www.MatrixMedicalNetwork.

com

NP Anne

The member said she hadnt been doing well since my visit with her last
year. In the interim, she had been to the hospital twice for newly diagnosed
chronic obstructive pulmonary disease (COPD). Just last week, she was
discharged after her third hospitalization. This one she said, was due to
difficulty breathing.

After her third hospitalization, she was prescribed two new medications that
indicated congestive heart failure (CHF). But she was adamant...no, that was
not the case. This despite guidelines for CHF posted on her refrigerator and
her being advised about sodium intake, sudden weight gain and weighing
herself every day. She had even been given a new scale.

I gently suggested there were indications she might have CHF which she
rejected.

Ever since starting the new medications, she said she was noticing visual
changes, increased shakiness, hoarseness and a stiff neck. I checked her
blood pressure when I started the visit and found it to be 92/56. Checking it
again, it was now 84/44. She said she was not experiencing any shortness of
breath or dizziness.

I called her cardiology office and the receptionist routed me to their CHF
team where I left a detailed message. I advised the member of where I was
transferred and she said she was told she did not have CHF. She had a follow-
up appointment with the cardiologist in a couple of weeks. I recommended
she take advantage of that opportunity to clarify her diagnosis, but in the
meantime, follow the directions she had been given.

After leaving, I completed a care management referral due to her multiple

hospitalizations and need for further education. About an hour later, I called
the member to see if her cardiology office had returned the call. She said
they did. They advised her to cut her medications in half, monitor her blood
pressure and call back at the end of the week to see if her symptoms were
better.
 www.MatrixMedicalNetwork.com

The member thanked me and said, Im glad you came today, because I
wouldnt have called them. I would have just waited for my appointment.