NU636 Unit 5: Discussion 2 Anti-coagulant Therapy

Initial Response

Scenario

A 77-year-old white male comes into your office complaining of feeling dizzy, short of breath, easily fatigued and having a sensation of his heart ‘skipping beats’.

He reports he has had these same symptoms numerous times over the last year or so, but they only lasted for about a day.
He thought since he has been experiencing them now for about 3 days he should come in and get checked out.
He was diagnosed with type 2 diabetes twenty years ago and hypertension fifteen years ago.
Current medications include Lisinopril 20 mg daily and Metformin 1000 mg daily.
BP 172/100, P 123 irregularly irregular, R 20
Skin is warm, pale with a slight gray cast; lungs are clear to auscultation; heart irregular rhythm

Please develop a discussion that responds to each of the following prompts. Where appropriate your discussion needs to be supported by scholarly resources. Be sure to include in-text citations in the context of the discussion and provide a full reference citation at the end of the discussion.

Initial Post

Utilize the information provided in the scenario to create your discussion post.

Construct your response as an abbreviated SOAP note (Subjective Objective Assessment Plan).

Structure your ‘P’ in the following format: [NOTE: if any of the 3 categories is not applicable to your plan please use the ‘heading’ and after the ‘:’ input N/A]

Therapeutics: pharmacologic interventions, if any – new or revisions to existing; include considerations for OTC agents (pharmacologic and non-pharmacologic/alternative); [optional – any other therapies in lieu of pharmacologic intervention]

Educational: health information clients need to address their presenting problem(s); health information in support of any of the ‘therapeutics’ identified above; information about follow-up care where appropriate; provision of anticipatory guidance and counseling during the context of the office visit

Consultation/Collaboration: if appropriate – collaborative ‘Advanced Care Planning’ with the patient/patient’s care giver; if appropriate -placing the patient in a Transitional Care Model for appropriate pharmacologic and non-pharmacologic care; if appropriate – consult with or referral to another provider while the patient is still in the office; Identification of any future referral you would consider making

Support the interventions outlined in your ‘P’ with scholarly resources.

Please be sure to validate your opinions and ideas with citations and references in APA format.

Solution: NU636 Unit 5: Discussion 2 Anti-coagulant Therapy

77-year-old white male presents with dizziness, SOB, fatigue, palpitations for 3 days. PMHx: type 2 diabetes x20 years, hypertension x15 years. Currently on Lisinopril 20 mg daily and Metformin 1000 mg daily.

BP 172/100, P 123 irregularly irregular, R 20, warm/pale skin with gray cast, clear lungs, irregular heart rhythm

Based on the PMHx, medications, exam findings and symptoms, the most likely diagnosis is atrial fibrillation with uncontrolled hypertension (Sagris et al., 2022). The irregularly irregular pulse, elevated BP and symptoms are consistent with AFib. The longstanding diabetes and hypertension have likely caused cardiac damage and arrhythmia (Sagris et al., 2022).

Therapeutics: Initiate metoprolol 25 mg BID to control heart rate in AFib (Wong et al., 2020). This will help to slow the heart rate and make him feel less fatigued. Adjust lisinopril dose up to 40 mg daily to better control BP. Studies have shown higher doses are more effective at reducing BP and protecting organs long term (Wong et al., 2020). Consider apixaban 5 mg BID due to his …..Please click purchase button below to get full answer for $5

(Solution) NU636 Unit 5: Discussion 2 Anti-coagulant Therapy