Shortness of breath with exertion
Order ID 53563633773 Type Essay Writer Level Masters Style APA Sources/References 4 Perfect Number of Pages to Order 5-10 Pages Description/Paper Instructions
“I’m here for a pharmaceutical refill because I ran out of my medications,” is the main complaint.
Mrs. Allen, a 68-year-old African American woman, comes to the clinic to get her prescriptions filled. The patient states that she has been experiencing shortness of breath for nearly three months. The SOB worsens with exercise, especially when she walks quickly, and it goes away when she rests. She also claims to be affected by shortness of breath, which wakes her up from her sleep on a regular basis. Her shortness of breath disappears after she sits upright on three pillows. She also has lower leg edema that has been bothering her for the past two weeks. She says she gets light-headed and has intermittent syncope episodes while climbing a flight of stairs, but it goes away as she sits down to rest. At home, she hasn’t tried any over-the-counter drugs.
She began taking her pills, but she did not refill them since she could not afford them because she works part-time and lives alone. Furthermore, she claims that she does not believe that taking all of these meds will help her illness.
PMH stands for Primary Hypertension with a history of myocardial infarction. 1 year ago today
Surgeries:
Left Anterior Descending (LAD) cardiac stent placement 1 year ago
Allergies: Penicillin
Vaccination History: Current
History of society:
No children and a high school graduate. Every day, he consumes one 4-ounce glass of red wine. She was a former smoker who gave up five years ago.
History of the family:
Both of my parents are still living. The father has a history of myocardial infarction and valvular heart disease; the mother is still living and has no cardiac history. He has one living sibling, who was diagnosed with MI five years ago at the age of 52.
ROS:
Constitutional: Exertion causes lightheadedness and faintness. + Orthopnea + Respiratory: Shortness of breath with effort. Cardiovascular: + 2 weeks of pitting leg edema.
Non-contributory psychiatric.
Examination of the body:
Signs of Life:
5 feet and 1 inch tall 175 pound weight Obese with a BMI of 32, blood pressure of 160/92, T 98.0, P 111, R 22 and non-labored.
HEENT: Normocephalic/Atraumatic, Bilateral cataracts; PERRLA, EOMI; Teeth in good condition Gum disease is not seen. NECK: Neck is flexible, with no visible tumors, lymphadenopathy, or thyroid enlargement. + Mild crackles on inhalation that do not go away with cough. Equal breath sounds are heard. Respiration in a symmetrical pattern. There are no signs of respiratory distress. HEART: S1 is normal, however S2 is present during expiration. At the apex, there is an S4; furthermore, there is a systolic murmur at the right upper sternal border that does not radiate to the carotids. Upper extremity pulses are 2+, and pedal pulses are 2+ bilaterally. Her knees had 2+ pitting edema on both sides. ABDOMEN: There is no distention in the abdomen. Nontender. 4 quadrants + bowel sounds There is no organomegaly. There are no perceptible lumps and the contour is normal. GENITOURINARY: There is no bilateral CVA tenderness. The GU exam has been postponed. + Heberden’s nodes at the DIP joints, hands; + Crepitus, bilateral knees Slow but steady gait. There is no kyphosis. PSYCH: Affect that is normal. Cooperative. SKIN: There are no rashes on my skin. It’s good for dry skin.
Hgb 13.2, Hct 38 percent, K+ 4.0, Na+137, Cholesterol 228, Triglycerides 187, HDL 37, LDL 190, TSH 3.7, glucose 98 were the results of the tests.
A:
Congestive Heart Failure is the primary diagnosis (CHF)
Primary hypertension, obesity, and osteoarthritis are secondary diagnoses (OA)
Peripheral Vascular Disease: Differential Diagnosis (PVD)
Plan:
Tylenol 650 mg PO every four hours as needed for arthritic discomfort
LFTs and TSH; 12-lead EKG, Chest X-ray; UA; Brain natriuretic peptide (BNP); UA; UA; UA; UA; UA; UA; UA; UA; UA; UA; UA; UA; UA; UA; UA; UA; UA; Ankle-brachial index; first 2D echo with Doppler.
Additional laboratory findings:
Results from a week ago: The EJ Fraction of the left ventricle has dropped to 35%.
BNP – this product is no longer available.
You must determine the drugs for CHF/ASCVD as a future FNP (Arteriosclerotic Cardiovascular Disease).
Questions:
1. What drugs should this patient be provided, according to the ACC/AHA guidelines?
2. Is he on any medication(s) because of his MI history?
?