Discussion Board

  Chief complaint: “I’m near for a medication resupply accordingly I ran out of my medicines”. HPI:  Mrs. Allen is a 68-year-old African American who presents to the clinic for recipe resupplys. The enduring indicates that she has noticed lack of met which instituted encircling 3 months ago. The SOB gets worse following a conjuncture effort, in-particular when she is walking secure, and it is established when she is relative. She reports that she is to-boot bothered by lack of met that wakes her up frequently during her drowse. Her symptoms of lack of met explain following sitting conscientious on 3 pillows. She to-boot has inferior leg edema pitting 1+ which instituted 2 weeks ago. She indicates that she repeatedly feels unweighty headed at times following a conjuncture intermittent syncope episodes conjuncture going up a funweighty of stairs, but it explains following sitting down to pause. She has not practised any balance the against medications at residence. She instituted vestibule her medications, but failed to resupply the recipes accordingly she cannot grant the medications as she singly works part-time and lives remaining. In conjunction, she reports that she does not imagine vestibule all these medications would acceleration her proviso anyway. PMH: Primary Hypertension, Previous truth of MI 1 year ago Surgeries: 1 year ago-Left Anterior Descending (LAD) cardiac stent placement Allergies: Penicillin Vaccination History:  Up-to-date Social truth: High nurture furrow married and no result. Drinks one 4-ounce glass of red wine daily. She is a anterior smoker and stopped 5 years ago. Family truth: Both parents are active. Father has truth of MI and valvular courage disorder; mother active and cardiac truth is hidden. He has one match who is active and has truth of MI 5 years ago at age 52. ROS: Constitutional: Lightheaded and faded following a conjuncture effort. Respiratory: Lack of met following a conjuncture effort. + 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 sacred. Negative for gum disorder. NECK: Neck yielding, no obvious masses, no lymphadenopathy, no thyroid extension. LUNGS: + Mild Crackles on inspiratory feature not enumerate following a conjuncture cough. Equal met sounds. Symmetrical respiration. No respiratory mortify. HEART: Normal S1 following a conjuncture S2 during spiritlessness. An S4 is famous at the apex; + systolic babble famous at the equitable higher sternal brim following a conjunctureout radiation to the carotids. Pulses are 2+ in higher extremities and 2+ in pedal pulses bilaterally. 2+ pitting edema to her knees famous bilaterally. ABDOMEN: No abdominal distention. Nontender. Bowel sounds + x 4 quadrants. No organomegaly. Normal contour; No obvious masses. GENITOURINARY: No CVA benevolence bilaterally. GU exam distant. MUSCULOSKELETAL: + Heberden's nodes at the DIP joints, hands. + Crepitus, bilateral knees. Slow remove but uniform. No Kyphosis. PSYCH: Normal desire. 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 Courage Failure (CHF) Secondary Diagnoses: Primary Hypertension, Obesity, Osteoarthritis (OA) Differential Diagnosis: Peripheral Vascular Disorder (PVD) Plan: Medications: Tylenol 650 mg PO Q4 hours as demanded for arthritis pain Labs: UA; Brain natriuretic peptide (BNP); LFTs and TSH; 12-lead EKG, Chest X-ray; Initial 2D imitation following a conjuncture Doppler; Ankle-brachial protest. Additional lab results: Imitation results 1 week ago: Left ventricular EJ Fraction decreased to 35 % BNP – not serviceable. As a advenient FNP, you demand to enumerate 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 demand medication(s) ardent his truth of MI?