I am needing a few paragraphs with scholarly references regarding the following case study. Include differential diagnoses, also include recommended treatment regimen involving diagnostics and medications administration or recommended changes in meds. and necessary follow up. It is critical that this is well back and spot on treatment plan considering this initial presentation.
George is a 76-year-old male who presents to the clinic with complaints of frequent nosebleeds (four in the past week) and easy bruising. The patient also complains of a runny nose and cough. He has a history of chronic atrial fibrillation and takes warfarin. About 3 weeks ago, the patient started taking Tagamet over-the-counter (OTC) for heartburn.
What problems with this patient can you identify? What contributes to this patient’s increased blood pressure?
Medications
Digoxin 0.25 mg QD
Cimetidine OTC BID
Pseudoephedrine SR 120 BID
Warfarin 7 mg QD
Allergies: NKDA
Physical Examination
VS: BP: 180/95, HR 75, irregularly irregular, RR 17, Wt. 95 kg
HEENT: WNL
abdomen: + Bowel Sounds
EXT: Bruising on arms and legs
NEURO: Alert & Oriented x 3
GEN: Well developed, well-nourished male.
ECG: atrial fibrillation.
Laboratory
Na 143
K 4.5
Cl 99
CO2 25
BUN 18
SCr 0.9
INR 4.8
Hct 42
Hbg 15
Digoxin 1.6ng/ml
