Unit 5 Anti-coagulant Therapy. Due 6-7-23. 1000w. 4 references.
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.
1. Construct your response as an abbreviated SOAP note ( Subjective Objective Assessment Plan).
2. 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]
3. 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]
4. 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
5. 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
6. Support the interventions outlined in your ‘P’ with scholarly resources.
7. What role does Anti-coagulant Therapy play among groups such as the patient in the study?
8. 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 Therapy
Chief Complaint- Dizziness, SOB, Fatigue, Palpitations
HPI- Patient reports feeling dizzy, short of breath, easily fatigued, and the sensation of his heart
skipping beats. Symptoms have been occurring numerous times over the past year, but they only
last for about a day. His symptoms now have persisted for 3 days.
PMH
Type 2 DM (2001)
Hypertension (2006)
Allergies-Unknown
Medications
Lisinopril 20mg PO daily
Metformin 1000mg PO daily
Social History- Unknown
Family History-Unknown
ROS:
General: Complaints of fatigue
HEENT: Reports dizziness
Cardiac: Reports sensation of heart skipping beats
Resp: Reports shortness of breath
Physical Exam:
General: 77 yo Caucasian male with acute complaints
VS: BP 172/100, HR 123 and irregularly irregular, RR 20
Skin: Warm, pale with slight gray cast
Cardiac: Heart irregular rhythm
Resp: Lungs clear
Labs/Diagnostics N/A
Assessment
1. I48.91 – Unspecified Atrial Fibrillation
Predisposing Factors: Age- increased occurrence after age 65, history of hypertension
and diabetes (Cash & Glass, 2018).
Complaints persistent with symptoms of atrial fibrillation: palpitations, fatigue,
dyspnea at rest or on exertion, dizziness. Patient also experiencing pallor, irregularly
irregular heart rhythm with a rate of 123 (Cash & Glass, 2018).
Plan
Diagnostics Recommendations per ( Family Practice Guidelines, 2018).
EKG
CBC, BMP (including electrolytes, blood glucose, BUN, Cr), magnesium, CrCl,
LFTs, Thyroid, liver, and lipid profile, BNP and NT-proBNP, PT, INR, aPTT
Cardiac Profile (including troponin, CPK, CK-MB)
Chest x-ray and 2-D echocardiogram
Exercise stress test or thallium stress test, if exercise induced arrthymia or CAD is
suspected
Holter monitoring
Evaluation of sleep apnea (Cash & Glass, 2018).
Therapeutics Recommendations per ( Family Practice Guidelines, 2018).
Anticoagulant therapy: (Coumadin, Pradaxa, Xarelto, Eliquis, Savaysa) Dose based on
CrCl and INR for coumadin
Antiplatelet therapy: Asprin 81mg or Plavix 75mg daily.
(Combined anticoagulant and antiplatelet therapies are commonly used to prevent
complications when two or more of the conditions are present: AF, mechanical valve
prosthesis, and drug-eluting stents).
Heart rate control: Beta Blocker if not contraindicated (Atenolol, Metoprolol, or
Propranolol) Calcium Channel Blockers (Diltiazem or Verapamil)
Heart Rhythm control: Sodium channel blockers (Disopyramide or Quinidine) or
Potassium channel blockers (Amiodarone, Dofetilide, Dronedarone, or Sotalol)
Surgical Intervention: Ablation for recurrent AF (Cash & Glass, 2018).
Education Recommendations per ( Family Practice Guidelines, 2018).
Encourage weight loss, smoking cessation, and stress management if indicated
Importance of controlling other chronic medication conditions such as HTN and GM
Counsel patient on proper nutrition (low-fat, low-cholesterol, low-sodium diet)
CrCl is needed for patients on Pradaxa and Xarelto
INR is needed for patients on Coumadin
If prescribed Coumadin, you will be given a list of foods that are high in vitamin K.
Bleeding risks associated with the use of anti-coagulation and anti-platelet therapies
Follow-up with your primary care provider and cardiologist on a regularly scheduled
basis (Cash & Glass, 2018).
Consultation/Collaboration Recommendations per ( Family Practice Guidelines, 2018).
Refer patient for immediate hospitalization to initiate thrombolytic therapy,
cardioversion, hypertensive management, and/or additional diagnostic testing due to
acute onset and symptomatic presentation
Refer to Cardiology for symptomatic, new onset AFib with RVR
Follow-up is determined by the patient’s needs, interventions performed, frequency of AF
reoccurrence, and presence of other medical conditions (Cash & Glass, 2018).
References
Cash, J., & Glass, C. (2018). Family Practice Guidelines. 4th ed. Springer Publishing. (Version
6.8.4625)