Unit 5 PUD And Anemia
Unit 5 PUD and Anemia.
The family of a 62-year-old white female called your office and ask if you could see their family member. The person being requested to be seen is known to you for the last twenty years.
Unit 5 PUD And Anemia
- She is your former supervisor and a fellow FNP.
- The family reports your colleague is demonstrating signs of dementia.
- They note that she has not been eating much for the past few weeks reporting she has a gnawing pain in her stomach. If she does eat she reports getting ‘full’ very quickly. She reports feeling mildly nauseous for the last few weeks.
- Your friend sustained a fall injury about 9 months ago from a ladder. She shattered some teeth and developed an infection. She is under the care of an oral surgeon.
- You have seen a few of her patients in your practice over the last couple weeks because ‘she is never in her office or available’ over the last few weeks.
- You reflect on your last few conversations with your colleague and think to yourself that you also thought she seemed ‘off her game’.
- You recommend her family take her to Urgent Care and you convince your colleague this is in her best interest.
- Labs drawn at Urgent Care reveal a Hgb of 8 and HCT of 24.
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.
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.
- What role does disease prevalence of Atrial fibrillation play among groups such as the patient in the study?
- Summarize a scholarly article that pertains to the case study and provide feedback.
Please be sure to validate your opinions and ideas with citations and references in APA format.
Unit 5 Anti-coagulant Initial Post
(Subjective) S: The Patient is a 77-year-old white male. The patient is here in the office
with complaints of feeling dizzy, shortness of breath, easily fatigued, and sensation of heart
“skipping beats”. Patient reports having the same symptoms over the last years, happening
several times that only last for about a day. He reports symptoms lasting for about 3 days and
decided to get checked out. Patients PMI includes type 2 diabetes 20 years ago and hypertension
15 years ago. Patient currently takes Lisinopril 20 mg daily and Metformin 1000 mg daily.
(Objective) O: BP 172/100, P 123 irregularly irregular, R 20. Skin: warm, pale with
slight gray cast; Lungs: clear to auscultation; Heart: irregular rhythm.
(Assessment) A: Atrial fibrillation. Irregular heart rates are a type of irregular cardiac
rhythm that can include both a fast and a slow heart rate. An arrhythmia can occur with or
without symptoms, and it can cause a person to have the sensation that their heart is beating too
quickly, too slowly, or missing a beat (Arcangelo et al., 2022). Arrhythmias can also lead to a
loss of consciousness, cardiac collapse, and even death. Changes in the heart’s mechanical or
transference regularity can be the root cause of irregular heart rates. These variations can lead to
a decline in the heart’s performance as well as its overall productivity (Arcangelo et al., 2022).
(Plan) P: Diagnosis of Atrial fibrillation.
To properly identify a cardiac arrhythmia, a comprehensive cardiac workup consisting of
lab tests and investigative investigations is required. It is recommended that a 12-lead ECG be
performed on the patient to diagnose and early detect atrial or ventricular shortenings, heart
blocks, and missing cardiac waves, as well as to identify whether the patient has suffered any
damage to cardiac tissue (Arcangelo et al., 2022). It is necessary to conduct a complete blood count, a measurement of BMP, TSH levels, and digoxin to identify any fundamental triggers of the irregular heart rate. In addition, a stress test, heart
enzymes, and possibly a Cath lab examination are also required. It is suggested that before to
initiating anticoagulant medication, baseline laboratory values be obtained (Arcangelo et al.,
2022). These values should include PT, INR, aPTT, urine, CBC (including platelet count), and a
liver profile. To assess the potential for bleeding, a comprehensive review of the patient’s entire
medical history, including any previous operations, as well as an in-depth analysis of all
medications, whether they are prescribed, purchased over the counter, or taken as herbal
supplements, must be completed (Arcangelo et al., 2022).
Therapeutics:
The patient has a score of 4 on the CHA2-DS2-Vasc. Patients with a score more than two
are considered to have a higher risk for stroke, and anticoagulant medication is suggested for
these patients. Warfarin is the medicine that is often indicated for patients whose creatinine
clearance is lower than 30 ml/min. Oral anticoagulants with a direct mechanism of action, such
as the anticoagulants Xarelto and Eliquis (Arcangelo et al., 2022). Once results from the
creatinine clearance have been evaluated, medication and appropriate dosage can be determined.
An acute myocardial infarction might be the cause of Afib. In addition, an electrocardiogram
should be done to check for ischemic abnormalities. If ischemia changes are observed in the
patient, it will be necessary to transfer them to the hospital (Arcangelo et al., 2022). Due to the
patient’s HR, it would be necessary to transfer him to the hospital. It is important to control the
ventricular rate. Patients who have normal LV systolic function of greater than 40% are ideal
candidates for intravenous administration of diltiazem, verapamil, and beta-blockers. In cases
when the EF is 40% or below, intravenous administration of beta-blockers or digoxin is
suggested (Arcangelo et al., 2022). Education:
Oral administration of warfarin should only be done once day. Because vitamin k is the
antidote to warfarin, numerous vegetables, including spinach, turnips, collard, mustard greens,
broccoli, Brussel sprouts, and cabbage, as well as herbal and green teas, should not be ingested
while taking this medication. Because soy products and olive oils include vitamin K, the patient
will need to carefully check all the labels on their medications (Arcangelo et al., 2022). The
patient will need to be educated about the danger of bleeding from the mouth, nose, urine, feces,
nose bleeds, bruises, blood, gastrointestinal bleeds, and vomiting blood (Arcangelo et al., 2022).
The patient needs to get care in an emergency department for bleeding that is not stopped. Inform
the patient about the critical need to seek medical attention to get the patient’s heart rate under
control. Inform patients about the danger of bleeding and the necessity of contacting a health
care provider if bleeding occurs (Arcangelo et al., 2022). If the patient is going to take warfarin,
they need to be educated on the significance of maintaining a regular diet and getting their INR
checked on a regular basis. It is essential to consume the same quantity of foods that are rich in
vitamin K daily. The patient is required to disclose the fact that they are taking anticoagulants to
all members of their medical team, including the dentist. It is essential to consume a substantial
meal before to taking rivaroxaban (Xarelto) (Arcangelo et al., 2022). To verify patients
understanding the “teach back” approach is an efficient means of removing any communication
barriers that may exist between the patient and the health educator, as well as evaluating the
patient’s level of comprehension of the material being presented. In this method, patients are
questioned about their level of comprehension by having them restate instructions using their
own language (Hawes, 2018).
Consultation/Collaboration: Cardiology consult
References
Arcangelo, V., Peterson, A., Wilbur, V., & Kang, T. (2022). Pharmacotherapeutics for Advanced
Practice: A Practical Approach (5th ed.). Wolters Kluwer.
Hawes E. M. (2018). Patient Education on Oral Anticoagulation. Pharmacy (Basel,
Switzerland), 6(2), 34. https://doi.org/10.3390/pharmacy6020034
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