Mrs. Cooper is a 78-year-old American Indian female who presented to your clinic with dyspnea on exertion
9. Mrs. Cooper is a 78-year-old American Indian female who presented to your clinic with dyspnea on exertion, fatigue, and recent weight gain of 8 pounds in the last 3 days. She has a history of heart failure, hyperlipidemia, coronary artery disease (CAD) (CABG X 2 – 3 years prior), Hypertension (HTN), Hyperlipidemia and Type II Diabetes. She lives a sedentary lifestyle and does not exercise. Her medications include Lisinopril 10mg, Metoprolol 25mg, Spironolactone 25mg, Atorvastatin 40mg Daily and Metformin 1000mg twice daily. Her physical examination revealed:
Vital signs: BP: 178/98, HR 111, RR 23, T 98.7, O2 of 89% on Room Air so the patient is placed on 2 L of oxygen via nasal cannula increases her O2 to 94%.
The patient is alert, oriented x4, anxious, PERRLA, with facial symmetry and reflexes intact.
The EKG shows sinus tachycardia and no new ischemic changes. Cardiac assessment revealed S3 heart sounds, bilateral pitting pedal edema 3+, and 2+ pulses in all extremities.
Auscultation of the lungs revealed bibasilar pulmonary rales. There was also use of accessory muscles and pursed lip breathing. All other assessment findings were unremarkable.
Discuss what patient education is essential for management of CHF in this patient.
10. What is the first line pharmacological therapy of CHF? Give a sample treatment plan, including the pharmacological management of a patient with CHF.
11. Differentiate between the diagnosis of COPD and CHF. Discuss your plan of care for each.
12. A 66-year-old Caucasian female with prediabetes presents for her annual physical. She has no complaints. The average of 3 serial BP readings in her right arm is BP 143/88. Her physical exam is unremarkable except for obesity. She has no history of myocardial infarction, stroke, kidney disease, or heart failure. After the visit, she measures her BP at home and returns 1 month later. The average BP from multiple clinic and home readings is 138/86.
Her height is 5’ 3” and weighs 190.4 pounds.
Her total cholesterol is 270 mg/dL, HDL 40 mg/dL, and LDL 170 mg/dL. She does not smoke.
What is your diagnosis for this patient (i.e- Hypertension? Isolated Hypertension? etc.) with rationale.
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