1345 – Client presents with a concern for intermittent palpitations. He reports they come on suddenly and that he also gets dizzy, short of breath, and fatigued. He indicated that they last anywhere from twenty to thirty minutes. He reports experiencing three episodes of palpations in the past week. He reports he has not taken any new medications or an increase in stress. He reports full adherence to all his prescribed medications. The client is alert and oriented. Denies any pain. Skin is dry and flaky, especially around the elbows and knees. Lungs are clear bilaterally. S1/S2 heart tones auscultated. Peripheral pulses are palpable and irregular. He reports feeling fatigued. Normoactive bowel sounds in all quadrants. Denies any nausea or vomiting. No edema was observed—no jugular venous distention.

Oral Temperature 99.2 ^o F (37.3^o C)

Heart rate 73/minute; irregular rhythm

Respirations 15/minute

Blood pressure 139/78 mm Hg

Oxygen saturation 95% on room air

Myocardial infarction

Psoriasis

Hypertension

Urolithiasis

Hemorrhoids

12-lead electrocardiogram: Atrial fibrillation

Diltiazem-XR 120 mg PO Daily

Warfarin 2 mg PO Daily