Question

Cardiovascular Case Study

Scenario

Joan is a 78 year old female who is scheduled with you today because she needs refills for her blood pressure medication. When you look at her record you notice that she has not been in for 14 months. You notice that there are a number of missed appointments on record, but that she has been calling in for refills for her meds. During the last call the office nurse told her she would need to come in for a visit to obtain the refills. Her record indicates that her medications at her last visit included lisinopril/hctz 10/12.5 and simvastatin 20mg daily.

She reports that she takes her blood pressure medication “most of the time” but doesn’t take the simvastatin regularly because her neighbor developed liver problems from it. She remembers in the past that she was told she has a “touch of sugar”. She feels good but she wants to get checked out and wants to “get her act together” and start taking care of herself because her brother, who is 48, just found out that he has “clogged arteries.” She would like some help with quitting smoking as well. She also tells you that she had a “little heart attack” when she was 72.

Her vital signs are: BP: 168/94, pulse: 84 and regular, resp: 18

Remember that the case study needs to include a minimum of two evidence-based practice articles to support your work. All papers must conform to the most recent APA standards.

Address these questions as well:

1. What additional subjective information do you need to obtain?
2. What other objective information do you need to obtain?
3. What labs/diagnostic tests are indicated and why?

You conduct the visit. The review of systems and physical exam, with the exception of her blood pressure and weight, are normal.

The diagnostic tests and laboratory test you ordered were normal with the exception of the following:

• EKG – Afib with a rate of 82
• Fasting Lipids: Total cholesterol: 242
• LDL: 176
• HDL: 36
• Trigs: 250
• Fasting glucose: 162
• Follow up HgbA1c done the following day - 7.3

4. What is your complete diagnosis list for this patient?
5. How will you manage her blood pressure?
6. How will you manage her cholesterol labs above?

During the follow up visit, you discuss the labs above and their implications.

7. What will you tell her?
8. What is Joan’s CHADS-Vasc score? What is her yearly risk for stroke? What treatment will you recommend based on her score and why?
9. Please estimate Joan’s 10-year ASCVD.
10. Please provide a plan of care that takes into account her top four current health problems from your prioritized problem list and develop her health promotion/disease prevention needs.

Answer 1

From the above case the subjective information to be obtained is the CT angiography . Objective question be asked is about previous history of stroke or thromboembolism. Lab test to be needed are echocardiography, lipid profile Fasting blood sugar , post prandial blood sugar and hba1c .

As from above lab tests the patient is hypertensive , diabetic and hyperlipidemic and very much prone to stroke

For blood pressure management I will add either Angiotensin 2 receptor blocker telmisartan 40mg and a diuretic furosemide 40mg .

For the cholesterol management I will add rosuvastatin 40 mg and strict control of diet .

i will tell her to control her diet strictly no to smoking and oily fried foods , regular brisk walk or excercise for atleast 20 min a day.

Her CHADSVASC score is 7

C- congestive heart failure -1

H - hypertension (140/90mmhg) -1

A- age ( >_75 yrs ) -2

D- diabetic

S- prior stroke -2

V - vascular disease (peripheral artery disease )-1

A- age (65-74yrs )

Sc- sex category ie female -2

Her annual risk of stroke is approx 4%

I will prescribe her with anticoagulants like dabigatrin or rivaroxaban because of high risk of stroke .

Her 10 year stroke risk is 7% which is quiet high .
So according to above the plan of care for her will be -

1) regular blood sugar checkup

2) frequent visits with the doctor periodically get her check up done

3) quit smoking

4) reduce salt intake and add green leafy vegetables to her diet

5) start brisk walk .