Please Reply To The Following 2 Discussion Posts

Please Reply to the following 2 Discussion posts:

 

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APA format with intext citation

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References at least one high-level scholarly reference per post within the last 5 years in APA format.

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DISCUSSION POST # 1 Talia

 

This is a 55-year-old male presenting to the clinic for the first time with medication refill requests and complaints of worsening shortness of breath for one week and weight gain of ten pounds in one week. He reports taking medication for hypertension and diabetes but does not recall the medication names. His vital signs are normal except for blood pressure of 176/100, heart rate of 112, respiratory rate of 26, and chest pain rated at 4 out of 10.

 

What other questions would you ask this patient?

 

To develop an effective plan of care for this patient, a thorough health history must be taken, and previous health records should be obtained from previous providers. To determine which medications this patient was taking, the provider could ask the patient to describe the pill color, size, and how often it was taken, or have the patient bring in the empty pill bottles. The patient’s blood pressure is high, likely due to not taking medication, and asking if he checks his blood pressure or blood sugar at home can provide valuable information about his condition. It is important to ask if he has a family history of heart disease, or if he has any history of heart attack or valve disease. Asking additional questions will provide a more accurate assessment and plan.

 

What are your top 3 differential diagnoses?

· Acute combined systolic (congestive) and diastolic (congestive) heart failure (I50.41). This is characterized by shortness of breath, fatigue, swelling in the legs, rapid heartbeat, and fluid retention (Ponikowski et al., 2016).

· COPD exacerbation (J44.1). This condition can also present with fatigue, shortness of breath, and swelling in the extremities.

· Acute dyspnea (R06.00). This condition is characterized by acute onset of shortness of breath and rarely is accompanied by edema (ICD10data.com., 2023).

 

What is your plan for this patient?

 

The plan for this patient is to complete diagnostic testing to determine the etiology for his acute shortness of breath with significant weight gain, which is most likely due to heart failure that he is at risk for. Patients with diabetes and hypertension are at high risk for developing heart failure (American Heart Association, 2023). He will need to have lab tests that include a complete metabolic panel, complete blood count, lipid panel, and hemoglobin A1c, and if available an electrocardiogram (ECG) and chest radiograph. This patient will need a referral to a cardiologist and an order for echocardiography to determine the type, severity, and degree of treatment (Ponikowski et al., 2016). Recommendations for goals of treatment include blood pressure control, treatment with statins for those at risk for coronary artery disease, counseling on lifestyle modifications, adequate control of diabetes, and treatment of other risk factors (Ponikowski et al., 2016). For symptomatic patients, it is recommended to start an ACE-inhibitor along with a beta-blocker to reduce the risk of complications (Ponikowski et al., 2016). In addition, diuretics may be considered in the presence of congestion and/or exercise intolerance (Ponikowski et al., 2016). Provide instruction for the patient to follow-up in four weeks to review the lab results and referral follow-up. Instruct to call the office if there are new or worsening symptoms or seek emergency medical attention with increased chest pain, worsening shortness of breath, or increased swelling.

 

DISCUSSION POST # 2Reply to Ashlesha

The primary cause of morbidity and mortality in diabetes is cardiovascular disease, exacerbated by hypertension. (John & Tomasz, 2018). HT and DM-II is the most common disease condition Treatment goal is maintaining glycemic goal and Lowering BP. The patient said not having medications for the last three months is a red flag, and their Vital is high VS: Temp- 98.6, HR – 112, Resp – 26, BP- 176/100, pulse ox 94%, ℅ 4/10 chest pain and more on he mentioned he gained 10 lb in 1 week. As a provider, I would like to ask the more questions like

 

What is the reason behind not getting medications?

Any chest pain, severity, and when it started, radiate or not?

Shortness of Air, time, duration, and how long started or any associated symptoms?

Recent hospitalizations and social and family history?

Level of consciousness, recent and long-term memory?

 

Complete body examination, including eye check-ups, and look for hemorrhages or papilledema, Lungs, heart sound, edema, and control BP according to American guidelines. Draw lab works for checking for Anemia, organ damage, and Glycemic control. EKG for monitoring cardiac functions to rule out emergencies for Emergency care.

 

There are three possible differentiated diagnoses:

 

Hypertensive Emergency

Hypertensive crises are a group of conditions defined by sudden and progressive elevation in systolic and diastolic BP, which usually reaches or exceeds 180 mm Hg/120 mm Hg (Alley & Schick, 2023). If not treated, hypertensive crises become a hypertensive emergency. Signs and symptoms associated with both hypertensive urgency and emergency include epistaxis, severe headache, shortness of breath, and anxiety; a hypertensive emergency can include chest pain, shortness of breath, orthopnea, fatigue, oliguria/hematuria, and vision changes. (Alley & Schick, 2023).

If the patient’s symptoms improved, I would educate them on medication compliance, take labs to assess organ function, and do close follow-ups.

Heart failure

Heart failure (HF) is a progressive clinical syndrome in which the heart fails to pump sufficient blood to the body due to a functional or structural disorder resulting from end-stage heart disease. Hypertension is a primary cause of heart failure, with DM II often contributing (Poitr et al., 2016). General symptoms of HF include fatigue, dyspnea, JVD, and fluid retention. To treat this patient, hypertensive meds would need to be given, EKG performed, and referral to cardiology once stabilized to get ECG and further workup and assessment. Treatment includes diuretics and antihypertensives.

 

Pulmonary Embolism

Pulmonary embolism (PE) is obstruction of one or more pulmonary arteries by an embolus entering the pulmonary circulation from a distant site, ranges in severity from nearly asymptomatic to fatal and is a common cause of death in hospitalized patients. (Vrind & Amandeep, 2022). The most common manifestations are dyspnea and tachypnea. The patient can develop sudden chest pain that mimics angina pectoris or myocardial infarction. Other signs and symptoms include anxiety, apprehension, tachycardia, fever, diaphoresis, hemoptysis, and syncope (Vrind & Amandeep, 2022). PEs are a common cause of death in the U.S. I would order a stat D dimer for this patient, along with a full assessment, and the patient would need to be sent out to start anticoagulation therapy.

Assessing for further labs such as Glucose monitoring, urine sample (protein in urine), and eye exams would be done to assess for further diagnosis based on findings of the physical and labs.