HPI: E.W. is a 40-year old African American male, who has had…

QuestionHPI: E.W. is a 40-year old African American male, who has had…HPI: E.W.  is a 40-year old African American male, who has had difficulty controlling his HTN lately. He is visiting his primary care provider for a thorough physical examination and to renew a prescription to continue his blood pressure medication.  PMH:  Chronic sinus infections Hypertension for approximately 11 yearsPneumonia 6 years ago that resolved with antibiotic therapy One major episode of major depressive illness caused by the suicide of his wife of 15 years, 5 years ago. No surgeries Allergies to Penicillin (Rash) FH:  Father died at age 49 from AMI; had HTN Mother has DM and HTNBrother died at age 20 from complication of CFTwo younger sisters are A & WSH:  The patient is a widower and lives alone. He has a 15-year-old son who lives with a maternal aunt. He has not spoken with his son for four years. The patient is an air traffic controller at the local airport. He smoked cigarettes for approximately 10 years but stopped smoking when he was diagnosed with HTN.  He drinks “several beers every evening to relax” and does not pay particular attention to the sodium, fat or carbohydrate content of the foods that he eats. He admits to “salting almost everything he eats, sometimes even before tasting it.” He denies ever having dieted. He takes an occasional walk but has no regular daily exercise program.  Meds: Hydrochlorothiazide 50 mg PO QDPseudoephedrine hydrochloride 60 mg PO Q6hr prnBeclomethasone dipropionate 1 spray into each nostril Q6 hr prn Review of Systems:  States that his overall health has been fair to good during the past 12 monthsWeight has increased by approximately 20 pounds during the last year Denies chest pain, shortness of breath at rest, headaches, nocturia, nosebleeds, and hemoptysisReports 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 the stool Self-treats occasional right knee pain with OTC extra-strength acetaminophen Denies any genitourinary symptoms Physical Exam and Lab tests General: The patient is an obese black man in no apparent distress. He appears to be his stated age.  Vital Signs: BP: 155/96 sitting HR: 73, regularRR: 15, unlabored Temp: 98.8 degrees FHeight: 5’11” Weight: 221 lbBMI: 31. HEENT:  Tympanic membrane intact and clear throughoutNo nasal drainageNo exudates or erythema in oropharynx PERRLA, pupil diameter 3. mm bilaterallySclera without icterusEOMIFundoscopy reveals mild arteriolar narrowing with no nicking, hemorrhages, exudates, or papilledema. Supple without masses or bruits Thyroid normal Negative lymphadenopathy Lungs: Mild basilar crackles bilaterallyNo wheezes Heart: RRRProminent S3 sound No murmurs or rubs  ABD:  Soft and nondistendedNon tender with no guarding or reboundNo masses, bruits, or organomegalyNormal bowel sounds Rectal/GU Normal size prostate without nodules or asymmetryHeme negative stool Normal penis and testes Ext: No CCELimited ROM right knee Neuro No sensory or motor abnormalitiesCNs II-XII intactNegative BabinskiDTRs=2+Muscle tone = 5/5 throughout Laboratory testsNa                      139meq/L RBC                    5.9mil/mm33 Mg                           2.4mg/dLK                          3.9meq/L WBC                   7,100/mm3 P04                          3.9mg/dLCl                        102meq/L AST                   29 IU/L Uric acid                 7.3mg/dLHCO3                  27 meq/L ALT                   43 IU/L Glu, fasting            110mg/dLBUN                     17mg/dL ALK phos       123 IU/L T. Chol                 275mg/dLCr                          1.0mg/dL GGT               119 IU/L HDL                      31mg/dLHgB                      16.9g/dL T. Bilirubin      0.9mg/dL LDL                     179mg/dLHct                         48% T. protein      6.0g/dL Trig                      290mg/dLPlt                   235,000/mm3 Ca                  9.3mg/dL PSA                    1.3ng/mL Urinalysis results: Appearance- clear, amber in colorSpecific gravity- 1.017Ph- 5.3Protein- negative  RBC- 0WBC- 0Bacteria- negative  ECG: Increased QRS voltage suggestive of LVH ECHO: Moderate LVH with EF = 46% ANSWER THE FOLLOWING QUESTION, HPI: E.W.  is a 40-year old African American male, who has had difficulty controlling his HTN lately. He is visiting his primary care provider for a thorough physical examination and to renew a prescription to continue his blood pressure medication.  PMH:  Chronic sinus infections Hypertension for approximately 11 yearsPneumonia 6 years ago that resolved with antibiotic therapy One major episode of major depressive illness caused by the suicide of his wife of 15 years, 5 years ago. No surgeries Allergies to Penicillin (Rash) FH:  Father died at age 49 from AMI; had HTN Mother has DM and HTNBrother died at age 20 from complication of CFTwo younger sisters are A & WSH:  The patient is a widower and lives alone. He has a 15-year-old son who lives with a maternal aunt. He has not spoken with his son for four years. The patient is an air traffic controller at the local airport. He smoked cigarettes for approximately 10 years but stopped smoking when he was diagnosed with HTN.  He drinks “several beers every evening to relax” and does not pay particular attention to the sodium, fat or carbohydrate content of the foods that he eats. He admits to “salting almost everything he eats, sometimes even before tasting it.” He denies ever having dieted. He takes an occasional walk but has no regular daily exercise program.  Meds: Hydrochlorothiazide 50 mg PO QDPseudoephedrine hydrochloride 60 mg PO Q6hr prnBeclomethasone dipropionate 1 spray into each nostril Q6 hr prn Review of Systems:  States that his overall health has been fair to good during the past 12 monthsWeight has increased by approximately 20 pounds during the last year Denies chest pain, shortness of breath at rest, headaches, nocturia, nosebleeds, and hemoptysisReports 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 the stool Self-treats occasional right knee pain with OTC extra-strength acetaminophen Denies any genitourinary symptoms Physical Exam and Lab tests General: The patient is an obese black man in no apparent distress. He appears to be his stated age.  Vital Signs: BP: 155/96 sitting HR: 73, regularRR: 15, unlabored Temp: 98.8 degrees FHeight: 5’11” Weight: 221 lbBMI: 31. HEENT:  Tympanic membrane intact and clear throughoutNo nasal drainageNo exudates or erythema in oropharynx PERRLA, pupil diameter 3. mm bilaterallySclera without icterusEOMIFundoscopy reveals mild arteriolar narrowing with no nicking, hemorrhages, exudates, or papilledema. Supple without masses or bruits Thyroid normal Negative lymphadenopathy Lungs: Mild basilar crackles bilaterallyNo wheezes Heart: RRRProminent S3 sound No murmurs or rubs  ABD:  Soft and nondistendedNon tender with no guarding or reboundNo masses, bruits, or organomegalyNormal bowel sounds Rectal/GU Normal size prostate without nodules or asymmetryHeme negative stool Normal penis and testes Ext: No CCELimited ROM right knee Neuro No sensory or motor abnormalitiesCNs II-XII intactNegative BabinskiDTRs=2+Muscle tone = 5/5 throughout Laboratory testsNa                      139meq/L RBC                    5.9mil/mm33 Mg                           2.4mg/dLK                          3.9meq/L WBC                   7,100/mm3 P04                          3.9mg/dLCl                        102meq/L AST                   29 IU/L Uric acid                 7.3mg/dLHCO3                  27 meq/L ALT                   43 IU/L Glu, fasting            110mg/dLBUN                     17mg/dL ALK phos       123 IU/L T. Chol                 275mg/dLCr                          1.0mg/dL GGT               119 IU/L HDL                      31mg/dLHgB                      16.9g/dL T. Bilirubin      0.9mg/dL LDL                     179mg/dLHct                         48% T. protein      6.0g/dL Trig                      290mg/dLPlt                   235,000/mm3 Ca                  9.3mg/dL PSA                    1.3ng/mL Urinalysis results: Appearance- clear, amber in colorSpecific gravity- 1.017Ph- 5.3Protein- negative  RBC- 0WBC- 0Bacteria- negative  ECG: Increased QRS voltage suggestive of LVH ECHO: Moderate LVH with EF = 46% Health ScienceScienceNursingNSG 240Share Question