Posted: September 20th, 2022

Mr. EBR is a 74-year-old retired Hispanic

Mr. EBR is a 74-year-old retired Hispanic gentleman with recognized coronary artery illness (CAD), who presents to your clinic with substernal chest ache for the previous three months. It is not positional; it reliably happens with exertion, roughly one to 2 instances each day, and is relieved with relaxation, or one or two sublingual nitroglycerin (NTG) tabs. It is related in high quality, however is a lot much less extreme, than the chest ache that occurred along with his earlier inferior myocardial infarction (MI) three years in the past. Till the previous three months, he has felt properly.
The chest ache is accompanied by diaphoresis and nausea, however no shortness of breath (SOB) or palpitations. He doesn’t vomit. He denies orthopnea, paroxysmal nocturnal dyspnea (PND), syncope, presyncope, dizziness, lightheadedness, and signs of stroke or transient ischemic assault (TIA). An echocardiogram executed after his MI demonstrated a preserved left ventricular ejection fraction (LVEF). Different medical issues embrace well-controlled sort 2 diabetes mellitus (DM), well-controlled hypertension (HTN), and hyperlipidemia, with low-density lipoprotein (LDL) at aim. He additionally has stage three persistent kidney illness (CKD) and diabetic neuropathy. He not smokes and doesn’t use alcohol or leisure medication. His each day medicines embrace: Atenolol 25 mg PO bid, Lisinopril 20 mg PO bid, aspirin 81 mg PO each day, Simvastatin 80 mg PO every night, and metformin 500 mg PO bid. Sort 2 diabetes mellitus (DM), well-controlled hypertension (HTN), and excessive ldl cholesterol (hyperlipidemia), with low-density lipoprotein (LDL) at aim, are another medical issues. He additionally has persistent kidney illness (CKD) in stage three and nerve harm from diabetes. He not smokes and would not drink or do medication for enjoyable. Atenolol 25 mg PO twice a day, Lisinopril 20 mg PO twice a day, aspirin 81 mg PO every single day, Simvastatin 80 mg PO each night, and metformin 500 mg PO twice a day are all medicines he takes every single day.
Mr. EBR’s bodily examination consists of the next: top 68 inches, weight 185 lb, Blood strain (BP) 126/78, coronary heart fee (HR) 64, Respiratory fee (RR) 16, and temperature 98.6°F orally. He is alert and oriented, and in no obvious misery (NAD). His neck is with out jugular venous distention (JVD) or carotid bruits. Lungs are clear to auscultation bilaterally. Cardiovascular: regular S1 & S2, RRR, with out rubs, murmurs or gallops. Stomach has energetic bowel tones and is comfortable, nontender, and nondistended (NTND). Extremities are with out clubbing, cyanosis, or edema. Distal pedal pulses are 2+ bilaterally
What would you add to the present remedy plan? Why?
Would you discontinue any of the at the moment prescribed remedy? Why or why not?
How does the prognosis stage three persistent kidney illness have an effect on your selections?
Why is the affected person prescribed multiple antihypertensive?
What is the good thing about the aspirin remedy on this affected person?
Dialogue Question Assignment #2
Record three lessons of medicine affecting the Hematopoietic System. Record the mechanism of motion for every class of drug. Select one remedy from the three lessons and talk about what dysfunction the drug is used to deal with? How typically the remedy is given? What labs ought to get monitored whereas the affected person is taking this remedy? Your response ought to be at the very least 350 phrases.

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