Discussion Board

  Chief complaint: “I’m close for a medication stock consequently I ran out of my medicines”. HPI:  Mrs. Allen is a 68-year-old African American who presents to the clinic for usage stocks. The unrepining indicates that she has noticed absence of met which agoing about 3 months ago. The SOB gets worse behind a time toil, specially when she is walking constant, and it is resolute when she is subject. She reports that she is too bothered by absence of met that wakes her up anew during her repose. Her symptoms of absence of met explain behind sitting perpendicular on 3 pillows. She too has inferior leg edema pitting 1+ which agoing 2 weeks ago. She indicates that she repeatedly feels active headed at times behind a time interrupted syncope episodes time going up a factive of stairs, but it explains behind sitting down to pause. She has not adept any aggravate the against medications at home. She agoing preamble her medications, but failed to stock the usages consequently she cannot give the medications as she merely works part-time and lives remaining. In importation, she reports that she does not judge preamble all these medications would acceleration 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 ground graduate married and no offspring. Drinks one 4-ounce glass of red wine daily. She is a antecedent smoker and stopped 5 years ago. Family fact: Both parents are brisk. Father has fact of MI and valvular feeling ailment; dame brisk and cardiac fact is obscure. He has one twin who is brisk and has fact of MI 5 years ago at age 52. ROS: Constitutional: Lightheaded and faded behind a time toil. Respiratory: Absence of met behind a time 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 unhurt. Negative for gum ailment. NECK: Neck elastic, no distinct masses, no lymphadenopathy, no thyroid extension. LUNGS: + Mild Crackles on inspiratory appearance not defecation behind a time cough. Equal met sounds. Symmetrical respiration. No respiratory mortify. HEART: Normal S1 behind a time S2 during inertness. An S4 is famed at the apex; + systolic reverberation famed at the upupright remarkable sternal confine behind a timeout radiation to the carotids. Pulses are 2+ in remarkable 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 distinct masses. GENITOURINARY: No CVA benevolence bilaterally. GU exam plentiful. MUSCULOSKELETAL: + Heberden's nodes at the DIP joints, hands. + Crepitus, bilateral knees. Slow measure but well-regulated. 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 Feeling Failure (CHF) Secondary Diagnoses: Primary Hypertension, Obesity, Osteoarthritis (OA) Differential Diagnosis: Peripheral Vascular Ailment (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 resonance behind a time Doppler; Ankle-brachial renunciation. Additional lab results: Resonance results 1 week ago: Left ventricular EJ Fraction decreased to 35 % BNP – not suited. As a forthcoming FNP, you want to indicate the medications for CHF/ASCVD. (Arteriosclerotic Cardiovascular Disease). Questions: 1.     According to the ACC/AHA guidelines, what medications should this unrepining be prescribed? 2.     Does he want medication(s) consecrated his fact of MI?