The Chart Review for Lorene M - Essay Example

"The Chart Review for Lorene M" is a perfect example of a paper on the cardiovascular system. 1. What leads demonstrate the ST Depression? aVL, V2, V3, V5, V62. Is Lorene Hypertensive per ACA 2017 Guidelines? Compare the ACA guidelines to JNC 8 guidelines and discuss what treatment you recommend to her BP and why. Lorene, with blood pressure readings of 146/90, is hypertensive as per the ANC 2017 guidelines. (Ioannidis, 2018).Lorene requires pharmacologic treatment for her BP that includes BP-lowering drugs as she has a high atherosclerotic CVD (ASCVD) risk.

(Ioannidis, 2018). This is evidenced by her age and history of Diabetes and dyslipidemia. She also due to her presentation with clinical cardiovascular disease (shortness of breath and shoulder discomfort) coupled with the average BP readings (146/90). (Ioannidis, 2018)First-line therapy, including calcium channel blockers and thiazide diuretics, should be initiated with a target goal of 130/80 as she has a history of comorbidities. (Dyslipidemia and Diabetes). Once-daily dosing where drugs are given as a combined therapy is encouraged to achieve continuous adherence.

Angiotensin-converting enzyme(ACE) inhibitors and Angiotensin receptor blockers (ARBs) may not be required initially as she is of African descent without confirmed chronic kidney disease. ("JNC 8 hypertension management guidelines released, discussed", 2014).Non-pharmacologic treatment to lower blood pressure should also be adopted. This includes the execution of weight loss exercises as she is obese. Restriction of sodium intake and the supplementation of the diet with potassium. (Whelton & Carey, 2017).3. What is the Primary diagnosis causing Lorene’s chest pain?

Include ICD 10 codes (no differentials)The primary diagnosis causing Lorene’s chest pain is acute myocardial infarction, unspecified I21.9("Code list: myocardial infarction - icd10", 2020)4. What other secondary diagnoses does Lorene have that should be addressed? (Include the rationale and a reference for your diagnoses)Insulin resistance syndrome arising from:BMI 33.5; Triglyceride levels 180 mg/dl; HDL 38; Blood pressure 146/90Including the risk factors: 60 years, History of Diabetes and Hypertension ("What are the AACE clinical criteria for insulin resistance syndrome?", 2020)5. Design a treatment plan and discuss how the intervention is applicable to Lorene's case.

Consider the following intervention: LabsComplete blood count -To determine Hemoglobin levels to rule out any anemia that could have led to shortness of breath. To determine the platelet count prior to the administration of any thrombolytic agents. To also determine the white blood cell count to rule out the possibility of an infection.Myocardial biomarkers High sensitivity cardiac troponin (hs-cTn) and Cardiac Troponin I and T –They are the choice biomarkers to determine any injury to the myocardium and, therefore, myocardial infarction owing to their high sensitivity and specificity; and facilitate risk stratification of the patient.

(Tamis-Holland et al., 2019)Creatinine kinase MB- To determine any death of myocardial cells as the levels are elevated after an injury before returning to normal levels after a few days.Serum lactate dehydrogenase levels- To facilitate confirmation of acute myocardial infarction.B type Natriuretic Peptide not for diagnosis but for facilitating risk stratification of the patient in case of acute myocardial infarction. ("Myocardial Infarction Workup: Approach Considerations, Electrocardiography, Cardiac Biomarkers", 2020)Blood glucose levels- To assess fasting or random blood glucose to determine whether the patient has Diabetes.

Lipid profile- To facilitate the choice of lipid-lowering agents to be used and measures concerning lifestyle changes to achieve target lipid levels. (Tamis-Holland et al., 2019)Urea, creatinine, and electrolyte levels- Prior to administration of medication.Durable Medical Equipment Diagnostic tests- Discuss the goal/purpose. Coronary Computed tomographic angiography(CCTA) –To non-invasively assess for coronary artery disease. (Tamis-Holland et al., 2019)Echocardiography to determine the functioning of ventricles that may be compromised by acute myocardial infarction.

Any consultation with outside provider/servicesMultidisciplinary assessment that includes:Cardiologist- For further review and assessment of the patient for early diagnosis and management.Diabetologist- For further evaluation and treatment and blood glucose control.Nutritionist- For advice on dietary intake.Medications- discuss why you chose a specific medication.Aspirin- It is useful in pain management and slowing down the formation of clots that might clog coronary arteries leading to myocardial infarction.

(Tamis-Holland et al., 2019)An antiplatelet agent such as clopidogrel –To inhibit aggregation of platelets, thereby slowing clot formation. (Tamis-Holland et al., 2019)Heparin- As antithrombin to prevent the formation of clots. Fibrinolytic such as streptokinase facilitate lysis of a clot, thereby restoring blood flow.A Vasodilator such as nitroglycerin for dilation of blood vessels, improving blood supply to the myocardium, thereby relieving any discomfort.Statins such as atorvastatin for prevention of recurrent myocardial infarctionReferrals –who and whyCardiologist – For further review and treatment.

Hypertension Specialist- Review owing to the chronicity of hypertension and its potential complications, including heart attack and stroke.Nutritionist: For nutritional advice on dietary intake.Follow up why and when Follow up after one month to evaluate blood pressure as she is at high risk for a cardiovascular event to assess drug treatment and dose evaluation and undergo repeat cardiac markers an electrocardiogram to determine cardiac risk.Education- specific and measurableGuidance on strict drug adherence to facilitate blood pressure control that includes daily drug intake).

Nutritional advice on diet intake that is healthy. Restriction of sodium intake(salt) and potassium supplementation in the diet (foods rich in potassium)Adjustment of weight-loss measures including exercise pending Daily monitoring of blood glucose levels using a glucometer as guided.Lifestyle Changes- specific to her cultural preferences and beliefsRestricting eating out and adhering to diet intake as advised.Avoiding alcohol intake (beer and wine) as it is a risk factor for cardiovascular events, hypertension, and Diabetes, given her medical history.

Avoiding smoking, including the occasional cigarette with her friends as it is a risk factor for cardiovascular diseases and given her family history.