Question

Mr. Smith, a 50-year-old male presents to the office for a comprehensive physical. His blood pressure reading is 162/110 mmHg, with an apical pulse rate of 79 beats/min and regular. He has a history of smoking and drinking six beers per night. He is 5’8" and 230 lbs. Mr. Smith works as a prison guard. He is not previously diabetic but has not had a physical exam since age 25, upon discharge from the military. He has a family history of diabetes (paternal) and his mother is deceased due to ovarian cancer at age 62. He does complain of a mild headache. Mr. Smith returns for his follow-up visit with a blood pressure reading of 143/92, apical pulse rate of 107 beats/minute and regular, with oral temp of 99.6°F. He now complains of a productive cough with green phlegm, feels “achy”, and has nasal congestion going on for the past 2 weeks.

Mr. Smith's First Visit  

• Describe potential cardiovascular and renal physical assessment findings for this patient.
• What tests would be ordered today and why?
• Provider a list of medication(s) with rationale(s) that you recommend be started today.
• Considering cardiovascular and renal standpoints, discuss what drug side effects, contraindications, or safety concerns would be important to consider.
• Discuss the education that would be provided to the patient today based on his risk factors.
• When would you follow up with this patient to determine therapeutic response and why?
• Discuss the cultural considerations that would important in the management of this client.

Mr. Smith's Two-Week Follow-up Visit

• Discuss your expected focused respiratory assessment findings.
• Provide a rationale for the respiratory medications would you start today.
• Discuss pharmacologic side effects, contraindications or safety issues that need to be considered.
• What education would be provided to the patient today and why?
• When would you follow up with this patient to determine therapeutic response and what would you expect to find at that follow-up visit?

Answer 1

• Here Mr. Smith's physical examination reveals he has hypertension 143/92mm of hg, pulse rate 107beats/minutes and temperature 99.6.Has habits of smoking.
• His BMI(body mass index )is 35 so he has obesity.
• Has headache
• Family history of diabetes
• Habits if smoking
• The above mentioned details indicate the individual has risk or potential for heart and renal disease.

Test are the following

• Blood routine examination especially WBC and ESR as the patient has slightly increase the temperature.
• ECG help to identify the electrical activity of heart.
• Renal function test such as Blood urea nitrogen and serum creatinine to find out renal disease.

List of medication

• Captopril(angiotensin coverting enzyme inhibitor )and metoprolol(beta blockers )is used to treat the hypertension and tachycardia respectively.

Metoprolol

• Side effect are tiredness, dizziness, fatigue, vomiting, depression, dry mouth etc
• Contraindication are sevee bradycardia, advanced AV block, heart disease.

Captopril

• Side effects are cough, warmth, numbness, loss of taste sensation and mild itching.
• Hypersensitivity, stenosis and pregnancy.

Education

• Cessation of smoking
• Exercise walking, jogging, bicycling etc
• Diet ie, well balanced and avoid high sodium food such as pickle, fried and processed food etc.
• Do meditation, yoga reduce stress which may cause hypertension.

Respiratory assess

• Smith has productive cough with yellow sputum. Purulent discharge indicate infection.
• So amoxicyllin for infection and guafenasin is used to productive cough
• Amoxcillin
• Side effect are nausea, vomiting, diarrhoea, rashes
• Contraindication are hypersensitivity, pregnancy etc