新型抗凝药病例讲解PPT课件

• History of Present Illness
➢Patient is 75-year-old male with hypertension, chronic kidney disease, osteoarthritis, and a remote history of prostate cancer.
Edmond P. I am having trouble keeping up with my medications.
What are the next steps?
1
Introduction
Age: 75 years Weight: 70.00 kg BMI: 23.7
Gender:Male Height: 172 cm Allergies: None
3
Introduction
• History of Present Illness
➢He denies any current palpitations, shortness of breath, chest pain, neurological symptoms, or other acute issues.
➢Six months ago, he was seen by his PCP for ongoing palpitations without other symptoms; echocardiogram was normal (including EF of 55% and normal valves); he was diagnosed with atrial fibrillation and started on warfarin (anticoagulation) and metoprolol (rate control).
6
PAST VISITS
DATE
RR
KG
BMI
TODAY
18
70
23.7
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Feb 21, 2018
21
70
23.7
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7
TESTS
• PAST TESTS
Date
21-Feb-18 21-Feb-18 21-Feb-18 21-Feb-18 21-Feb-18 21-Feb-18
5
Physical Examination Notes
A. GENERAL:Well-developed, well-nourished male in no distress B. HEENT: Acephalic; atraumatic, C. EOMI, normal oropharynx D. NECK: Normal thyroid, no lymphadenopathy, no carotid bruits E. LUNGS: Clear to percussion and auscultation; without rales, rhonchi, or wheezes F. CARDIAC: Irregularly irregular rhythm, no murmurs, gallops or rubs G. ABDOMEN: Soft, non-tender; no masses or hepatosplenomegaly H. EXTREMITIES: No edema, mild bruising I. NEURO: Alert, fluent, moves all four extremities normally
➢He notes moderate chronic pain in his hips and knees when walking. ➢He has no history of abnormal bleeding. ➢He has an orthopedics appointment scheduled in the near future to
➢He has trouble going to the lab every few weeks for the INR monitoring required for warfarin therapy.
➢ He missed his last two lab appointments altogether andin so he self-discontinued this medication a few days ago.
discuss further management of his osteoarthritis pain
4
Introduction
Family and Social History
➢ Wife Nadine, helps him get around the house. 3 children and 17 grandchildren live a few hours away but visit often. Patient has difficulty driving without assistance, which is beyond the capabilities of his wife. His immediate family helps with large household tasks and running errands when they come to visit.
2
Introduction
• History of Present Illness
➢He came in today to talk about his difficulties keeping up with his warfarin therapy.
➢He has some osteoarthritis-related mobility limitations that affect his hips and knees most prominently, and he finds travel somewhat onerous.