NR 508 Week 3 Discussions Task

NR 508 Week 3 Discussions Task

NR 508 Week 3 Discussions Task

discussion part one 

elliot is a 74 year-old male who presents to your clinic with complaints of frequent nosebleeds (4 in the past week) and several severe bruises scattered variously throughout his anatomy. the patient is also complaining of a runny nose, cough, and head/chest congestion.NR 508 Week 3 Discussions Task he has a history of chronic atrial fibrillation and is currently prescribed and taking warfarin. approximately 3 weeks previously, he started taking over-the-counter cimetidine for heartburn he was experiencing.  below is a list of the patient’s medications, his physical examination, and his laboratory findings:

medications

digoxin 0.25 mg qd cimetidine otc bid

pseudoephedrine sr 120 bid warfarin 7 mg qd

allergies: nkda 

physical examination

vs: bp: 180/95, hr 75, irregularly irregular, rr 17

weight: 95 kg

heent: wnl  NR 508 Week 3 Discussions Task

abd: + bowel sounds ext: bruising on arms and legs

neuro: alert & oriented x 3 gen: well developed, well-nourished male

ecg: atrial fibrillation 

laboratory

na 143 meq/l k 4.5 meq/l

cl 99 mmol/l co2 25 meq/l

bun 18 mg/dl scr 0.9 mg/dl NR 508 Week 3 Discussions Task

inr 4.8 hct 42%

hbg 15 mg/dl digoxin 3.8 ng/ml

what problems should be identified in this patient?

what are the precise mechanisms of action of each drug?

what do you think is contributing to the patient’s hypertension?  NR 508 Week 3 Discussions Task

are there any drug interactions that you can identify as associated with this current drug regimen, and if so how, mechanistically, are they occurring?

what is the clinical significance of these interactions?

discussion part one 

cynthia is a 65-year-old african american female who presents to the clinic for a check-up. her last examination was ~5 years ago. she has no specific, significant, or urgent complaint. she explains that her only issues are thirst, fatigue, and leg numbness and tingling, which is beginning to occur more often. you decide to do a physical exam, as well as draw labs and receive the following results:  NR 508 Week 3 Discussions Task

 social history: no smoking or alcohol consumption.

physical examination:

gen: well nourished, slightly obese female

vs: bp 180/103 hr 73 rr 13 t 98.4 weight 90 kg, height 5’6”

heent: perrla

cor: rrr, nmrg

chest: cta

neuro: monofilament test shows decreased peripheral sensation

ext: normal

laboratory (fasting):

na 139 meq/l

k 3.8 meq/l

alt 34 u/l

ca 9.1 mg/dl

cl 102 mmol/l

hco3 22 meq/l

ast 39 u/l

tp 6 g/dl

bun 33 mg/dl

scr 2.0 mg/dl

alb 4.1 g/dl

cholesterol 254 mg/dl

bg 300 mg/dl

tsh 0.12 mu/ml

ua: sg 1.013 mg/24h, ph 6.5, +++ protein

what are the major problems in this patient, and what diagnoses do these values indicate?

additionally, what is your assessment and pharmacological plan for each of these problems including the medication, dose, and mechanism of action? NR 508 Week 3 Discussions Task

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