PATIENT PRESENTATION Chief Complaint ‘I just fell downI don’t know what happened, just fix it!’ HPI Michael Gonzalez is a 67-year-old Hispanic man…

Question PATIENT PRESENTATIONChief Complaint”I just fell down—I don’t know what happened, just fix it!”HPIMichael Gonzalez is a 67-year-old Hispanic man who has just been transferred to the medicine unit fromthe ICU. Last week he was transported by ambulance to the emergency department after his sister foundhim unresponsive on the floor. He was down for an unknown length of time. A CT scan at admission wasnegative for hemorrhage but verified a small left subcortical infarct. There was also ECG evidence of aprior MI.PMHType 2 diabetesHypertensionFHFather had Type 2 diabetes and hypertension; deceased from MI age 54Mother (deceased) had Alzheimer’s diseaseSister has Type 2 diabetes, hypertensionSHUnmarried, lives with his sisterETOH: patient admits to ~12 pack beer each dayTOB: 2 ppd × 52 yearsDenies illicit drug useMeds :NoneOTC/Herbal: NoneAll: NKDAROSPatient refuses to answer questions and tells the medicine team to “get out of my room.” His sister, whois his medical power of attorney, apologizes to the team for her brother’s behavior, and states that “hehates doctors” and has not received any health care that she is aware of since their father died over 30years ago. The only reason that he is still in the hospital is that he is too weak to walk out. She states shewas unaware that the patient had had an MI in the past, and when she asked him about it, he said it was”none of your business.” The physical exam and laboratory information are from 2 days ago when patientwas transferred from the critical care unit—he has refused all labs since his transfer to the medicine floor.Physical ExaminationGen: Unpleasant, thin, agitated Hispanic manVS: BP 163/104, P 77, RR 18, T 37.1°C; Wt 54 kg, Ht 5’7”Skin:Warm and dry, normal turgorHEENT: PERRLA; EOMI; funduscopic exam deferred; TMs intact; oral mucosa clearNeck/Lymph Nodes: Neck supple, no lymphadenopathy, thyroid smooth and firm without nodulesChest: CTA bilaterally, no wheezes, crackles, or rhonchiCV: RRR, no MRG, normal S1 and S2; no S3 or S4Abd: (+) BS, no hepatosplenomegalyGenit/Rect: DeferredExt: No pedal edema, pulses 2+ throughout hypertensionNeuro: No gross motor-sensory deficits presentHead CT: Negative for hemorrhage; evidence suggestive of small left subcortical infarctCarotid Dopplers: 50% stenosis RCA, 55% stenosis LCAAssessmentMr. Gonzalez is a thin, elderly, Hispanic man who appears older than his stated age. His sister states thatalthough he has diabetes and hypertension, he does not take any medications that she has ever seen, andhe does not monitor his blood glucose. Patient has uncontrolled diabetes, hypertension, hyperlipidemia,and history of MI (as determined by ECG reading), and is now S/P ischemic stroke, likely secondary tocarotid artery disease.QUESTIONS. Using Microsoft Word, answer the following questions.1. What drug-related problems does this patient have?2. What laboratory values indicate the presence and severity of hyperlipidemia in this patient?3. What are the pharmacologic and nonpharmacologic goals of treatment in this patient?4. What pharmacotherapeutic options are available for controlling this patient’s hyperlipidemia andpreventing future CHDrelated events?5. Develop a specific pharmacotherapeutic regimen for this patient. This regimen should include drug,dosage, and duration of therapy.6. Based on your recommendations, provide appropriate counseling to this patient regardingpharmacologic and nonpharmacologic recommendations. Health Science Science Nursing PHARMACY 5A Share QuestionEmailCopy link Comments (0)