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Author Question: You are working in the internal medicine clinic of a large teaching hospital. Today your first ... (Read 116 times)

deesands

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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 coronary artery disease (CAD) and hypertension (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 chest x-ray (CXR) examination revealed cardiomegaly, and a 12-lead
  electrocardiogram (ECG) showed sinus tachycardia with left bundle branch block (LBBB). You review J.M.'s
  morning blood work and initial assessment.
 
  Laboratory Results
  Chemistry
  Sodium 142 mEq/L
  Chloride 95 mEq/L
  Potassium 3.9 mEq/L
  Creatinine 0.8 mg/dL
  Glucose 82 mg/dL
  BUN 19 mg/dL
  Complete Blood Count
  WBC 5400/mm3
  Hgb 11.5 g/dL
  Hct 37
  Platelets 229,000/mm3
  Initial Assessment
  Complains of increased fatigue and shortness of breath, especially with activity, and waking up
  gasping for breath at night, for the past 2 days.
  Vital Signs
  Temperature 97.9  F (36.6  C)
  Blood pressure (BP) 142/83 mm Hg
  Heart rate 105 beats//min
  Respiratory rate 18 breaths/min
 
  As you review these results, which ones are of possible concern, and why?

Question 2

After taking the second NTG SL tablet, B.T. complains of a terrible headache and worries that he is getting worse.
 
  What is happening, and what should you tell him?


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jaaaaaaa

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deesands

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Reply 2 on: Jun 25, 2018
Thanks for the timely response, appreciate it


amynguyen1221

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Reply 3 on: Yesterday
Excellent

 

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