- All Nkda Ros Patient Refuses To Answer Questions And Tells The Medicine Team To Get Out Of My Room His Sister Who I 1 (158.34 KiB) Viewed 82 times
All: NKDA ROS Patient refuses to answer questions and tells the medicine team to "get out of my room." His sister, who is his medical power of attorney, apologizes to the team for her brother's behavior, and states that "he hates doctors" and has not received any health care that she is aware of since their father died over 30 years ago. The only reason that he is still in the hospital is that he is too weak to walk out. She states she was unaware that the patient had had an Ml in the past, and when she asked him about it, he said it was "none of your business." The physical exam and laboratory information are from 2 days ago when patient was transferred from the critical care unit-he has refused all labs since his transfer to the medicine floor. Physical Examination Gen: Unpleasant, thin, agitated Hispanic man VS: BP 163/104, P 77, RR 18, T 37.1°C; Wt 54 kg, Ht 5'7" Skin:Warm and dry, normal turgor HEENT: PERRLA; EOMI; funduscopic exam deferred; TMs intact; oral mucosa clear Neck/Lymph Nodes: Neck supple, no lymphadenopathy, thyroid smooth and firm without nodules Chest: CTA bilaterally, no wheezes, crackles, or rhonchi CV: RRR, no MRG, normal S1 and 52; no S3 or 54 Abd: (+) BS, no hepatosplenomegaly Genit/Rect: Deferred Ext: No pedal edema, pulses 2+ throughout hypertension Neuro: No gross motor-sensory deficits present Head CT: Negative for hemorrhage; evidence suggestive of small left subcortical infarct Carotid Dopplers: 50% stenosis RCA, 55% stenosis LCA Assessment Mr. Gonzalez is a thin, elderly, Hispanic man who appears older than his stated age. His sister states that although he has diabetes and hypertension, he does not take any medications that she has ever seen, and he does not monitor his blood glucose. Patient has uncontrolled diabetes, hypertension, hyperlipidemia, and history of MI (as determined by ECG reading), and is now S/P ischemic stroke, likely secondary to carotid artery disease. QUESTIONS. Using Microsoft Word, answer the following questions. 1. What drug-related problems does this patient have? 2. What laboratory values indicate the presence and severity of hyperlipidemia in this patient? 3. What are the pharmacologic and nonpharmacologic goals of treatment in this patient? 4. What pharmacotherapeutic options are available for controlling this patient's hyperlipidemia and preventing future CHDrelated events? 5. Develop a specific pharmacotherapeutic regimen for this patient. This regimen should include drug, dosage, and duration of therapy. 6. Based on your recommendations, provide appropriate counseling to this patient regarding pharmacologic and nonpharmacologic recommendations.