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ACC guidelines for primary care aging adult

ACC guidelines for primary care aging adultACC guidelines for primary care aging adultHPI: BJ, a 68-year-old AA female presents to the clinic for prescription refillsPlease review the following case.Chief complaint: medication refill ”ran out of medicine”HPI: BJ, a 68-year-old AA female presents to the clinic for prescription refills. The patient also indicates that she has noticed shortness of breath which started about 3 months ago. The SOB gets worse with activity, especially when she is playing with her grandchildren but it goes away once she sits down to rest. She reports that she is also bothered by shortness of breath that wakes her up at night, but it resolves after sitting upright on 3 pillows. She also has lower leg edema which started 1 week ago. She also indicates that she often feels light headed and faint while going up the stairs, but it subsides after sitting down to rest. She has not tried any OTC medications at home. She never filled her prescriptions, which she received at her checkup 6 months ago, she did not think it was important.PMH:HypertensionPrevious history of MI in 2010Surgeries:2010-Left Anterior Descending (LAD) cardiac stent placementORDER A PLAGIARISM-FREE PAPER HEREAllergies: AmoxicillinVaccination History:She receives an annual flu shot. Last flu shot was this yearHas never had a PneumovaxHas not had a Td in over 20 yearsHas not had the herpes zoster vaccineSocial history:High school graduate, a widow with one son who loves out of state. She drinks one 4-ounce glass of red wine daily. She is a former smoker that stopped 20 years ago.Family history:Both parents are deceased. Father died of a heart attack; mother died of natural causes. She had one brother who died of a heart attack 20 years ago at the age of 52.ROS:Constitutional: Lightheaded and faint with exertion.Respiratory: Shortness of breath with exertion (playing with grandchildren and stairs). + OrthopneaCardiovascular: + leg and ankle swelling x 1 weekPsychiatric: Not taking medications for 6 months – ”ran out”Physical examination:Vital SignsHeight: 5 feet 2 inches Weight: 163 pounds BMI: 29.8 BP 150/86 T 98.0 po P 100 R 22, non-labored; UrHEENT: normocephalic, symmetric. Bilateral cataracts; PERRLA, EOMI; Upper and lower dentures in place a fitting well. No tinnitusNECK: Neck supple; non-palpable lymph nodes; no carotid bruits. Thyroid non-palpableLUNGS: inspiratory cracklesHEART: Normal S1 with S2 split during expiration. An S4 is noted at the apex; systolic murmur noted at the right upper sternal border without radiation to the carotids.ABDOMEN: Normal contour; active bowel sounds all four quadrants; no palpable masses.ACC guidelines for primary care aging adultPV: Pulses are 2+ in upper extremities and 1+ in pedal pulses bilaterally. 2+ pitting edema to her knees noted bilaterallyGENITOURINARY: no CVA tenderness; not examinedMUSCULOSKELETAL: Heberden’s nodes at the DIP joints of all fingers and crepitus of the bilateral knees on flexion and extension with tenderness to palpation medially at both knees. Kyphosis and gait slow, but steady.PSYCH: normal affect; her Mini-Cog Score is 3. Her PHQ-9 score is 22.SKIN: Sparse hair noted on lower legs and feet bilaterally with dry skin on her ankles and feet.Labs:: Hgb 12.2, Hct 37%, K+ 4.2, Na+140, Cholesterol 230, Triglycerides 188, HDL 37, LDL 190, TSH 3.7, glucose 98A:Primary Diagnosis:ACC guidelines for primary care aging adultCongestive Heart Failure (CHF) (150.9)Secondary Diagnoses:Primary Hypertension (I10)Depression F32.3:Obesity (E66):Osteoarthritis (OA) (715.90)Differential Diagnosis:Peripheral Vascular Disease (PVD) (173.9)P:Medications:Sertraline 25 mg. Take 1 tab PO QD disp#30, 1 refillTylenol 650 mg PO Q4 hours as needed for arthritis painLabs: UA; Brain natriuretic peptide (BNP); LFTs and TSH.12-lead EKG, Chest X-ray; Initial 2D echo with Doppler; Ankle-brachial indexEducation:Congestive heart failure is caused by the inability of your heart to pump blood effectively enough to meet the demands of your body. If you think of your body as any other pump, if fluid does not move well through the system, then it will back up into other spaces. When blood backs up it puts a lot of pressure on the blood vessels, which forces fluid to leak out into the nearby tissue. With CHF, this fluid usually moves into your lungs, legs, or abdomen.The signs of worsening CHF include decreased energy level, shortness of breath during your normal routine, increased swelling to your legs and feet, your clothes feel tight, or a wet sounding cough. Call the office if these symptoms occur.ACC guidelines for primary care aging adultWeigh yourself every morning at the same time. If you have a 3 pound weight gain in 24 hours, or a 5 pound weight gain over a week, you should call the office.Exercise and maintaining a normal weight is very important. You should try to exercise at least 20-30 minutes a day, more if possible. Start slow with walking.Decrease your salt intake. Do not add any extra salt to foods. Salt makes you retain fluid, and it makes you want to drink more fluid. Avoid fast food and prepared food as they are usually very high in sodium.If you notice your legs swelling, elevate them up and rest. Do not drink alcohol and continue to avoid smoking or second hand smoke.Take your medications as directed, with water. Do not stop them abruptly or skip doses.I have started you on a medication for depression. It can take 2 weeks to start to feel it working and up to a month until you can fell the real benefits.ACC guidelines for primary care aging adultIf you start to feel more depressed, like you want to harm yourself or others, please contact me right away or got to the ER.Referrals: may refer based on lab resultsFollow up: return to office in 2 weeksAdditional lab results:Echo results: LVEF 39%BNP – 682 pg/mlQuestions: You determine the medications for CHF/ASCVDAccording to the ACC/AHA Guidelines, what is BJ’s heart failure stage?According to the ACC/AHA Guidelines, what medications should BJ be prescribed? Does she need medication given her history of MI? Write her complete prescriptions using the prescription writing format. ACC Guidelines for Primary Care Aging AdultToday’s population is faced with the challenge of managing heart failure. The American College of Cardiology (ACC) has documented guidelines that clinicians should use in the treatment of heart failure. These guidelines were developed with the aim of ensuring consistency in the treatment process in order to help the affected patients to achieve positive health outcomes. The ACC works in collaboration with the American Heart Association (AHA) to reduce the heart failure prevalence as well as the rates of mortality as a result of the disease. Greater adherence to the ACA guidelines has been associated with an increase in the survival rates for the heart failure patients (American Heart Association, 2017). To effectively use the guidelines, nurses must first identify the heart failure stage for the patient and be in a position to document the right prescription.ACC guidelines for primary care aging adultOverview of the CaseIn the given case study, patient BJ who is currently aged 68 years has reported to the clinic in order to obtain a medication refill. She has also reported that she has been experiencing shortness of breath for the past three months. The shortness of breath gets worse with activity and reduces with rest. According to BJ, she cannot sleep comfortably at night due to the shortness of breath, but the problem resolves on sitting upright on 3 pillows. The patient also states that she has an edema on the lower leg which started a week ago. Besides, experiences breathing difficulty when she is going up the stairs. This normally resolves when she sits down to rest. BJ received her final prescription when she went for a check-up 6 months ago. She has not refilled the prescription and has tried any over-the-counter (OTC) medications. The nurse who is providing care to BJ must determine her heart failure stage and prescribe the right medication for her to refill her initial prescription.ACC guidelines for primary care aging adultHeart Failure Stage            Considering the given subjective and objective data, it can be concluded that BJ is at stage C of heart failure. Such a conclusion has been made because BJ currently presents with symptoms related to shortness of breath which is usually an indication of stage C heart failure. The symptoms include leg edema, S4 sound, orthopnea, sleep-disordered breathing, anemia, and a history of hyperlipidemia, hypertension, and MI. Furthermore, BJ has low density and high density lipoproteins (LDL and HDL) which suggests that she has a high cardiac risk.ACC guidelines for primary care aging adultBefore prescribing medication for BJ, the clinician should conduct a number of diagnostic tests in order to determine how her heart is functioning. The laboratory tests to be performed include CMP, complete UA, ECG, Iron level for anemia, lipid panel for LDL and HDL, CBC, K+, and an x-ray for the chest. The laboratory tests will help the clinician to determine if various organs including the heart, kidney, and liver are functioning properly (Goroll, A., & Mulley, 2009). Besides, they will help the nurse to determine the cholesterol level and the presence of any other infection that may be contributing to BJ’s poor health. Again, by performing the ECG, the nurse will be able to assess heart function and to establish the severity of heart damage if any. Moreover, an echocardiogram will enable the clinician to determine the performance of the heart chamber, the heart valves, and the heart muscles (American Heart Association, 2017; Goroll, A., & Mulley, 2009).ACC guidelines for primary care aging adultMedication            The clinician must refer to the ACC guidelines when selecting the right medication for BJ’s prescription refill. The Angiotensin Receptor Blockers (ARBs) are the best pharmacological substances for the patient. As documented in the ACC guidelines, the angiotensin receptor blockers have for a long time been used to effectively treat patients with heart failure. The drugs has significantly reduced mortality rates due to the disease. In addition to improving symptoms of heart failure, ARBs are associated with limited cases of an angioedema and severe cough in the treated patients (American Heart Association, 2017; Goroll, A., & Mulley, 2009). It is important to note that BJ needs these medications considering her MI. The complete prescription for the patient is as follows;Rx: Coreg 6.25 mg; Sig: take one tablet by mouth daily; Disp: 30; Refills: 0.ACC guidelines for primary care aging adultAfter documenting the prescription above, the clinician must ensure that the patient perfectly understands its contents and the meaning of all the abbreviations used. Additionally, the nurse should educate the patient about the significance of adhering to the medications and the importance of discussion her health status with family members (Elliott et al., 2017).In summary, effective treatment of patients with heart failure can be achieved by using the clinical practice guidelines that have been documented by the American College of Cardiology (ACC). The nurse must be careful to select medications as per the guidelines and by considering the patient’s heart failure stage. Notably, the nurse must use the correct format when writing the prescription for the patient.ACC guidelines for primary care aging adult ReferencesAmerican Heart Association. (2017). 2017 ACC/AHA/HFSA focused update of the 2013 ACCF/AHA guideline for the management of heart failure. Retrieved from, R. et al. (2017). Medicines management, medication errors and adverse medication events in older people referred to a community nursing service: A retrospective observational study. Drugs-Real World Outcome, 3(1), 13-24. doi:  10.1007/s40801-016-0065-6Goroll, A., & Mulley, A. (2009). Primary care medicine: Office evaluation and management of the adult patient. Philadelphia, PA: Lippincott Williams and Wilkins. ACC guidelines for primary care aging adult

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