X-ray; Initial 2D resonance delay Doppler; Ankle-brachial apostacy. Additional lab results: Resonance results 1 week ago: Left ventricular EJ Fraction decreased to 35 % BNP – not conducive. As a coming FNP, you insufficiency to detail the medications for CHF/ASCVD. (Arteriosclerotic Cardiovascular Disease). Questions: 1.     According to the ACC/AHA guidelines, what medications should this enduring be prescribed? 2.     Does he insufficiency medication(s) loving his narrative of MI?