Assignment 10.2: Shadow Health-Focused Exam: Hypertension and Type 2 Diabetes

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Assignment 10.2: Shadow Health-Focused Exam: Hypertension and Type 2 Diabetes Patient: Arun Patel DOB: 10/06/1981 Height: 5’9 Weight: 233lbs Allergy: NKDA Diagnosis: Hypertension (Diagnosed 1 ... year ago) & Diabetes Mellitus Type 2 (Diagnosed 5 years ago) Scenario: Arun Patel is a 38-year-old Indian American male who came to the clinic today for a follow-up appointment in regards to his treatment for hypertension and diabetes type 2. Home medications: • Hydrochlorothiazide 50mg PO daily (Started 1 year ago) • Metformin 850mg PO 3x day with meals (Started 5 years ago) • Escitalopram 20mg PO daily (Started 13 years ago) Vitals: Temp 37C (Temporal), Blood pressure 146/94 (Automatic), Heart rate 75 (NSR), O2 sat 98% (room air), Respiratory rate 23. Assessment: Mr. Patel came to the clinic for a follow-up appointment for the treatment of his hypertension and type 2 diabetes. He states he has been growing more worried and anxious about life. He is currently a student and teaches film at the local university which is his main source of income. He does have limited funds although he does have health insurance through his employer and can afford prescription medications at a reasonable to inexpensive cost. The patient states he was diagnosed with generalized anxiety disorder 13 years ago and has been on Escitalopram ever since. He denies any depressive symptoms but does have panic attacks on occasion which can be exacerbated by conflict with his family. The patient states he has no chest pain, shortness of breath or headaches but has been increasingly thirstier and urinating more frequently due to diuretic use. He denies any swelling/edema at this time. Mr. Patel admits to following an unhealthy diet including fast food, fried foods, and sugar. He also denies adding any extra salt to his food but does state his food is generally "very salty" most likely due to cultural dietary preferences. The patient states he has gained approximately 15lbs. since last visit and does not exercise due to time constraints and lack of motivation. The girlfriend is a good support system and he states he breaths slow when he becomes anxious and/or has panic attacks. Denies any substance use. Smoked cannabis in undergraduate school but denies current use. Denies any tobacco use. Denies any alcohol use. Mr. Patel is currently maxed out on Metformin at 2550mg a day showing no appropriate blood glucose control. He has also maxed out Hydrochlorothiazide at 50mg a day with ineffective blood pressure control. The medical diagnosis and recommendations are supported by the following data presented by the patient at clinic simulation today: Lab Values & BPTrends: Last visit (6 months ago) • Blood glucose – 142 (Fasting) • A1C – 7.5% Lab visit (1week prior) • Blood glucose – 210 (Fasting) • A1C – 9.3% Home glucose monitoring • 4 weeks ago – 218 (Random) [Show More]

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