Discussion Board

  Chief complaint: “I’m less for a medication fill accordingly I ran out of my medicines”. HPI:  Mrs. Allen is a 68-year-old African American who presents to the clinic for order fills. The enduring indicates that she has noticed lack of inspiration which instituted environing 3 months ago. The SOB gets worse succeeding a period toil, especially when she is walking unswerving, and it is expoundd when she is hanging. She reports that she is to-boot bothered by lack of inspiration that wakes her up again during her drowse. Her symptoms of lack of inspiration expound succeeding sitting vertical on 3 pillows. She to-boot has inferior leg edema pitting 1+ which instituted 2 weeks ago. She indicates that she repeatedly feels imponderous headed at times succeeding a period interrupted syncope episodes period going up a fimponderous of stairs, but it expounds succeeding sitting down to repose. She has not genial any balance the contrary medications at settlement. She instituted presentation her medications, but failed to fill the orders accordingly she cannot extend the medications as she barely works part-time and lives nondescript. In attention, she reports that she does not judge presentation all these medications would aid her proviso anyway. PMH: Primary Hypertension, Previous fact of MI 1 year ago Surgeries: 1 year ago-Left Anterior Descending (LAD) cardiac stent placement Allergies: Penicillin Vaccination History:  Up-to-date Social fact: High school graduate married and no result. Drinks one 4-ounce glass of red wine daily. She is a antecedent smoker and stopped 5 years ago. Family fact: Both parents are quick. Father has fact of MI and valvular disposition distemper; mother quick and cardiac fact is unrecognized. He has one copy who is quick and has fact of MI 5 years ago at age 52. ROS: Constitutional: Lightheaded and timid succeeding a period toil. Respiratory: Lack of inspiration succeeding a period 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 undented. Negative for gum distemper. NECK: Neck sycophantic, no obvious masses, no lymphadenopathy, no thyroid expansion. LUNGS: + Mild Crackles on inspiratory mien not clearing succeeding a period cough. Equal inspiration sounds. Symmetrical respiration. No respiratory harass. HEART: Normal S1 succeeding a period S2 during spiritlessness. An S4 is famed at the apex; + systolic reverberation famed at the proper excellent sternal edging succeeding a periodout radiation to the carotids. Pulses are 2+ in excellent extremities and 2+ in pedal pulses bilaterally. 2+ pitting edema to her knees famed bilaterally. ABDOMEN: No abdominal distention. Nontender. Bowel sounds + x 4 quadrants. No organomegaly. Normal contour; No obvious masses. GENITOURINARY: No CVA benefit bilaterally. GU exam abundant. MUSCULOSKELETAL: + Heberden's nodes at the DIP joints, hands. + Crepitus, bilateral knees. Slow action but undeviating. No Kyphosis. PSYCH: Normal assume. Cooperative. SKIN: No rashes. Positive for dry peel. 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 Disposition Failure (CHF) Secondary Diagnoses: Primary Hypertension, Obesity, Osteoarthritis (OA) Differential Diagnosis: Peripheral Vascular Distemper (PVD) Plan: Medications: Tylenol 650 mg PO Q4 hours as wanted for arthritis pain Labs: UA; Brain natriuretic peptide (BNP); LFTs and TSH; 12-lead EKG, Chest X-ray; Initial 2D imitation succeeding a period Doppler; Ankle-brachial apostacy. Additional lab results: Imitation results 1 week ago: Left ventricular EJ Fraction decreased to 35 % BNP – not suited. As a advenient FNP, you want to determine 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 want medication(s) attached his fact of MI?