Case Study 6 Essay examples

1288 Words Jul 22nd, 2015 6 Pages
You are working in the internal medicine clinic of a large teaching hospital. Today your first patient is 70-year-old J.M, a man who has been coming to the clinic for several years for management of CAD and HTN. A cardiac catheterization done a year ago showed 50% stenosis of the circumflex coronary artery. He has had episodes of dizziness for the past 6 months and orthostatic hypotension, shoulder discomfort, and decreased exercise tolerance for the past 2 months. On his last clinic visit 3 weeks ago, a CXR showed cardiomegaly and a 12-lead ECG showed sinus tachycardia with left bundle branch block. You review his morning blood work and initial assessment.

Laboratory Testing:
Chemistry

H

Initial Assessment:

Complains of
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Inhibits sodium-potassium ATPase, increasing cardiac output and increases force of contraction. This medication is utilized in HF

Potassium Chloride: Maintain potassium and cardiac contractions. Treatment for hypokalemia.

6. When you go to remove the medication in the automated dispensing machine, you see that Carvedilol (Coreg) is stocked, will you give it to J.M. Explain.

Carvedilol is used in the treatment of HF as well as HTN, both of which J.M have. This medication would benefit J.M, however this medication is contraindicated in patients with severe heart condition and may cause bundle branch blocks, which J.M recently had. I would not give this medication to J.M for this reason.

7. As you remove the digoxin tablet from the automated dispending machine, you note that the dosage on the label is 250mcg. How many tablets would you give?

8. Based on the new medication orders, which blood test or tests should be monitored carefully? Explain your answer.

Digoxin levels need to be monitored for “dig” toxicity. J.M is at a higher risk for toxicity not only because of his increased age, his medication regiment is intended to cause potassium changes. These changes can cause patients to be more sensitive to Digoxin.

Electrolytes (Sodium, Potassium) need to be monitored to prevent hypokalemia. When electrolyte imbalances occur this will affect the heart by increasing the HR and create dysrhythmias.

9. When

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