Problem:
The patient is a 69-year-old female who has been taking rivaroxaban for two weeks for prevention of embolic stroke associated with chronic nonvalvular atrial fibrillation. Her medical history is positive for Type II Diabetes Mellitus for 10 years and hypertension for 12 years. Her surgical history includes a gastric bypass in 2010 and appendectomy in 1971. Her medical history reveals occasional nose bleeds, COVID-19 in June of 2022 and DVT in 2021. The nurse practitioner documents that she has multiple contusions and petechiae on the forearms. The patient admits she bleeds easily and has to be cautious when she is using her gardening and lawn tools. Vital signs are recorded as: BP 144/90, HR 88, R 20 and a temperature 98.6F. CBC: WBC 9.6 RBC 4.6 Hgb 11.1 Hct 34% MCV 84 MCHC 31 RDW 14.5% Platelets and WBC differential are unremarkable Ferritin 13 Immunization History: Influenza October 2021 Tdap 2019 Zoster 2017 PPSV23 2012 Yellow Fever 2016 Hep B 2015