NRNP 6566 Week 3 Knowledge Check

• Question 1 Mrs. Franklin is a 68-year-old woman with long-standing, persistent AF being managed with rhythm control on dofetilide. She also has type 2 diabetes mellitus (T2DM), hypertension, and a myocardial infarction 3 years ago. What is her CHADS2 and CHA2DS2-VASc score? How would you interpret those scores in deciding on treatment for Mrs. Franklin? Correct Answer: CHADS2 score=2 (HTN, T2DM) A score of greater than 2 is considered high risk for stroke. CHA2DS2-VASc score=5 (age >65, female, HTN, T2DM, coronary artery disease [CAD]) A score of greater than 2 is considered high risk for stroke. Many patients are hesitant to begin anticoagulation due to the expense and inconvenience. However, after understanding that a 4% annual risk for stroke (if the CHA2DS2-VASc Score is 4) equates to 40% risk over 10 years, patients are more willing to comply. • Question 2 A 58-year-old male complains of a galloping heart rate and shortness of breath. Vital signs are BP 110/74, P 156, RR 22 Oxygen sat is 96%. Continuous EKG monitoring identifies periods of sinus tachycardia as well as episodes of atrial fibrillation. Laboratory results for this patient show: Hemoglobin 13.3 g/dl Hematocrit 39% WBC 8.7 Platelets 172,000 Sodium 140 Potassium 3.7 TSH 0.0 mIU/L T4 3 mg/dl T3 6.6 pg/ml What is your working diagnosis and what two initial medications would you prescribe for this patient?