C.D is a 55-year-old African American male who presents to his p
C.D is a 55-year-old African American male who presents to his primary care provider with a 2-day history of a headache and chest pressure. PMH Allergic Rhinitis Depression Hypothyroidism Family History Father died at age 49 from AMI: had HTN Mother has DM and HTN Brother died at age 20 from complications of CF Two younger sisters are A&W Social History The patient has been married for 25 years and lives with his wife and two children. The patient is an air traffic controller at the local airport. He has smoked a pack of cigarettes a day for the past 15 years. He drinks several beers every evening after work to relax. He does not pay particular attention to sodium, fat, or carbohydrates in the foods he eats. He admits to salting almost everything he eats, sometimes even before tasting it. He denies ever having dieted or exercised. Medications Zyrtec 10 mg daily Allergies Penicillin ROS States that his overall health has been fair to good during the past year. Weight has increased by approximately 30 pounds in the last 12 months. States he has been having some occasional chest pressure and headaches for the past 2 days. Shortness of breath at rest, headaches, nocturia, nosebleeds, and hemoptysis. Reports some shortness of breath with activity, especially when climbing stairs and that breathing difficulties are getting worse. Denies any nausea, vomiting, diarrhea, or blood in stool. Self treats for occasional right knee pain with OTC Ibuprofen. Denies any genitourinary symptoms. Vital Signs B/P 190/120, HR 73, RR 18, T. 98.8 F., Ht 61, Wt 240 lbs. HEENT TMs intact and clear throughout No nasal drainage No exudates or erythema in oropharynx PERRLA Funduscopy reveals mild arteriolar narrowing without nicking, hemorrhages, exudates, or papilledema Neck Supple without masses or bruits Thyroid normal No lymphadenopathy Lungs Mild basilar crackles bilaterally No wheezes Heart RRR No murmurs or rubs Abdomen Soft and non-distended No masses, bruits, or organomegaly Normal bowel sounds Ext Moves all extremities well Neuro No sensory or motor abnormalities CNs II-XII intact DTRs = 2+ Muscle tone=5/5 throughout What you should do: Develop an evidence-based management plan. Include any pertinent diagnostics. Describe the patient education plan. Include cultural and lifespan considerations. Provide information on health promotion or health care maintenance needs. Describe the follow-up and referral for this patient. Prepare a 35-page paper (not including the title page or reference page).