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2 pages/≈550 words
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APA
Subject:
Health, Medicine, Nursing
Type:
Coursework
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English (U.S.)
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Topic:

Concerns for Patient with Progressive Weakness, Cramping, and Diarrhea

Coursework Instructions:

Please answer all questions below thoroughly with evidence based citations for any and all information needed.
ST is a 5’9”, 130 kg 77 year old female presenting to you today with complaints of progressive weakness, cramping, and diarrhea lasting several days. She was seen in the local ER the day before and given IV hydration. She was diagnosed with viral gastroenteritis, had some labs drawn and was sent home. Her s/s continue and she feels like she may pass out, prompting her visit to you today.
Labs from the ER show that her INR was 5.8. She was told to hold her Coumadin last night. Additional labs from the ER show everything was normal except glucose 158, BUN 87, Creatinine 3.63, CK 194, WBC 13.2, and platelets 515.
VITALS: 112/78, HR 116, RR 18, Pulse ox 98%, Temp 98.1 orally
PMH: HTN, hyperlipidemia, afib, hyperglycemia, diverticulitis, GERD
MEDS: Warfarin 10 mg on W, 7.5 mg all other days, Verapamil 120 mg po daily, Lisinopril 5 mg po daily, Simvastatin 80 mg po qhs, HCTZ 12.5 mg qd, Omeprazole 20 mg po qam , Omega-3-fatty acids OTC qd (she reports that she takes 4 pills divided bid)
NKDA
ROS: c/o generalized weakness, States that she has a poor appetite for 3 days, c/o muscle aching in her low back and legs, Denies recent ill contacts, Denies fever, Denies abd pain except for “cramp” before he has diarrhea, Denies blood in stool.
1. What concerns do you have given ST’s presentation, PMH, and medications? What other questions would you ask ST?
2. When should her INR be checked again? How did you determine that? Discuss the half-life and mechanism of action of Coumadin. What is your plan for her Coumadin today?
3. Describe possibilities for the abnormal labs seen in the ER. What are her possible differential diagnoses? Why would the ER order a CK?
4. What treatment does this patient need? Why?
5. What changes (if any) are needed with her medication profile once she is well? Justify your changes.
6. What patient education does this patient need going forward?
7. What health maintenance would you discuss at this visit and when would you follow up next?

Coursework Sample Content Preview:

Gastroenteritis
Name
Institution
Course
Instructor
Date
Gastroenteritis
1. What concerns do you have given ST’s presentation, PMH, and medications?
Reviewing ST’s lab report shows that her INR, glucose, Creatinine, CK, BUN, WBC, and platelets are high. An INR range of 2.0 to 3.0 is an effective therapeutic array for an individual taking warfarin. A glucose level above 140 may indicate prediabetes. High BUN readings may indicate that the patient’s kidneys are not functioning normally. A high creatinine level indicates underlying problems such as dehydration. A CK level of 194 is high, which may mean the client has a muscle injury or heart damage or is prone to blood clots. High WBC is a sign of infection or inflammation in the body (Deshmukh & Merchant, 2020). The high number of platelets shows the patient is still at risk of clots in the blood vessel.
What other questions would you ask ST?
I would ask ST if she drinks alcohol; alcohol has the effect of raising INR. I would also ask her about her last meal, whether she has an increased urge to urinate, how frequently she drinks water, and if she has ever experienced the above symptoms. I would also request her HBA1C levels to identify the average blood sugar levels over the past three months. Lastly, I would ask ST about the drugs and injections she uses to control the sugars.
2. When should her INR be checked again?
ST should come for an INR checkup again after 3 days.
How did you determine that?
ST had a test the previous day, and the medics advised her to skip warfarin the following night. As a result, waiting at least 48 hours after the dose change before testing INR is essential because earlier testing may not imitate the complete response of the dose alteration (Chang et al., 2022).
Discuss the half-life and mechanism of action of Coumadin.
Coumadin has a terminal half-life of approximately one week after a single dose; the effective half-life, on the other hand, lasts anywhere from 20 to 60 hours, with a median of around 40 hours. 92% of warfarin is eliminated through urine, primarily as metabolites through glomerular filtration in the kidney (Chang et al., 2022). Coumadin blocks one of the chemicals (proteins) that utilizes vitamin K to create coagulating factors. This process upsets the coagulating system, making it take more time for the blood to clot.
What is your plan for her Coumadin today?
An abrupt stop of Coumadin can affect a patient negatively and even lead to death (Chang et al., 2022). Since St’s platelets are still high, she should continue taking Coumadin as usual and skip a single dose once every week. When she returns for the next checkup, we can decide whether to continue reducing the amount or maintain it as it is.
3. Describe possibilities for the abnormal labs s...
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