Question

A 47 year old male patient, who is a house painter and whom you haven’t seen in several years, presents with chronic fatigue and mild chest pain frequently relieved by taking a break from painting. He’s married to a 47-year-old woman with multiple sclerosis and has two married children and one grandchild living nearby. He also complains of frequent eructation, flatulence, and indigestion after eating. He was told (when he weighed 30 lbs. less than he does now) that he could control his hyperlipidemia by diet.

• CC: “I’m always tired, and I have this annoying chest pain when I climb a ladder.”
• Past medical history: Anxiety, cholecystectomy, vasectomy
• Vital signs: Blood pressure (BP): 146/88; height, 6 ft; weight, 242 lbs.
• Lab results: TC 230; LDL 180; HDL 32

Question 1
What additional subjective data do you think the patient will share?

Question 2
What is his 10-year risk assessment according to ClinCalc? Should he be started on lipid-lowering therapy? (Go to the ClinCalc Web site and ‘plug in’ his data to see what his risk potential is. What do the American College of Cardiology/American Heart Association guidelines suggest he do about cholesterol treatment?)

Question 3
What is your plan of care?

Question 4
What additional patient teaching is needed?

Answer 1

1. The additional subjective data that the patient should provide is whether the pain subsides after taking rest , whether it happens only when he works or it also occurs when he is resting . Is the pain is stabbing kind of and spreads to the left arm ,jaw and upper back . All these data will help to diagnose it as angina or heartburn .

2. The patient should be treated with moderate to high intensity station therapy because he comes under the group of individuals without ASCVD or diabetes who are 40 to 75 years of age with LDL between 70 to 189 mg/dl and a 10 year ASCVD risk of 7.5 %or more .

3. Plan of care include the following :-

- statin therapy

- Diet management

- regular follow ups

- weight reduction

- vitals monitoring

4. Patient teaching :-

- Explaining the patient about the disease condition

- Explaining the patient the important of management include weight reduction ,diet modification etc

- Encourage them to express their concern

- Making them aware of the importance of taking g regular medications and regular follow up visits .