Question: the home health nurse visits a 76yearold woman m j...
The home health nurse visits a 76-year-old woman, M. J., who lives on the side of a very steep mountain, once a week for the last year. M. J. has diabetes mellitus, hypertension and hyperthyroidism and is in atrial fibrillation. She stopped smoking 5 years ago but before that she smoked one-half pack a day. Her last week laboratory test results include internal normalized ration (INR) 1.7, sodium 129, potassium 5.8, chloride 102, carbon dioxide 20, haemoglobin A1C (HgbA1C) 8.3, blood urea nitrogen (BUN) 45, creatinine 1.5, Hgb 10.1, platelets 215,000, leucocyte count 6.8 and glucose 289.
It is noted by the home health nurse that M. J. had a 5-min spell of visual loss in her right eye which has not recurred; however, during this period, the patient felt her left leg and left hand “funny,” and her left leg and foot got so weak that she was unable to walk. She has a heart murmur which is loudest over the right sternal border and more prominent during the systolic phase. M.J. also hears bruits on both sides of her neck with the right side being louder than the left. Her vital signs include blood pressure (BP) 135/72 (in right arm) and 110/66 (in left arm), irregular heart rate, i.e. 75 to 90 beats per minute and 90% to 92% oxygen saturation at room temperature.
Q1 what is the main concerns regarding MJ as a provider?
Q2 based on the lab results given what changes would you make in her medication profile?