Question: What's wrong with this patient? What therapy should be suggested for this disease? Prognosis in an Elderly Female, by V. Dimov, M.D., Reviewer: S. Randhawa, M.D. A 96-year-old African American female (AAF) was admitted from a nursing home with complaints of abdominal pain, nausea and vomiting (N/V), dizziness, confusion and double vision for 5 days. She was discharged from the hospital just 4 days ago. Digoxin was started during that previous hospitalization for control of tachycardia in atrial fibrillation. One day prior to discharge, digoxin level was 1.8 mg/mL and digoxin dose was decreased to 125 mcg PO Q 48 hr. Past medical history (PMH): Hypertension, atrial fibrillation, coronary artery disease, stroke, congestive heart failure. Medications: Metoprolol, digoxin,
Question: What's wrong with this patient? What therapy should be suggested for this disease?
Prognosis in an Elderly Female, by V. Dimov, M.D., Reviewer: S. Randhawa, M.D.
A 96-year-old African American female (AAF) was admitted from a nursing home with complaints of abdominal pain, nausea and vomiting (N/V), dizziness, confusion and double vision for 5 days. She was discharged from the hospital just 4 days ago. Digoxin was started during that previous hospitalization for control of tachycardia in atrial fibrillation. One day prior to discharge, digoxin level was 1.8 mg/mL and digoxin dose was decreased to 125 mcg PO Q 48 hr.
Past medical history (PMH): Hypertension, atrial fibrillation, coronary artery disease, stroke, congestive heart failure.
Medications: Metoprolol, digoxin, ASA (aspirin), lisinopril, furosemide (Lasix), Coumadin (warfarin), esomeprazole (Nexium).
Physical examination: In pain, combative and confused.
VSS.
Chest: Occasional bibasilar crackles.
Cardiovascular System: Clear S1 and S2, irregularly irregular rhythm, HR 101 bpm.
Abdomen: Soft, epigastric tenderness, no rebound, + BS.
Extremities: No edema.
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