Which information in Mrs. Neal's history places her at a higher risk for falls? Select all that apply. Age Lives alone Diuretic use Being afraid to fall again Taking antihypertensive medication CASE STUDY DETAILS
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Mr. J. is a 75-year-old widower and quite active. He has a history of elevated blood pressure, which he controls effectively with diet and exercise at the local community center. Recently he has been neglecting his appearance and hygiene and his friends at the community center have noted his absence from many activities. He has missed appointments with his nurse practitioner at the local clinic stating that he thought the appointments were "next week." While playing cards with his friends, he becomes angry and throws his cards down, saying, "This is a stupid game!" His adult daughter visits him while on a business trip in a nearby city and notes his confusion and irritability. When the nurse practitioner refers him to a gerontology assessment unit, a preliminary diagnosis of early Alzheimer's disease is made. 1. What are the possible causes of Mr. J.'s irritability? 2. How will early Alzheimer's disease affect his ability to control his weight and blood pressure as he has done in the past? 3. What problems does Mr. J. face if medication is prescribed for his elevated blood pressure? 4. What potential complications could occur if Mr. J.'s weight increases to 20% over the desirable weight?
Suman K.
Medical History: Mr. AB, a 60-year-old Caucasian male, comes to your fitness center for an exercise program. He is apparently healthy but has a 15-year history of hypertension. His goal is to improve his health and fitness and reduce his risk for heart disease. In the past, he did heavy resistance training and powerlifting. At present, he has a body mass index of 31 kg·m–2. His medications include aspirin (325 mg daily) and atenolol (50 mg daily). He has a family history of premature CHD; his low-density lipoprotein (LDL) cholesterol is elevated (165 mg·dl–1); his resting BP is 148/88 mmHg; and his resting heart rate is 60 beats·min–1. He drinks three or four cans of beer with dinner each evening. Diagnosis: Mr. AB has a lengthy history of hypertension. Additional risk factors include obesity, age, family history, dyslipidemia, sedentary lifestyle, and elevated alcohol consumption. Exercise Test Results: During a recent maximal exercise test, Mr. AB exercised for 6 minutes using the Bruce treadmill protocol and achieved a maximum heart rate of 130 beats·min–1 and BP of 240/90 mmHg. He did not develop any significant arrhythmias or ST-segment changes. Exercise Prescription: Mr. AB achieved 81% of his age-predicted maximal heart rate (HRmax). The test was negative for underlying cardiovascular ischemia. The initial prescription should be set at a modest intensity (40% VO2R), and emphasis should be placed on building exercise duration to increase energy expenditure. Non-weight-bearing activities should be emphasized initially to minimize the risk of musculoskeletal injury. Questions: 1. Is it necessary for Mr. AB to exercise at high intensity to help manage his hypertension? 2. How will atenolol (a beta-blocker) affect the prescription of a target heart rate range for Mr. AB? 3. What is an appropriate aerobic exercise prescription for Mr. AB? 4. What advice would you give Mr. AB about going back to heavy resistance training and powerlifting? 5. What additional lifestyle modifications should be discussed with Mr. AB to optimize his BP control?
Sri K.
Yvonne Chen is an 86 year old who has been bought into the emergency department by her daughter. Mrs Chen normally lives alone, and was recently released from hospital following admission for exacerbation of heart failure. Her daughter, Jane is concerned about her mother's generalised weakness, aches and pains, intermittent shortness of breath and poor appetite. Her daughter believes she has lost about 10 kg since her release from hospital. Mrs Chen occasionally complains of nausea, and has vomited once or twice in the last 24 hours. On assessment in the ED, Mrs Chen was alert and orientated, her respiratory rate was 22 with oxygen saturation of 93% on room air, her heart rate was 39 with an irregular rhythm and a systolic murmur (an ECG shows atrial fibrillation, but no acute changes), her blood pressure was 139/46, her temperature was 37.5. ​​​​​​​ Yvonne's past medical history includes: end stage congestive heart failure, hypertension, atrial fibrillation, aortic stenosis, age-related macular degeneration, chronic renal insufficiency, dysphagia, and a previous right total hip replacement. 1. Yvonne's current medications include, Amiodarone 200 mg oral daily, Warfarin 2.5mg oral every evening, Digoxin 125mcg oral daily, Esomeprazole 20mg oral daily before breakfast, Carvedilol 3.125mg oral twice daily, Furosemide 20mg oral daily, Potassium chloride 600mg oral daily. Following admission her blood results reveal INR 6.5, potassium of 5.2 mmol/L, digoxin level of 2.4 ng/mL, creatinine level of 2.2 mg/dL and a Blood Urea Nitrogen (BUN) of 48 mg/dL. Given the assessment and your knowledge of Mrs Chen's past medical history what factors may be contributing to her presenting signs and symptoms? (Note: Your answer should take into consider Yvonne's medical history and all medication received. Remember to incorporate latest evidence based practice in your answer). 2. Given your concerns above - what changes do you think might need to be made to her current medications? (Note: Your answer should take into consider Yvonne's medical history and all medication received. Remember to incorporate latest evidence based practice in your answer)​.
Akash M.
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