Mr GB, a 78-year-old British Pakistani male, is a resident in a local care home. He had a fall in the care home 4 weeks ago and had to go to hospital where he had a hip replacement. He stayed in hospital for 10 days and was recently discharged back to the care home. His current medication is listed below. Aspirin 75mg tablet: 1 OD Omeprazole 20mg capsule: 1 OD Atorvastatin 20mg tablet: 1 ON Metformin 500mg MR tablets 1 BD Sitagliptin 100mg tablet: 1 OD Amlodipine 5mg tablets: 1 OD Salbutamol 100mcg CFC free inhaler: 2 puffs QDS Trimbow® inhaler: 2 puffs BD Carbocisteine 375mg capsule: 1 TDS Paracetamol 500mg tablet: 1-2 QDS PRN Sertraline 50mg tablets: 1 OD Zopiclone 3.75mg tablet: 1 ON PRN Cavillion® durable barrier cream: Apply to affected area PRN Past medical history Eczema (since 1982) Family history Mother diagnosed with angina at age 52 years Maternal grandfather died aged 80 years following a stroke Social history Does not consume alcohol Smoker – 30 pack years (20 cigarettes per day for 30 years) Retired construction worker Is married, wife aged 72-year-old and has 3 grown up children who visit him at weekends Observations today (taken by nursing staff in care home) Blood pressure 135/83 mmHg Weight 86kg Height 1.57m Normal bowel habit and urine output Difficulty swallowing solid dosage forms for past 5 days Routine blood results from 2 weeks ago conducted by GP following discharge from hospital: Urea and electrolytes Test Result Units Reference Range Serum sodium 139 mmol/L 137 - 145 Serum potassium 4.3 mmol/L 3.5 - 5.1 Serum bicarbonate 25 mmol/L 22 - 29 Serum chloride 97 mmol/L 95 - 108 Serum urea 4.0 mmol/L 2.5 - 7.5 Serum creatinine 73 micromol/L 46 - 92 Estimated GFR 63 mL/min/1.73m2 >60 Lipid profile Test Result Units Reference Range Total cholesterol 2.9 mmol/L 2.6 - 5.5 HDL 1.1 mmol/L ≥ 1.5 Total:HDL cholesterol ratio 3.2 - ≤ 4 Triglycerides 1.4 mmol/L ˂ 1.7 LDL cholesterol 2.5 mmol/L ≤ 3 Evaluate Mr. GB’s risk of cardiovascular disease and explain why the 10 factors you identify might increase or decrease his risk.
Mr GB, a 78-year-old British Pakistani male, is a resident in a local care home. He had a fall in the care home 4 weeks ago and had to go to hospital where he had a hip replacement. He stayed in hospital for 10 days and was recently discharged back to the care home. His current medication is listed below.
Aspirin 75mg tablet: 1 OD
Omeprazole 20mg capsule: 1 OD
Atorvastatin 20mg tablet: 1 ON
Metformin 500mg MR tablets 1 BD
Sitagliptin 100mg tablet: 1 OD
Amlodipine 5mg tablets: 1 OD
Salbutamol 100mcg CFC free inhaler: 2 puffs QDS
Trimbow® inhaler: 2 puffs BD
Carbocisteine 375mg capsule: 1 TDS
Paracetamol 500mg tablet: 1-2 QDS PRN
Sertraline 50mg tablets: 1 OD
Zopiclone 3.75mg tablet: 1 ON PRN
Cavillion® durable barrier cream: Apply to affected area PRN
Past medical history
Eczema (since 1982)
Family history
Mother diagnosed with angina at age 52 years
Maternal grandfather died aged 80 years following a stroke
Social history
Does not consume alcohol
Smoker – 30 pack years (20 cigarettes per day for 30 years)
Retired construction worker
Is married, wife aged 72-year-old and has 3 grown up children who visit him at weekends
Observations today (taken by nursing staff in care home)
Blood pressure 135/83 mmHg
Weight 86kg
Height 1.57m
Normal bowel habit and urine output
Difficulty swallowing solid dosage forms for past 5 days
Routine blood results from 2 weeks ago conducted by GP following discharge from hospital:
|
Urea and electrolytes |
|||
|
Test |
Result |
Units |
Reference Range |
|
Serum sodium |
139 |
mmol/L |
137 - 145 |
|
Serum potassium |
4.3 |
mmol/L |
3.5 - 5.1 |
|
Serum bicarbonate |
25 |
mmol/L |
22 - 29 |
|
Serum chloride |
97 |
mmol/L |
95 - 108 |
|
Serum urea |
4.0 |
mmol/L |
2.5 - 7.5 |
|
Serum creatinine |
73 |
micromol/L |
46 - 92 |
|
Estimated GFR |
63 |
mL/min/1.73m2 |
>60 |
|
Lipid profile |
|||
|
Test |
Result |
Units |
Reference Range |
|
Total cholesterol |
2.9 |
mmol/L |
2.6 - 5.5 |
|
HDL |
1.1 |
mmol/L |
≥ 1.5 |
|
Total:HDL cholesterol ratio |
3.2 |
- |
≤ 4 |
|
Triglycerides |
1.4 |
mmol/L |
˂ 1.7 |
|
LDL cholesterol |
2.5 |
mmol/L |
≤ 3 |
Evaluate Mr. GB’s risk of cardiovascular disease and explain why the 10 factors you identify might increase or decrease his risk.
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