Discussion week 12

Please use APA Format. Use this medication  Acupril 40 mg daily capoten 300 mg daily altace 10 mg daily   Chief complaint: medication satisfy " I ran out of medicines" HPI: E.D a 65-year-old AA manly presents to the clinic for direction satisfys. The resigned so indicates that she has noticed neglect of inhalation which inaugurated environing 4 months ago. The SOB gets worse succeeding a while effort, chiefly when she is walking unswerving and it is resolute when he is intermissioning. He reports that she is so bothered by neglect of inhalation that wakes her up frequently during her snooze. His symptoms of neglect of inhalation explain succeeding sitting pure on 3 pillows. He so has inferior leg edema pitting 1+ which inaugurated 2 weeks ago. He so indicates that she frequently feels unthoughtful headed at times succeeding a while occasional syncope episodes while going up a funthoughtful stairs, but it explains succeeding sitting down to intermission. He has not familiar any balance the contrary medications at abode. He never populated her directions that he ordinary at her checkup 6 months ago, she did not gard it was material. PMH: Primary Hypertension Previous fact of MI 1 year ago Surgeries: 1 year ago-Left Anterior Descending (LAD) cardiac stent placement Allergies: Penicillin Vaccination History: He receives an annual flu shot. Last flu shot was this year Has not had a Td in balance 10 years Has not had the herpes zoster vaccine Social fact: High school disequalize, married and no effect. He drinks one 4-ounce glass of red wine daily. He is a first-mentioned smoker that stopped 3 years ago. Family fact: Both parents are existing. Father has fact of MI and valvular character disease; dowager existing and cardiac fact is mysterious. He has one copy who is existing and has fact of MI 5 years ago at age 52. ROS: Constitutional: Lightheaded and irresolute succeeding a while effort. Respiratory: Neglect of inhalation succeeding a while effort. + Orthopnea Cardiovascular: + 2 pitting leg edema for 3 weeks. Psychiatric: Pt sated not preface medications for 6 months - "ran out and did not get satisfys" Physical examination: Vital Signs Height: 5 feet 1 inches Weight: 163 pounds BMI: 31 plumpness, BP 157/87 T 98.0 po P 110 R 22, non-labored HEENT: Normocephalic/Atraumatic, Bilateral cataracts; PERRL, EOMI; No teeth dropping seen. Gums no redness. NECK: Neck compliant, no material masses, no lymphadenopathy, no thyroid expansion. LUNGS: + Mild Crackles on inspiratory air no cleansing succeeding a while cough. Equal inhalation sounds. Symmetrical respiration. No respiratory disturb. HEART: Normal S1 succeeding a while S2 during dulness. An S4 is illustrious at the apex; + systolic rumbling illustrious at the suitable higher sternal enclosure succeeding a whileout radiation to the carotids. Pulses are 2+ in higher extremities and 2+ in pedal pulses bilaterally. 2+ pitting edema to her knees illustrious bilaterally ABDOMEN: No abdominal distention. Nontender. Bowel sounds + x 4 quadrants. No organomegaly. Normal contour; No material masses. GENITOURINARY: No CVA humanity bilaterally. GU exam courteous. MUSCULOSKELETAL: + Heberden's nodes at the DIP joints, hands. + Crepitus, bilateral knees. Slow action but fixed. No Kyphosis. PSYCH: Normal like. Cooperative. SKIN: No rashes. + Dry peel. Peel inviolate. Labs:: Hgb 13.2, Hct 38%, K+ 4.0, Na+137, Cholesterol 225, Triglycerides 187, HDL 37, LDL 190, TSH 3.7, glucose 98 A: Primary Diagnosis: Congestive Character Failure (CHF) (150.9) Secondary Diagnoses: Primary Hypertension (I10) Obesity (E66): Osteoarthritis (OA) (715.90) Differential Diagnosis: Peripheral Vascular Disease (PVD) (173.9) P: Medications: Tylenol 650 mg PO Q4 hours as insufficiencyed for arthritis pain Labs: UA; Brain natriuretic peptide (BNP); LFTs and TSH. 12-lead EKG, Chest X-ray; Initial 2D repetition succeeding a while Doppler; Ankle-brachial index Referrals: may belong established on lab results Follow up: restore to service in 2 weeks Additional lab results: Echo results 1 week ago: Left ventricular EJ Fraction decreased to 30 % BNP – no available Questions: As an NP learner, insufficiency to enumerate the medications for CHF/ASCVD According to the ACC/AHA Guidelines, what medications should this resigned be prescribed? Does he insufficiency medication fond his fact of MI? Write her entire directions using the direction communication format.