Mr. Russell is a 73-year-old male who presents to your clinic with complaints heart palpitations
and light headedness on and off for the past 3 months. He has a history of hypertension and is
currently prescribed HCTZ.
...
Mr. Russell is a 73-year-old male who presents to your clinic with complaints heart palpitations
and light headedness on and off for the past 3 months. He has a history of hypertension and is
currently prescribed HCTZ. He also is complaining of heartburn and belching after a large meal.
Vital Signs: B/P 159/95, Irregular HR 88, Resp. 22, Weight 99 kilograms (217 lbs)
Lower extremities with moderate 3+edema noted in left leg, 2 + edema in right leg, ABD + BS,
Neuro AOX3,
Labs: NA 143mEq/L (135-145), CL 99 mmol/L (96-106) BUN 18mg/dL (7-20), Hbg 15 (13-17),
Total cholesterol -TC 234 mg/dL (less than 200), LDL 137 mg/dL (less than 100), HDL 35 mg/dL
(40-50), triglycerides 241mg/dL (less than 150).
What are your treatment goals for Mr. Russell today?
Address concerning vital signs of HTN, irregular HR, palpitations, edema, lab values,
heartburn/belching, preventative measures and education.
Electrocardiogram (EKG) initially to rule life-threatening arrhythmias that may alter course of
treatment or that need to be addressed immediately and/or need cardiology consult. Wilken
(2016) supports EKG’s to helpfully evaluate palpitations and considers potentially essential for
diagnosis in a primary care setting. It is also the first test used for therapeutic decision making
for progression and/or stabilization of HTN impact (Woo & Robinson, 2016)
Address HTN using the JNC 8 guidelines for HTN, and addressing potentially complications of
undiagnosed HF including peripheral edema. The JNC 8 guidelines recommend in patients
greater than 60 years of age (Mr. Russell is 73), without diabetes or chronic kidney disease to
have blood pressure reading less than 150/90 (Elam, 2017). Mr. Russell currently fits into
Hypertension stage I due systolic BP 140-159 and diastolic BP 90-99 per the JNC 7 guidelines
that were unchanged in the JNC 8 guidelines (Woo & Robinson, 2016). . Echocardiogram and
doppler flow studies are needed for diagnostic purposes for suspicious HF and/or cardiac
dysfunction will need to be scheduled as soon as possible in an outpatient setting (Woo &
Robinson, 2016).
The recommended guidelines from the American College of Cardiology and American Heart
Association (ACCF/AHA) include laboratory values needed for HF that include renal function,
complete blood count, urinalysis, serum electrolytes including magnesium and calcium,
hemoglobin A1c, liver function tests, fasting lipid levels, BNP, troponin T, and thyroid stimulating
hormones (Woo & Robinson, 2016). These values are for screening and diagnosis of HF and
organ function. These tests should be completed day of office visit prior to medication
administration.
Identify lifest
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