St Thomas University Healthcare System Response
Description
- You should respond to your peers by extending, refuting/correcting, or adding additional nuance to their posts.
- All replies must be constructive and include at least two references.
Ferlanda Pierrelus.
Weekly clinical experience. Clinical Week 2
I learned this week how to include patient preferences, functional capacities, and co-morbid conditions into a treatment plan. I view the care of elderly patients as a distinct clinical challenge since older patients typically had longer medical histories, used more drugs, and responded differently to treatment than younger ones. I do, however, like the medical complexity of these cases. Another difficulty is communicating with family members about the hopelessness of care and navigating end-of-life concerns because “as a practitioner, one wants to fix things; one does not want to call it quits,” but “clearly, that has to happen.” Additionally, I recognized compliance as a barrier when patients with cognitive impairments or financial constraints cannot adhere to specific care regimens. Financial restraints on older individuals may also make navigating topics such as home nurse affordability more difficult. Practitioners need to have the fundamental skills necessary to safely, effectively, and compassionately care for older patients. It is critical to understand how to care for elderly patients.
One of the patients I encountered is a 69-year-old female originally from Cuba who has been diagnosed with hypertension, asthma, hyperlipidemia, and rheumatoid arthritis. She came to the clinic for the management of her chronic conditions. She is not in any discomfort. In terms of ADLs, she is quite functioning (6/6), with no falls, no urinary incontinence, and no memory problems. The woman indicated that she had seen her rheumatologist just a few weeks prior and had been diagnosed with Bradycardia. Her vital signs were as follow B.P.: 126/81, T: 97.1, HR: 50, R.R.: 18, Ht: 5ft 2in, Wt.: 155lbs, BMI (percentile):18.3. An EKG was performed and revealed NSR in conjunction with LAD and Bigeminy.
The condition known as ventricular bigeminy occurs when every normal sinus pulse is followed by a premature ventricular complex (PVC). So every second beat is reproduced as a premature ventricular complex ( Rai A. and Blissitt L., 2020). PVCs are common in patients suffering from heart illness caused by infection, ischemia, or inflammation. PVCs can also be caused by electrolyte imbalances, stressful situations such as hypoxia or surgery, and chemicals such as caffeine, alcohol, and cigarettes, among other things. Furthermore, activation of the autonomic nervous system might result in the formation of PVCs ( Rai A. and Blissitt L., 2020). A CMP, CBC, TSH, and lipid panel were ordered.
The differential diagnosis is Atrial fibrillation, Sinus arrhythmia, and Premature atrial contraction ( PAC ) – all of which have a very similar sensation to PVCs but are benign. A PAC has a shorter compensating pause than a PVC ( Farzam K. and Richards J.R., 2021 ).
No pharmacological treatment is necessary at this time. PVCs are benign in the majority of patients and do not require intervention. Treatment is reserved for patients with symptoms or hemodynamic impairment and may involve various antiarrhythmic drug classes or radiofrequency ablation ( Rai A. and Blissitt L., 2020).
The patient was educated in lifestyle changes:
Strategies to alleviate stress include consistently engaging in physical activity, meditation, or yoga.
Abstain from caffeine, alcohol, smoking, and recreational drugs.
Keep a log of her symptoms to help identify other causes.
The patient was referred to a Cardiologist for further diagnostic options, including echocardiography and stress testing. The patient will be seen again in four weeks. The patient was urged to return to the clinic immediately if the condition deteriorated.
References
Farzam K. and Richards J.R. ( 2021 ). Premature Ventricular Contraction. https://www.ncbi.nlm.nih.gov/books/NBK532991/ (Links to an external site.).
Rai A. and Blissitt L. ( 2020). Ventricular bigeminy after electroconvulsive therapy: a case report. Journal of Geriatric Care and Research, 2020, Vol 7, No 1. ISSN 2397-5628.
Have a similar assignment? "Place an order for your assignment and have exceptional work written by our team of experts, guaranteeing you A results."
