Case Study of Male Patient With history of Hypertension And Diabetes

An 89-year-old Male patient with a medical history of Hypertension, Diabetes Mellitus 2, and Hyperlipidemia presented to your clinic with c/o of “dyspnea on exertion” x 1 month. He reports noticing black tarry stools, but he thought the stools were due to his diet and he did not pay much attention. He became worried when he noticed that he was getting more tired with little or no activity.

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In Clinical practice, there might be times that you will need to discuss cases with your peers/colleagues to generate feedback and maximize optimal treatment plans for your patient. In light of this, post the answers to this discussion post on the discussion board, while responding to at least two of your peers. Case Study of Male Patient With history of Hypertension And Diabetes

Questions

As the Primary care NP seeing this patient, what other questions would you ask to elicit a good history and narrow down your differentials?
What other differentials would you consider with this patient?
What diagnostic imaging or laboratory tests would you consider with this patient? State reasons and cite references from your textbook.
What medications would you treat this patient with and state the reason for your choice of medications with reference? Also write out the prescription with the appropriate dosage, timing, and a number of days you are prescribing the medication for?
What patient education or referral would you consider for this patient?

Other Clinical Questions

First, the NP should enquire about the patient’s current medications. Drugs used to treat upset stomachs, such as bismuth subsalicylate, contain bismuth that calms the belly. However, bismuth is likely to turn the patient’s stool and tongue black. Therefore, enquiring about his current drug list would allow the NP to rule out black tarry stools as a potential drug-related side effect. The patient further reported experiencing dyspnea on exertion for the last month. Statins and beta-blockers can expose patients to dyspnea (Rasmussen et al., 2020)Case Study of Male Patient With history of Hypertension And Diabetes. This patient might be using this medication since he has a positive history of hyperlipidemia and hypertension. Thus, the NP should ask him if he is currently using statins to lower his cholesterol or if he is currently managing his high blood pressure with beta-blockers. This subjective information would allow the NP to determine if the patient is experiencing dyspnea as a drug-related side effect. Lastly, the NP should enquire if the patient has experienced other respiratory symptoms associated with COPD, such as an ongoing productive cough or wheezing.

 Potential Differentials

Gastrointestinal (GI) bleeding: This clinical feature signifies various disorders of the digestive system, such as ulcers, reflux, and cancer. It affects various parts of the digestive system (GI tract), starting from the mouth to the anus. The most common symptoms of GI include abdominal cramping, dyspnea, dark-colored stool containing blood, pale appearance, tiredness, fatigue, weakness, and vomiting with blood (James, 2021). The patient reported experiencing dyspnea for a month, accompanied by black tarry stools and increased fatigue. Thus, GI is considered the most appropriate pertinent diagnosis for this patient.

Chronic obstructive pulmonary disease (COPD) new onset: Another potential differential diagnosis is a new onset of COPD. This respiratory disorder is characterized by irritation and swelling inside the airways, limiting airflow. COPD is attributed to multiple respiratory symptoms, such as trouble breathing, daily cough accompanied by mucus, chest tightness, and a wheezing sound with breathing (Wang & Zeng, 2020)Case Study of Male Patient With history of Hypertension And Diabetes. Besides, COPD patients report general symptoms, such as feeling very tired and swelling in legs or ankles (Wang & Zeng, 2020). The patient reports experiencing dyspnea for one month and getting more tired with minimum or no activity, qualifying for COPD diagnosis. Nonetheless, COPD is ruled out due to the absence of significant pertinent positives of COPD, including a persistent productive cough, chest tightness, and wheezes.

Heart failure: Patients with cardiac disorder experience various clinical manifestations, including persistent cough, wheezing, nausea, reduced appetite, dyspnea, increased heart rate, confusion, edema, or fatigue (Bozkurt et al., 2021). Pertinent positives in this patient include dyspnea and getting more tired with minimum or zero activity. However, heart failure is dismissed due to several relevant negatives, including the absence of persistent cough, nausea, wheezing, reduced appetite, increased heart rate, confusion, or edema.

Laboratory tests

A recommended lab test is the complete blood count (CBC), which is used to assess signs of GI bleeding in the blood sample, such as anemia. A hemoglobin level below the average would depict anemia, a significant symptom of GI bleeding (Kamboj et al., 2019)Case Study of Male Patient With history of Hypertension And Diabetes.

Medications

The recommended medication is Ceftriaxone, 1 g intravenously per 24 hours, administered 1 g/day IV in a single daily dose for 7 days. This medication is recommended due to its effectiveness in treating GI bleeding in elderly adults with this condition and its high safety profile (Kamboj et al., 2019).

Patient Education

He should be educated about the importance of eating healthy diets with low carbohydrates and fats to enhance the management of his lifestyle diseases, including diabetes mellitus. Additionally, he should adhere to the DASH diet to enhance management of his hypertension Filippou et al., 2020).

References

Agunbiade, A., Routsolias, J. C., Rizvanolli, L., Bleifuss, W., Sundaresan, S., & Moskoff, J. (2021). The effects of ceftriaxone by intravenous push on adverse drug reactions in the emergency department. The American Journal of Emergency Medicine, 43, 245-248. https://www.sciencedirect.com/science/article/abs/pii/S0735675720301649

Bozkurt, B., Coats, A. J., Tsutsui, H., Abdelhamid, M., Adamopoulos, S., Albert, N., … & Zieroth, S. (2021). Universal definition and classification of heart failure: a report of the heart failure society of America, heart failure association of the European society of cardiology, Japanese heart failure society and writing committee of the universal definition of heart failure. Journal of Cardiac Failure, 27(4), 387-413. Case Study of Male Patient With history of Hypertension And Diabetes https://www.sciencedirect.com/science/article/pii/S1071916421000506

Filippou, C. D., Tsioufis, C. P., Thomopoulos, C. G., Mihas, C. C., Dimitriadis, K. S., Sotiropoulou, L. I., … & Tousoulis, D. M. (2020). Dietary approaches to stop hypertension (DASH) diet and blood pressure reduction in adults with and without hypertension: a systematic review and meta-analysis of randomized controlled trials. Advances in Nutrition, 11(5), 1150-1160.

James, W. (2021). Gastrointestinal Pathologies, Dysfunctions, and Disorders. Mosby’s Pathology for Massage Professionals-E-Book: Mosby’s Pathology for Massage Professionals-E-Book, 306.

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Kamboj, A. K., Hoversten, P., & Leggett, C. L. (2019, April). Upper gastrointestinal bleeding: etiologies and management. In Mayo Clinic Proceedings (Vol. 94, No. 4, pp. 697-703). Elsevier.

Rasmussen, D. B., Bodtger, U., Lamberts, M., Nicolaisen, S. K., Sessa, M., Capuano, A., … & Jensen, M. T. (2020). Beta-blocker, aspirin, and statin usage after first-time myocardial infarction in patients with chronic obstructive pulmonary disease: a nationwide analysis from 1995 to 2015 in Denmark. European Heart Journal-Quality of Care and Clinical Outcomes, 6(1), 23-31. https://academic.oup.com/ehjqcco/article/6/1/23/5273489

Wang, K., & Zeng, R. (2020). Cough and Expectoration. Handbook of Clinical Diagnostics, 27-29 Case Study of Male Patient With history of Hypertension And Diabetes