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Comparing Health Outcome in Adjoining Counties

Comparing Health Outcome in Adjoining Counties

This assignment consists of four paragraphs in length, word document and double spacing.  12 point new roman front.  If you have any questions, please let me know

HCM -320 1-2 Journal:Guidelines and Rubric Overview : In this journal, you will have the opportunity to consider the healthcare economics of two adjacent counties in the Kansas Ci ty metropolitan area. Read Case 2.1 in Chapter 2 of your textbook.

In your journal assignment, answer the following case study questions:

? What are the main inputs to health mentioned in this case? Are there important inputs to health that the case does not mention?

? What health behaviors should get priority?

? Does income play a role in improving health?

? How important is health insurance in improving health?

? Wyandotte County has relatively few primary care physicians. Should the number of primary care physicians be a priority?

? What role, if any, should the federal government play in improving health?

? How do you think your answers would differ if you were a resident of Wyandotte County? Support your responses with examples from the case or references to your textbook.

Use the journal as an opportunity to familiarize yourself with the final project requirements and case study. Journal activities in this course are private between you and your instructor. Only the instructor can view and comment on your assignments. Rub ric

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Guidelines for Submission: Your journal assignment should be 2 to 4 paragraphs in length. Submit assignment as a Word document with double spacing, 12 – point Times New Roman font, and one -inch margins.

Critical Elements Proficient (100%) Needs Improvement (75%) Not Evident (0%) Value Inputs Discusses the main health inputs mentioned in this case, identifies important inputs not mentioned and supports stance with examples from the case or references to the textbook Discusses the main health inpu ts mentioned in this case, identifies important inputs not mentioned but does not support stance.

Does not discuss the main health inputs mentioned in this case 14 Health Behavior Discusses what health behaviors should get priority and supports stance with examples from the case or references to the textbook Discusses what health behaviors should get priority, but does not support stance.

Does not discuss what health behaviors should get priority 14 Income Level Describes how income plays a role in improving health and supports description with examples from the case or references to the textbook Describes how income plays a role in improving health but does not support description.

Does not describe how income plays a role in improving health 14 Health Insurance Describes the importance of health insurance in improving health and supports description with examples from the case or references to the textbook Describes the importance of health insurance in improving health, but does not support description.

Does not describe the importance of health insurance in improving health 14 Primary Care Providers Discusses the quantity of primary care physicians and determines whether or not this quantity should be a priority and supports response with examples from the case or references to the textbook Discusses the quantity of primary care physicians and determines whether or not this quantity should be a priority, but does not support response with examples from the case or references to the textbook.

Does not discuss the quantity of primary care physicians 14 Government Role Defines the role of the federal government plays in improving health and supports description with examples from the case or references to the textbook Defines the role of the federal government plays in improving health, but does not explain why or why.

Does not define the role of the federal government plays in improving health 15 Resident Perspective Discusses whether healthcare economics issues would be different from the perspective of a Wyandotte County resident, and explains why or why not.

Discusses whether healthcare economics issues would be different from the perspective of a Wyandotte County resident, and explains why or why not, but does not explain why or why not Does not discuss whether healthcare economics issues would be different from the perspective of a Wyandotte County resident 15 Total 100%

Comparing Humanistic Existential Psychotherapy with Other Approaches

Psychotherapy is a viable treatment for a variety of mental health issues. Wheeler (2020) defines psychotherapy as a process of treating emotional difficulties and mental illnesses by way of verbal and psychological techniques. Currently, several psychotherapeutic approaches are in existence including but are not limited to existential therapy and cognitive behavioral therapy. Humanistic existential psychotherapy is a psychotherapeutic approach that focuses on the human condition as a whole (Wheeler, 2020).

However, cognitive-behavioral therapy (CBT) which has gained its popularity since its establishment in the 1960s is deployed as a treatment modality for a multitude of mental disorders such as anxiety, substance use disorders, and depression. This piece of writing concentrates on comparing humanistic-existential therapy with cognitive behavioral therapy along with their associated outcomes when used in the treatment of patients.

Humanistic existential therapy uses a positive approach that appreciates human capacities and aspirations while simultaneously acknowledging their limitations (Feizi et al., 2019). This form of psychotherapy is a long-term process that helps an individual get in touch with the real experiences they are feeling. It deals with the last concerns of human beings’ existence such as death along with fears of isolation, meaninglessness, guilt lack of relationships, and emptiness (Grande, 2019). The fundamental aim of this therapy is to enable a patient to reach self-actualization in the presence of existential dilemmas. Nevertheless, existential therapy has been criticized for several reasons.

To begin, as opposed to other modalities of psychotherapy, this particular therapy lacks specific and concrete techniques for its administration. Similarly, existential therapy is nondirective which at times makes it restrictive and frustrating to the patients (Grande, 2019). Cognitive-behavioral therapy on the other hand is a goal-oriented, structured, and deductive hands-on form of therapy in which the therapist and the patient work in a collaborative manner with the target of modifying patterns of behavior and thinking to effectuate beneficial transformation in the patient’s mood and way of living (Fordham et al., 2018). Cognitive-behavioral therapy finds its basis through its theorization of the bidirectional nature of cognitive, physical, emotional, and behavioral relationships.

CBT has widely been criticized for focusing on individuals’ capacity to change themselves. Also, this therapy receives a setback for dwelling only on specific and current problems without taking a look at the underlying etiologies of mental health conditions. The above two modalities of psychotherapy differ in several ways which are discussed in the subsequent paragraphs.

CBT as a talking therapy focuses on the recognition of maladaptive thoughts and behaviors and subsequently challenges the patient to inaugurate a distinct course of action and thinking to enhance his overall psychological and physical wellbeing (Fordham et al., 2018). Existential therapy on the other hand focuses on evaluating human consciousness of oneself including the core existence which facilitates self-actualization and self-flourishing. Arguably, CBT is a well-structured, directed and designed form of psychotherapy that is utilized in various settings such as individual, family, and group whereas existential therapy, lacks specific concrete techniques, it is nondirective and is greatly elemental in an individual setting (Feizi et al., 2019).

Additionally, CBT emphasizes patient safety and happiness by encouraging the adoption of pristine thoughts and alterations in behaviors in the presence of maladaptive thoughts and behaviors that lead to good psychological and physical wellbeing. Nonetheless, existential therapy strongly contemplates the absence of permanent safety and happiness in life thus prioritizing the formation of identity (Feizi et al., 2019). The above dissimilarities are crucial and impact the practice of PMHNP. The PMHNP must recognize the mental health issue of concern and select the appropriate therapy that will be beneficial to the patient based on the pros and cons as well as the distinctive characteristics of each of the above psychotherapeutic modalities.

From the PsychotherapyNet (2009) in the James Bugental live case consultation psychotherapy video, the patient complains of “not feeling alive” and being “constricted in his life” warrants the use of humanistic-existential therapy as the treatment of choice. The rationale behind this is that existential therapy enables self-awareness, authenticity and increases awareness about life decisions. Moreover, this kind of therapy helps an individual find purpose and meaning in life, creates a positive attitude towards life, self-actualizes and self-nourishes an individual. Therefore, the patient benefited from a deeper discovery of the larger sense of himself (Feizi et al., 2019).

Cognitive-behavioral therapy could also be used in the management of the patient in the above video. However, this modality would necessitate the identification of maladaptive behaviors and thoughts behind being “constricted in life” and “not feeling alive” and then imposing a positive change. The expected potential outcome with the use of CBT depends on a multitude of factors including patient commitment, effective communication, patient-therapist relationships, and therapist skills (Fordham et al., 2018).  In the event that all the named variables are at optimum, the patient would likely develop novel ways of thinking and positive attitudes towards life.

Summary

Psychotherapy is a critical treatment modality for mental health illnesses and emotional difficulties. It is vital to select the appropriate psychotherapeutic technique based on the patient to achieve the most effective patient outcomes. Humanistic existential therapy seeks an in-depth understanding of the large sense of oneself to facilitate self-actualization. CBT deploys the bidirectional interconnection between cognitive, emotional, behavioral, and physical relationships to impact positive change in behavior and thinking for better physical and psychological wellbeing. Lastly, the sources used are scholarly since they are peer-reviewed journal articles, published within the last five years and from sites recommended for scholarly articles such as NCBI, PubMed, CINAHL, and MEDLINE.

References

• Feizi, M., Kamali, Z., Gholami, M., Abadi, B. A. G. H., & Moeini, S. (2019). The effectiveness of existential psychotherapy on attitude to life and self-flourishing of educated women homemakers. Journal of Education and Health Promotion, 8, 237. https://doi.org/10.4103/jehp.jehp_473_18
• Fordham, B., Sugavanam, T., Hopewell, S., Hemming, K., Howick, J., Kirtley, S., das Nair, R., Hamer-Hunt, J., & Lamb, S. E. (2018). Effectiveness of cognitive-behavioral therapy: a protocol for an overview of systematic reviews and meta-analyses. BMJ Open, 8(12), e025761. https://doi.org/10.1136/bmjopen-2018-025761
• Grande, T. (2019, January 9). Theories of counseling – Existential Therapy. Youtube. https://www.youtube.com/watch?v=YvAvc2aWup0
• PsychotherapyNet. (2009, June 29). James bugental live case consultation psychotherapy video. Youtube. https://www.youtube.com/watch?v=Zl8tVTjdocI
• Wheeler, K. (2020). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice. Springer Publishing Company. https://doi.org/10.1891/9780826193896

Complete the HRSA Data Warehouse Website Activity

Complete the HRSA Data Warehouse Website Activity

What are the responsibilities of community and public health nurses in promoting health and decreasing illness and injury in populations, families, and individuals? Provide specific examples from your community.

Assignment

1. Read about the HRSA Data website and what it does here: https://datawarehouse.hrsa.gov/about/abouthdw.aspx
2. Explore the rest of the tabs on the site.
3. Watch the “How-To Video: Find a Health Center Locator Tool” tutorial found at the following link: https://data.hrsa.gov/how-to-videos
4. Explore some data by selecting Clark County, Nevada using the Data by Geography tool here: https://data.hrsa.gov/hdw/tools/DataByGeography.aspx
5. Next use the HRSA Fact Sheets tool located here: https://data.hrsa.gov/data/fact-sheets to look up HRSA’s activities in HHS regions, states, counties, and congressional districts and compare the data to the Clark County, Nevada data you found using your geography results. Analyze the data included in the fact sheets. Consider the data sets found in the fact sheets. How does Nevada compare nationwide when it comes to the data sets? What about Clark County?
6. Complete a new search using the Data for Geography tool for your state and county. Compare the results of your query to your Clark County, Nevada search.
7. Identify HRSA program resources for HIV/AIDS in your state and county. What are they? How many clinics are funded by HRSA?

Write a two-page paper reflecting on the data you collected and analyzed. How will this data warehouse be useful to you as a professional nurse? Your paper should be at least two pages in length, in APA format, typed in Times New Roman with 12-point font, and double-spaced with 1” margins.

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You must proofread your paper. But do not strictly rely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort on your part and you can expect your grade to suffer accordingly. Papers with numerous misspelled words and grammatical mistakes will be penalized. Read over your paper – in silence and then aloud – before handing it in and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes.

Use a standard 10 to 12 point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. It is better to let your essay run over the recommended number of pages than to try to compress it into fewer pages.

Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor.

The paper must be neatly formatted, double-spaced with a one-inch margin on the top, bottom, and sides of each page. When submitting hard copy, be sure to use white paper and print out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument.

ADDITIONAL INSTRUCTIONS FOR THE CLASS

Discussion Questions (DQ)

Initial responses to the DQ should address all components of the questions asked, include a minimum of one scholarly source, and be at least 250 words.
Successful responses are substantive (i.e., add something new to the discussion, engage others in the discussion, well-developed idea) and include at least one scholarly source.
One or two sentence responses, simple statements of agreement or “good post,” and responses that are off-topic will not count as substantive. Substantive responses should be at least 150 words.
I encourage you to incorporate the readings from the week (as applicable) into your responses.

Weekly Participation

Your initial responses to the mandatory DQ do not count toward participation and are graded separately.
In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days, for a total of three replies.
Participation posts do not require a scholarly source/citation (unless you cite someone else’s work).
Part of your weekly participation includes viewing the weekly announcement and attesting to watching it in the comments. These announcements are made to ensure you understand everything that is due during the week.

APA Format and Writing Quality

Familiarize yourself with APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for APA paper templates, citation examples, tips, etc. Points will be deducted for poor use of APA format or absence of APA format (if required).
Cite all sources of information! When in doubt, cite the source. Paraphrasing also requires a citation.
I highly recommend using the APA Publication Manual, 6th edition.

Use of Direct Quotes

I discourage overutilization of direct quotes in DQs and assignments at the Masters’ level and deduct points accordingly.
As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content.
It is best to paraphrase content and cite your source.

LopesWrite Policy

For assignments that need to be submitted to LopesWrite, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me.
Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes.
Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own?
Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for tips on improving your paper and SI score.

Late Policy

The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies.
Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances.
If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect.
I do not accept assignments that are two or more weeks late unless we have worked out an extension.
As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.

Communication

Communication is so very important. There are multiple ways to communicate with me:

Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class.
Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.

Comparison Of Research Articles Sample Paper

Part 2: Analysis of the Two Articles

Introduction

Diabetes is an ailment that occur in humans when the blood sugar/blood glucose rises above the recommended level. The body derives its sugar from blood glucose that comes from the food consumed. Too much glucose in the body may have a negative impact on the body due to the inability of insulin to keep check on blood sugar (Raghavan et al., 2019). These article compares two research articles published by a scholarly journal on diabetes. One of the articles chosen for comparison is Deaths Attributable to Diabetes in the United States: Comparison of Data Sources and Estimation Approaches by Stokes and Preston, (2017). The second journal article chosen on diabetes is Diabetes Mellitus–Related All?Cause and Cardiovascular Mortality in a National Cohort of Adults by Raghavan et al., (2019).

1.Summary of the topic you chose with rationale

            I chose the topic diabetes because it is one of most prevalent and fast-rising disease in my community, country and the world by extension. Secondly, diabetes is rated as one of the top-5 killer diseases in America which means it requires urgent attention. Medically, diabetes is the inability of the body to regulate the body’s blood sugar resulting into complications (Noubiap et al., 2019). Some of the medical conditions and mental disorders that may be experienced due to diabetes include; stroke, heart disease, depression, anxiety, obesity, high blood pressure, frustration, bodily pain especially at the joints among other related problems.  It can either be acute, which means short in nature or it can be chronic which means on-going and long. Type 1 diabetes is the most common type of diabetes that affects millions of people worldwide. It is usually short in nature and lasts between a few days and or weeks. It is usually caused by a number of factors such as unhealthy life styles and other health risks such as bad eating habit. On the other hand, chronic diabetes may go for many months or even longer.

Consequences of Diabetes

Productivity

One of the negative consequences of diabetes which goes to affect quality of life is reduced productivity. Lack of sleep at night leaves one weak, stressed and frustrated which affects both the quality and quantity in terms of production. Many aspects of modern life are measured on one’s productivity. School, work and jobs are all measured on quality and quantity of production. People experiencing diabetes are not able to be as productive as required by the virtue of the fact that they are not well (Cowie et al., 2018) This reduction in their productivity will affect the quality of lives they live because, high production is associated with much returns and vice versa.

Increased Chances of Accidents

As seen in the results/findings of the two studies, diabetes greatly weakens people’s reflexes which lead to individuals being slow or reacting slower than usual.  Slow reflexes increase an individual’s vulnerability to accidents. For example, many drivers with diabetes may cause an accident mainly because they failed to respond to an emergency situation on the road because they did not respond fast enough. A good example is when a driver in front brakes suddenly, the driver behind will need to react to this situation by hitting the brakes hard to avoid a collision. Those with diabetes may not be in a position to react fast enough in such situations.

Worsening Medical Conditions

The many researchers on the relation between diabetes and medical conditions attest to the fact that diabetes can worsen existing medical conditions and, in some cases, though rare may lead to a medical condition. People with diabetes, heart diseases, and other chronic illnesses may see their conditions worsening because of the inability to get adequate sleep. Many doctors nowadays advice their patients on the importance of having as much sleep at night as possible because their recovery squarely lies on having enough sleep, medication and other factors.

2. Description of the Major Functions Provided by Research and Data Monitoring of Health Care Delivery in the United States

A critical function performed by the two articles is two evaluate the vulnerable demographics in society for diabetes. In the article by Raghavan and colleagues, the study focuses trend of mortality in diabetes and related causes of mortality such as cardiovascular among adults. This study is critical because it brings critical information on diabetes and its relation with other chronic ailments such as heart disease and its impact on adults. This study links diabetes with cardiovascular disease. Through the cohort study group, this research shows critical link between diabetes and other conditions that people having diabetes are likely to suffer from.

Conversely, the study by Stokes and Preston is critical because it studies the prevalence of diabetes since 1980-2104. The data contained in this research is critical in evaluating the trends of diabetes from the 1980s till present. For example, this study reveals that the prevalence rate of diabetes in America has jumped from 4.3% to 9.0% in men from 1980 and 2014 (Stokes, & Preston, 2019). The research also shows that the prevalence of the disease for women for the same period jumped from 5.0 to 7.9% for the same period. These statistics are critical for governments because they can use it to monitor and manage the disease.

3. Potential Environments Within Health Care Delivery Appropriate To Research And Data Monitoring.

In healthcare industry, the importance of research and data monitoring cannot be overemphasized. Research deals with creating/finding out new information about diseases/health trends. Data deals with collection of data, access, and retrieval of data. Research plays a pivotal role in the discovery of new treatments while finding answers to the things are not known. Secondly research fill gaps in available knowledge and change the way professionals in the healthcare industry operate (Harding et al., 2019). Concerning data monitoring, the two articles, like other credible research studies improve the quality of patient care by providing critical information concerning specific conditions-for this case diabetes. In the healthcare industry, data benefits the world because they it plays critical multiple roles such as revealing trends diseases and treatments, health surveillance, monitoring disease outbreaks.

4. Assessment of The Role the Allied Health Professional Does, Or Could, Play, In Research and Data Monitoring of Health Care Delivery in The United States.

Allied health professionals provide critical services that enhances and maintains the quality of care they provide to their patients within the settings of their practice. Allied healthcare professionals such as Athletic Training, mmusculoskeletal, injury geriatric, assessment physiotherapist, and Health Care Provider are some of the groups that benefit from research and data monitoring. The first critical importance of the two articles to allied healthcare workers is that they can use the result of the studies to improve patient care and outcomes. These professionals use critical information contained in research studies to create effective treatment plans and solutions based on the findings of critical research studies.

References

• Animaw, W., & Seyoum, Y. (2017). Increasing prevalence of diabetes mellitus in a developing country and its related factors. PloS one, 12(11), e0187670.
• Cowie, C. C., Casagrande, S. S., Menke, A., Cissell, M. A., Eberhardt, M. S., Meigs, J. B., … & Fradkin, J. E. (2018). Diabetes in America.
• Harding, J. L., Pavkov, M. E., Magliano, D. J., Shaw, J. E., & Gregg, E. W. (2019). Global trends in diabetes complications: a review of current evidence. Diabetologia, 62(1), 3-16.
• Noubiap, J. J., Nansseu, J. R., Nyaga, U. F., Nkeck, J. R., Endomba, F. T., Kaze, A. D., … & Bigna, J. J. (2019). Global prevalence of diabetes in active tuberculosis: a systematic review and meta-analysis of data from 2· 3 million patients with tuberculosis. The Lancet Global Health, 7(4), e448-e460.
• Raghavan, S., Vassy, J. L., Ho, Y. L., Song, R. J., Gagnon, D. R., Cho, K., … & Phillips, L. S. (2019). Diabetes mellitus–related all?cause and cardiovascular mortality in a national cohort of adults. Journal of the American Heart Association, 8(4), e011295
• Stokes, A., & Preston, S. H. (2017). Deaths attributable to diabetes in the United States: comparison of data sources and estimation approaches. PloS one, 12(1), e0170219

Comprehensive Adult Health History and Physical Examination Sample

PATIENT INFORMATION

Name: Mr. V.O

Date of Birth: 5/5/1965

Age: 46

Ethnicity: African American (Nigerian)

Gender: Male

Source: Patient

Date of Assessment: 4/1/2021

Occupation: Photographer

Allergies: Allergic to pollens and house dust mites. The allergens make him have a runny nose and watery eyes

Current Medications:

1. Metoprolol ER Succinate 50mg tablet, Dosage 1 tablet=50mg, , Route-PO, frequency-Daily
2. Losartan/HCTZ 100/12.5mg, Dosage- 1 tablet-100/12.5mg, Route -PO, frequency-Daily
3. Aspirin 81mg chewable tablets, Dosage- 1 tablet=81mg, Route-PO, frequency-Daily
4. Metformin 500mg tablets, Dosage- 1 tablet=500mg, Frequency-Daily, Route-PO
5. Vitamin D3 5,000 IU tablet, Dosage5000 IU – 1 Tablet, route – PO, Frequency- Daily

PMH:

Childhood Illnesses: Presbyopia diagnosed at 10 years of age.

Allergic rhinitis since childhood

Adult Illnesses: Diabetes diagnosed in 2012

-Hypertension diagnosed in 2012

-There is a history of past hospitalization due to hyperosmolar non-ketotic coma. No previous blood transfusion. No history of TB or HIV. No previous history of surgical procedures.

Immunizations: All up to date. Last tetanus vaccine given on 10th 7/2020

Personal/social History: Studied photography for 2-years at a college level (Associate in Arts degree), He smokes and he is a social drinker.

Family History: His grandpa is John Onuchukwu, who succumbed to Cholera at the age of 96yrs (1871-1967). The grandmother, Elizabeth onuchukwu, died at 91(1886-1977). The cause of death was not determined as she died in sleep. His dad, Benjamin Onuchukwu, died at age 79 (1930-2009) of prostate cancer while the mother, Theresa Onuchukwu died at age 84(1936-2020) of corona virus. He has four other siblings: Josephat Onuchukwu born in 1957, 64 years old today, alive and suffering from presbyopia; Uche Onuchukwu born in1978, 43yrs old today suffers from ulcer; Mark onuchukwu born in 1973, 48yrs old today and has high blood pressure and Chimezie Onuchukwu (1976), 45 years old, suffers from high blood pressure.

He has 2-children 1. Oluebube Onuchukwu born in 2007, aged 14 today, suffers from presbyopia 2. David Onuchukwu born in 2011, aged 10 today, suffers from presbyopia

Nutritional History: three major meals per day with frequent snacks in between.

Subjective Data:

Chief Complaint: I can’t read very well even with my eye- glasses

Symptom analysis/HPI:

The client is a known presbyopic patient. He has been using eye glasses since childhood but for the past three months, complaints of inability to read with or without the glasses. He reports that he cannot read clearly prints that are at a close distance to him; he has to move the reading materials away from the eyes. Further, he has a problem reading smaller prints; he therefore uses larger fonts for his phone. He requires a bright light to read and is unable to see in a dim room. Sometimes he strains a lot until the eyes aches. He reports frequent headaches. He also reports squinting quite often. As a photographer, his eyes are the most important organs; therefore, the condition has adversely affected his job and a cause of his current financial strains since he is the breadwinner.

He also reports associated dyspnea only on exertion. He had one episode of chest pain in the past three months. He reports he has had problems achieving a weight loss since childhood. Due to his job, he travels quite often and eats a lot of junk food at different restaurants. He also reports to eat three meals per day with snacks and sweetened drinks in between the main meals. Moreover, he could occasionally miss medications while he travelled. He is a known diabetic and hypertensive patient since 2012.

Review of Systems (ROS)

CONSTITUTIONAL: Denies fever, fatigue. Reports added weight.

NEUROLOGIC: Reports headaches. Denies loss of consciousness

HEENT: Head: Denies head injury. Eyes: Reports blurred vision and pain. He uses glasses. He reports watery eyes on exposure to pollen and house dust mites. Ears: Denies pain, discharge, loss of hearing, tinnitus, and vertigo. No previous ear infections. Nose: reports runny nose on exposure to pollen and house dust mites. He denies congestion, stuffiness, itching, bleeds or sinus tenderness. Throat: Denies sore throat, voice changes and halitosis.

RESPIRATORY: Reports exertional dyspnea. He denies cough, sputum production and hemoptysis.

CARDIOVASCULAR: He is hypertensive. He denies palpitations, orthopnea, limb edema, paroxysmal nocturnal dyspnea.

GASTROINTESTINAL: Denies nausea and vomiting. Denies abdominal pain, diarrhea, constipation, flatulence and any bowel changes

GENITOURINARY: Denies urgency, frequency, nocturia, dysuria, burning sensation, flank pains and hematuria. Denies previous or current urinary tract infections

MUSCULOSKELETAL: Denies joint pain or stiffness.

SKIN: Denies rushes, hypo/hyper pigmentations, pruritus or skin infections.

Objective Data:

General appearance: An African American male adult in a fair general condition. He walks into the examination room in a normal gait. He is obviously obese. He is relaxed, calm and well composed. He is well kempt and groomed with nicely coiffed hair and with a nice fragrance. He is friendly, and overfamiliar with the environment. He is in a conscious mind. He has a clear and a coherent speech.

He is not in an obvious respiratory distress. He is not pale or jaundiced. No edema, cyanosis, lymphadenopathies. He is well hydrated

Measurement:

Weight=230lbs; Height- 5 feet 4 inches; BMI-39.5 kg/m2;

Vital signs: BP-125/83 mmHg; HR-83 beats/minute; RR- breaths/minute; SPO2-98%; Pain score-0

Skin: He has a dark complexion and black hair. The skin is moist and warm. The skin has a smooth and with normal turgidity. The fingernails are pink in color, oval shaped, and have no pathologic lesions. The toe nails are pink in color, round shaped without pathologic lesions. No primary or secondary skin lesions.

Head & Face: The head is normocephalic with no lacerations, deformities or asymmetry. The hair dark and well distributed throughout the scalp. The scalp is dry with no lesions, infective or inflammatory.

The face is oval shaped. Facial movements are symmetric. No drooping of eyelids, no involuntary facial movements.

Right eye: Present. Primary position, looking straight ahead and the visual axis is parallel to the head’s sagittal plane. Allergic shiners present. Visual acuity is less than 6/12. The eye lids’ opening is symmetrical. There are no lumps, scales, discharge, pus or mucus around the eyelids margins. The conjunctiva is white. The cornea is clear, and has a lustrous surface. The iris is flat and brownish in color with a centrally located pupil. The pupil is round, 3mm in diameter in a bright lit room and constrict to direct light (illumination). The lens is transparent with increased curvature. Extra ocular muscles are intact. On ophthalmoscopy, red reflexes are normal, there is mild macular edema with dot and blot hemorrhage.

Left eye: Present. Primary position, looking straight ahead and the visual axis is parallel to the head’s sagittal plane. Allergic shiners present. Visual acuity is 6/12. The eye lids’ opening is symmetrical. There are no lumps, scales, discharge, pus or mucus around the eyelids margins. The conjunctiva is white. The cornea is clear, and has a lustrous surface. The iris is flat and brownish in color with a centrally located pupil. The pupil is round, 3mm in diameter in a bright lit room and constrict to direct light (illumination). The lens is transparent with increased curvature. Extra ocular muscles are intact. On ophthalmoscopy, red reflexes are normal. Macular edema is not as marked as on the right side. Dot and blot hemorrhage present.

Ear: Both ears are present on either sides of the face. The auricles are symmetric. On otoscopy, the external auditory meatus are clear without wax impaction. The tympanic membrane are translucent and pale gray in color with a cone of light at the 5 o’clock position.

Tuning fork tests:

-Weber’s test is central

Rhine’s test-air conduction is greater than bone conduction. Normal results

Nose: Normal external nasal anatomy with bilateral symmetrical nares. A transverse nasal crease is present. Using a speculum, the mucosa is moist and pink in color. Normal septum; no deviation, perforations, tumors or ulcers. Turbinates are boggy and pale blue in color. Maxillary sinuses are non-tender

Mouth & Throat: the lips are symmetrical and pink in color. Oral mucosa is moist and pink in color; no ulcerations, erythema or other lesions. The gums are pink in color, no bleeds, not swollen, no odor, no ulcerations. 32-teeth, whitish in color; 2 maxillary incisors are yellow; no dentures or prosthesis. Tongue is pink, central, rough dorsal surface, no ulcers, hairs or furrows, smooth ventral surface, comfortably fits the oral cavity. Palate is pink with a ridged hard palate. Pharynx: Tonsils are present, no enlargement, or exudates. Uvula present and upwardly movable.

Neck: No cervical lymphadenopathies. Trachea centrally located. No palpable central neck mass

Back: Inspection: No deformity, no skin lesions, no surgical scars, no masses. Palpation: No tenderness over the spine and muscles. Shoulder symmetrical

Posterior Thorax & Lungs: inspection: No masses, moves with respiration. Palpation: bilateral symmetrical, normal tactile fremitus, no tenderness or masses. Percussion: Normal resonance. Auscultation: Bilateral equal air entry, bilateral vesicular breath sounds heard. vocal fremitus normal

Breasts, Axillae, and Epitrochlear Nodes: Being male, no significant findings. Absent axilla and epitrocheal nodes

Upper Extremities: Hands: no color discoloration, no masses/swelling, no deformity, warm temperature, no tenderness, wrist, metacarpo-phalangeal and inter-phalangeal joints exhibit full range of motions. Arm: No color discoloration, no masses, no deformity, warm temperature, elbow joint full flexion and extension. Shoulder joints symmetrical, shoulder joint full range of motions. Full neck flexion, extension, rotation and cervical side-bending. Bulk, tone, reflexes are normal. Muscle power of 5/5 in both upper limbs. Radial and brachial pulse present, symmetrical, regular, and of good volume.

Anterior Thorax: Inspection: symmetrical, moves with respiration, no skin lesions, no masses. Palpation: No masses, no tenderness, bilateral equal chest expansion, tactile fremitus normal. Percussion: Normal resonance. Auscultation: Bilateral equal air entry, bilateral vesicular breath sounds heard. Vocal fremitus normal

Cardiovascular: Normal jugular venous pressure. Carotid pulse is present, regular, strong, good volume, no bruits. The precordium is normal and not hyperactive. Point of maximum impulse is at 5th intercostal space, an in mid-clavicular line. S1 and S2 are heard, no thrills, murmurs or any other added sounds.

Abdomen: Inspection: Marked abdominal distension with central obesity. No dilated veins, no surgical scars, no therapeutic marks, moves with respiration. On light palpation, no tenderness is elicited, no masses, no organomegally. On deep palpation, no tenderness elicited, no masses, no organomegally. No tenderness over the costovertebral angles. Liver and spleen not enlarged. Percussion: Tympanic. Auscultation: Bowel sounds heard

Lowe Extremities: femoral, popliteal, dorsalis pedis and posterior tibial pulses are present, regular, strong and of good volume bilaterally. No palpable inguinal lymphadenopathy. No discoloration or ulcerations of the lower extremities. No lower limb edema. Hip joint, knee joint, ankle joint, metatarsophalangeal and inter-phalangeal joints are flexible, and exhibit full range of motions specific for the particular joint. There is normal muscle bulk, tone and reflexes. Muscle power 5/5 bilateral lower limbs. No varicose veins. The right and left legs are neutrally aligned (no varus or valgus deformities). External genitalia is normal, no hernia findings. Negative Romberg’s test

Nervous System: GGCS-15/15. Patient is oriented in time, person and place. CN I, II, III, IV, VI are intact. CN VI, VIII, IX, X are normal. There is normal sensation to pain, light touch and vibration. Normal muscle bulk, tone, and reflexes. Muscle power 5/5 in both limbs.

Active Problems

1. Diabetes-the patient was diagnosed of diabetes in 2012. He is obese, a risk factor for diabetes (ADA, 2019). Further, the patient is an active smoker and an occasional drinker. Smoking and alcohol are modifiable risk factor for diabetes mellitus (ADA, 2019). Moreover, the patient is an African American, an ethnic community with higher risks for diabetes mellitus (Sapra & Bhandari, 2020). Diabetes mellitus causes chronic micro vascular complications such as retinopathy. Patients with retinopathy presents with blurred vision and a progressive and an insidious visual acuity loss (Shukla & Tripathy, 2021). Therefore, diabetic retinopathy is a differential diagnosis in the case described. The findings in the patient including a low visual acuity, macular edema and dot and blot hemorrhages could underpin the diagnosis.
2. Hypertension-the patient has been hypertensive since 2012. Long durations of hypertension predispose an individual to complications such as retinopathies and cardiovascular events. The patient reports a one episode of chest pain in the past three months. Prescription of Aspirin, as evidenced in the medication list is an intervention to prevent the cardiovascular events such as myocardial infarction or coronary artery disease (Zanchetti, 2017). Retinal complications include hypertensive retinopathy, a possible differential diagnosis in the patient.
3. Allergic rhinitis: on exposure to allergens, the condition is characterized by watery eyes, itchy nose, sneezing and nasal obstruction (Akhouri & House, 2021). The patient is allergic to pollen and house dust mites which are perennial allergens. She reports to have runny nose and watery eyes on exposure to the allergens. The diagnosis is underpinned by the physical examination findings which reveal a boggy and pale blue turbinates. Further, the patient has allergic shiners and a transverse nasal crease which are ocular and nasal signs respectively of allergic rhinitis (Akhouri & House, 2021).
4. Presbyopia: Age related condition characterized by a loss in the flexibility of the lens. In children, it occurs as farsightedness. Characteristic features include inability to read prints closer to the eye, moving reading materials far away from the eyes, straining, headaches, and squinting (Singh & Tripathy, 2020). Visual acuity is decreased on physical examination. The patient present with the typical features; however, his case could be superimposed with diabetic and hypertensive retinopathy.

Risk Profile

1. Obesity
2. Physical inactivity

References

• Akhouri, S., & House, S. A. (2021). Allergic Rhinitis. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK538186/
• Sapra, A., & Bhandari, P. (2020). Diabetes Mellitus. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK551501/
• Shukla, U. V., & Tripathy, K. (2021). Diabetic Retinopathy. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK560805/
• Singh, P., & Tripathy, K. (2021). Presbyopia. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK560568/#_NBK560568_pubdet
• Zanchetti, A. (2017). Predisposing factors, accompanying diseases and complications of hypertension. Journal of Hypertension, 35(4), 655–656. https://doi.org/10.1097/HJH.0000000000001306

 

1871-19671886-1977Grandfather: John

Died: 96yrs

From cholera

Grandmother: Elizabeth

Died: 91yrs

Died while sleeping

Cause: Unknown

1869-1959Grandpa: James

Died: 90

Cardiac arrest

1880-1966Grandma: Hannah

Died: 86

Stroke

1930-2009Dad: Benjamin

Died: 79

Prostate Cancer

 

1936-2020Mother: Theresa

Died: 84

COVID-19

Valentine: Patient14Presbyopia10Presbyopia1965 to date

Age: 46yrs

DM; HTN; Obesity; Allergic rhinitis; Presbyopia

64Brother: Josephat

Presbyopia

1957 to date481973 to date451976 to dateBrother: Chimezie

HTN

431978 to date

Brother: Uche

Gastric Ulcers

2007 to date2011 to dateAppendix

 

masses

and malignancy.

Finding: No supraclavicular lymphadenopathy

Pro Tip: Palpating the lymph nodes helps to identify characteristics relaying information about inflammation

treatment plan

NURS 6512 Comprehensive Assessment Tina Jones Shadow Health Transcript Provided

NURS 6512 Week 1: Discussion

Building A Health History – We Can Reliably Complete This And Related Assignments In This Course, Including All The Required Shadow Health Assessments. These Include Tina Jones Health History, Focused Cough Assessment On Danny Rivera, Focused Assessment – Chest Pain On Brian Foster, And The Comprehensive Health Assessment On Tina Jones.

Effective communication is vital to constructing an accurate and detailed patient history. A patient’s health or illness is influenced by many factors, including age, gender, ethnicity, and environmental setting. As an advanced practice nurse, you must be aware of these factors and tailor your communication techniques accordingly. Doing so will not only help you establish rapport with your patients, but it will also enable you to more effectively gather the information needed to assess your patients’ health risks.

For this Discussion, you will take on the role of a clinician who is building a health history for a particular new patient assigned by your Instructor.

Resources

Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources. 

WEEKLY RESOURCES

To prepare:

With the information presented in Chapter 2 of Ball et al. in mind, consider the following:

• By Day 1 of this week, you will be assigned a new patient profile by your Instructor for this Discussion. Note: Please see the “Course Announcements” section of the classroom for your new patient profile assignment.
• How would your communication and interview techniques for building a health history differ with each patient?
• How might you target your questions for building a health history based on the patient’s social determinants of health?
• What risk assessment instruments would be appropriate to use with each patient, or what questions would you ask each patient to assess his or her health risks?
• Identify any potential health-related risks based upon the patient’s age, gender, ethnicity, or environmental setting that should be taken into consideration.
• Select one of the risk assessment instruments presented in Chapter 2 or Chapter 5 of the Seidel’s Guide to Physical Examination text, or another tool with which you are familiar, related to your selected patient.
• Develop at least five targeted questions you would ask your selected patient to assess his or her health risks and begin building a health history.

BY DAY 3 OF WEEK 1

Post a summary of the interview and a description of the communication techniques you would use with your assigned patient. Explain why you would use these techniques. Identify the risk assessment instrument you selected, and justify why it would be applicable to the selected patient. Provide at least five targeted questions you would ask the patient.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the Reply button to complete your initial post. Remember, once you click on Post Reply, you cannot delete or edit your own posts and you cannot post anonymously. Please check your post carefully before clicking on Post Reply!   

Read a selection of your colleagues’ responses.

BY DAY 6 OF WEEK 1

Respond to at least two of your colleagues on 2 different days who selected a different patient than you, using one or more of the following approaches:

• Share additional interview and communication techniques that could be effective with your colleague’s selected patient.
• Suggest additional health-related risks that might be considered.
• Validate an idea with your own experience and additional research

Learning Resources

• Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2023). Seidel’s guide to physical examination: An interprofessional approach (10th ed.). St. Louis, MO: Elsevier Mosby.

o   Chapter 2, “The History and Interviewing Proce
This chapter explains the process of developing relationships with patients in order to build an effective health history. The authors offer suggestions for adapting the creation of a health history according to age, gender, and disability.

o   Chapter 5, “Recording Information”
This chapter provides rationale and methods for maintaining clear and accurate records. The authors also explore the legal aspects of patient records.

• Sullivan, D. D. (2019). Guide to clinical documentation (3rd ed.). Philadelphia, PA: F. A. Davis.

o   Chapter 2, “The Comprehensive History and Physical Exam” (pp. 19–29)

• Adly, N. N., Abd-El-Gawad, W. M., & Abou-Hashem, R. M. (2019). Relationship between malnutrition and different fall risk assessment tools in a geriatric in-patient unit. Aging Clinical and Experimental Research, 32(7), 1279–1287. https://doi.org/10.1007/s40520-019-01309-0
• Chow, R. B., Lee, A., Kane, B. G., Jacoby, J. L., Barraco, R. D., Dusza, S. W., Meyers, M. C., & Greenberg, M. R. (2019). Effectiveness of the “Timed Up and Go” (TUG) and the Chair test as screening tools for geriatric fall risk assessment in the ED. The American Journal of Emergency Medicine, 37(3), 457–460. https://doi.org/10.1016/j.ajem.2018.06.015
• Diamond-Fox, S. (2021). Undertaking consultations and clinical assessments at advanced level. British Journal of Nursing, 30(4), 238–243. https://doi.org/10.12968/bjon.2021.30.4.238

Shadow Health Support and Orientation Resources

Use the following resources to guide you through your Shadow Health orientation as well as other support resources:

• Shadow Health. (2021). Welcome to your introduction to Shadow Health. https://link.shadowhealth.com/Student-Orientation-Video
• Shadow Health. (n.d.). Shadow Health help deskLinks to an external site. Retrieved from https://support.shadowhealth.com/hc/en-us
• Shadow Health. (2021). Walden University quick start guide: NURS 6512 NP students. Download Walden University quick start guide: NURS 6512 NP students. 
• Document: Shadow Health Nursing Documentation Tutorial Download Shadow Health Nursing Documentation Tutorial(Word document)

Required Media

Welcome and General Course Guidelines
Dr. Tara Harris reviews the overall guidelines and the expectations for the course. Consider how you will manage your time as you review your media and Learning Resources throughout the course to better prepare for your Discussions, Case Study Lab Assignments, Digital Clinical Experience (DCE) Assignments, and your Midterm and Final Exams (14m).

Module 1 Introduction
Dr. Tara Harris reviews the overall expectations for Module 1. Please pay special attention to the registration requirements for your use of Shadow Health for your Digital Clinical Experience (DCE) Assignments as well as the criteria for the DCE Assignments (3m).

Building a Comprehensive Health History – Week 1 (19m)

Optional Resources

• LeBlond, R. F., Brown, D. D., & DeGowin, R. L. (2020). DeGowin’s diagnostic examination (11th ed.). New York, NY: McGraw- Hill Medical.

o   Chapter 2, “History Taking and the Medical Record” (pp. 1)

Comprehensive Assessment Tina Jones Shadow Health Transcript, Subjective, Objective & Documentation

This comprehensive shadow health assessment of Tina Jones enables the student to master the art of patient data collection, with head to toe history taking and physical assessment.

The process is highly involving, time-consuming and may require one to complete in different sessions, yet the goal is to be able to assess a patient in one sitting, taking as minimal time as possible. We can help you complete this and other shadow health assessments as and when needed, with excellent scores assured. Comprehensive Assessment Tina Jones Shadow Health Transcript

Transcript

All Lines (645) Interview Questions (210) Statements (41) Exam Actions (394)

Hello, my name is Tammy. I will be conducting an interview and a physical exam.Greet
07/22/20 5:37 PM EDTHey.What is your name?Question
07/22/20 5:37 PM EDTTina Jones.What is your date of birth?Question
07/22/20 5:37 PM EDTFebruary 17th.How old are you?Question
07/22/20 5:43 PM EDTI’m 28.What brings you into the clinic today?Question
07/22/20 5:43 PM EDTI came in because I’m required to have a recent physical exam for the health insurance at my new job.Do you have any current health problem?Question
07/22/20 5:44 PM EDTI don’t have anything specific going on today. I mean, I still have asthma and diabetes, but both of those are under control. I’m taking good care of my health these days.What is your new job?Question
07/22/20 5:44 PM EDTI’m going to be an Accounting Clerk at Smith, Stevens, Stewart, Silver & Company. I’ll be helping a more experienced accountant with her clients, and then eventually I’ll get more responsibility, and build my own client list. I start in two weeks–I’m really excited!Comprehensive Assessment Tina Jones Shadow Health TranscriptThat is great.Empathize
07/22/20 5:45 PM EDTThanks.When was your last physical exam?Question
07/22/20 5:45 PM EDTLet’s see . . . I had two doctor’s appointments earlier this year. About five months ago, I came in here for a check-up, and the nurse practitioner got me on metformin. Then a few weeks later I saw a gynecologist for a pap smear.What did your gynecologist say?Question
07/22/20 5:45 PM EDTShe said everything looked good, except that I had PCOS, which the nurse here had said was possible. She started me on birth control, and it seems to be helping things.Comprehensive Assessment Tina Jones Shadow Health TranscriptHow often do you take birth control?Question
07/22/20 5:48 PM EDTI take it every morning, with breakfast.What is the name of the birth control pill you took?Question
07/22/20 5:49 PM EDTThey’re called Yaz.Has your menstrual cycle improved since taking Yaz?Question
07/22/20 5:50 PM EDTNow that I’m on the pill I’m getting my period every month.That is great. I am glad you are having your period every month.Empathize
07/22/20 5:50 PM EDTThanks.Comprehensive Assessment Tina Jones Shadow Health TranscriptHow long have you had asthma?Question
07/22/20 5:51 PM EDTI’ve had asthma a long time. . . since I was really little.What age were you diagnosed with asthma?Question
07/22/20 5:51 PM EDTMy doctor told me when I was pretty little… I think I was about two and a half? I used to have a lot of trouble with asthma attacks back then.Comprehensive Assessment Tina Jones Shadow Health TranscriptI am sorry about the experience.Empathize
07/22/20 5:52 PM EDTThanks.Comprehensive Assessment Tina Jones Shadow Health TranscriptHow do you manage your asthma?Question
07/22/20 5:52 PM EDTI try to avoid things that give me breathing problems, but when my asthma starts to act up, I just use my inhaler.What are your triggers for asthma?Question
07/22/20 5:53 PM EDTBeing around cats is the worst, but dust and running up stairs can make my breathing bad, too. I haven’t had a full asthma attack in years, though.Comprehensive Assessment Tina Jones Shadow Health TranscriptIt is important to stay away from triggers.Educate
07/22/20 5:54 PM EDTThanks for telling me.Comprehensive Assessment Tina Jones Shadow Health TranscriptWhat happens when you are around dust?Question
07/22/20 5:54 PM EDTI used to have a reaction when I was in a dusty house for a long time. . . I would get allergies, like sneezing and stuff, and then my asthma would act up. But that hasn’t happened since I got my daily inhaler.Comprehensive Assessment Tina Jones Shadow Health TranscriptWhat inhaler do you use?Question
07/22/20 5:59 PM EDTThe daily inhaler is Flovent, and the rescue inhaler is Proventil.Comprehensive Assessment Tina Jones Shadow Health TranscriptHow often do you use Flovent?Question
07/22/20 6:00 PM EDTTwice a day.When did you most recently use the Flovent inhaler?Question
07/22/20 6:01 PM EDTI use my Flovent inhaler two times a day.Comprehensive Assessment Tina Jones Shadow Health TranscriptWhen did you last use your inhaler?Question
07/22/20 6:03 PM EDTI used my Flovent inhaler this morning–I have to take it twice a day. My albuterol. . . I’ve maybe used it twice since I came in with those asthma problems. Once three months ago, and before that it had been months, too.Comprehensive Assessment Tina Jones Shadow Health TranscriptHow much Albuterol do you use?Question
07

I have a few friends I’ve known since middle or high school, and we’re all pretty close. Plus I have my friends from church.

What is your relationship like with your family?Question
07/22/20 7:39 PM EDTThings are pretty good between all of us–we’re a tight knit family. I think we’re pretty special, the way we all get along.That is great.Empathize
07/22/20 7:39 PM EDTThanks.Are you involved in church?Question
07/22/20 7:39 PM EDTYeah. We go to First Baptist, and we do a lot with our church community. We socialize before and after church, and I go to Bible study on Wednesdays, too.Comprehensive Assessment Tina Jones Shadow Health TranscriptAre you feeling stressed?Question
07/22/20 7:40 PM EDTI’m feeling really good lately. . . not stressed at all.How do you cope with stress?Question
07/22/20 7:40 PM EDTI’ve realized that I got overwhelmed with everything back when I had those sleep problems. Just coming in and talking to someone here about it helped a little because I felt like I was doing something. So I’ve been trying to address problems as they come when I can, and that helps. That, plus the stuff I’ve always done–attending church, especially–is all working well for me.Comprehensive Assessment Tina Jones Shadow Health TranscriptThanks.Comprehensive Assessment Tina Jones Shadow Health TranscriptAre you feeling depressed?Question
07/22/20 7:41 PM EDTNo, I’m actually feeling really good these days.How do you feel about your life?Question
07/22/20 7:41 PM EDTI’m starting my new job in two weeks, and I’m excited about that. I’m going to be an Accounting Clerk at this nice accounting firm. I’m hoping I’ll learn a lot in that position, and within a couple of years, I’ll get promoted and be given new responsibilities. I always want to learn new things and improve my job.Comprehensive Assessment Tina Jones Shadow Health TranscriptAre you feeling anxious?Question
07/22/20 7:41 PM EDTI guess I had anxiety back when I was having those sleep problems. . . I’ve been feeling much better lately, though.Comprehensive Assessment Tina Jones Shadow Health TranscriptDo you have sleeping problems?Question
07/22/20 7:42 PM EDTI’m sleeping a lot better now, which is a relief.Good to hear.Empathize
07/22/20 7:42 PM EDTThanks.How many hours are you sleeping a night?Question
07/22/20 7:42 PM EDTI’m usually asleep by 11:30, and I wake up at 8, about 8 or 9 hours a night.That is great.Empathize
07/22/20 7:42 PM EDTThanks.Have you ever smoked tobacco?Question
07/22/20 7:43 PM EDTNo. I think it’s gross.Have you ever used cocaine?Question
07/22/20 7:43 PM EDTNo way, I have no interest in that. That stuff can mess you up.Have you ever used heroin?Question
07/22/20 7:49 PM EDTUh, no.Have you ever used illegal drugs?Question
07/23/20 3:17 PM EDTWell, I used to smoke pot. . . but I don’t do that anymore.What was the last time you smoked pot?Question
07/23/20 3:17 PM EDTI haven’t smoked pot since I was twenty or twenty-one.Do you have any family history of mental illness?Question
07/23/20 3:18 PM EDTNo. They’re crazy, but nobody’s diagnosed with anything.Have you had suicidal thoughts?Question
07/23/20 3:19 PM EDTNo, I’ve never done that.Any new family medical history report?Question
07/23/20 3:20 PM EDTMy mom has some issues; I think some of my grandparents did, too.How old is your mom?Question
07/23/20 3:21 PM EDTMom is 50.What medical problems does your mum have?Question
07/23/20 3:21 PM EDTMom has high cholesterol and blood pressure, I think. She seems to be doing okay though.What medical problems did your father have?Question
07/23/20 3:22 PM EDTHe had high blood pressure and cholesterol, and diabetes too…the same kind as me.How old is your brother?Question
07/23/20 3:24 PM EDTHe’s almost 27.Does he have any medical issues? (Clarified to Does your younger sister have health problems?.)Question
07/23/20 3:25 PM EDTShe’s pretty healthy. She has asthma too, but she rarely has attacks. (Clarified to if my younger sister has health problems.)Does your brother have health issues? (Clarified to Does your brother have medical problems?.)Question
07/23/20 3:25 PM EDTNo, I don’t think so. He’s a little big, maybe. (Clarified to if my brother has health issues.)How old is your maternal grandmother?Question
07/23/20 3:26 PM EDTNana was 73 when she died of a stroke about five years ago. I think she had high blood pressure and cholesterol, too.How old is your maternal grandfather?Question
07/23/20 3:27 PM EDTPoppa died of a heart attack when he was 80. . . he had some blood pressure and cholesterol issues when he was alive, too.Any medical history for your paternal grandmother?Question
07/23/20 3:30 PM EDTShe takes some blood pressure pills and has high cholesterol, but Granny’s doing great for 82.Does your dad’s father have health issues?Question
07/23/20 3:30 PM EDTGrandpa Jones had colon cancer, and that caused all kinds of problems for him. Plus, he had high blood pressure and…I’m pretty sure he had diabetes.Comprehensive Assessment Tina Jones Shadow Health TranscriptHave you had any recent illnesses?Question
07/23/20 3:31 PM EDTNo. . . the last time I was sick was when I was having those heartburn problems a while ago.Any fever?Question
07/23/20 3:32 PM EDTI haven’t had a fever.Any chills?Question
07/23/20 3:32 PM EDTNope, no chills.Any acne?Question
07/23/20 3:32 PM EDTI took something for my acne. . . tetracycline, I think, back in high school. Since then I’ve just washed my face, I haven’t used anything special. But my zits have gotten better, and I think it’s because I’m on birth control now.Has your body hair improved?Question
07/23/20 3:32 PM EDTI think I have a little less body hair than I used to.Do your eyes feel itchy?Question
07/23/20 3:33 PM EDTThey haven’t been itchy lately at all.Are you having any redness in your eyes?Question
07/23/20 3:33 PM EDTMy eyes haven’t been red lately. . . not since I came in with those allergies a while ago.Are your eyes dry?Question
07/23/20 3:34 PM EDTMy eyes don’t feel dry.Do you have any pain in your eyes?Question
07/23/20 3:34 PM EDTI haven’t had any eye problems lately–I went to the eye doctor a few months ago and got these glasses; she checked everything out and said it looked good.Are you having any ear problems?Question
07/23/20 3:34 PM EDTMy ears feel fine.Any changes in your hearing?Question
07/23/20 3:36 PM EDTMy hearing is good.Any ear pain?Question
07/23/20 3:36 PM EDTMy ears feel fine.Ear drainage? (Clarified to Do you have drainage from your ears?.)Question
07/23/20 3:36 PM EDTNothing is coming out of my ears. (Clarified to if I have ear drainage.)Any changes in your sense of smell?Question
07/23/20 3:46 PM EDTNo.Any nose bleeds?Question
07/23/20 3:47 PM EDTNope, my nose isn’t bleeding at all.Any sinus pressures?Question
07/23/20 3:47 PM EDTMy sinuses have been fine.Has your sense of taste changed?Question
07/23/20 3:47 PM EDTNo, I think my sense of taste is fine.Are you having dry mouth?Question
07/23/20 3:48 PM EDTMy mouth hasn’t been dry.ANY pain in your mouth?Question
07/23/20 3:48 PM EDTNo, my mouth feels fine.ANY sore throat?Question
07/23/20 3:49 PM EDTNo, it’s fine.Any issue with your gums?Question
07/23/20 3:49 PM EDTMy gums have been fine.Any issue with your tongue?Question
07/23/20 3:49 PM EDTMy tongue feels fine.Any difficulties when swallowing?Question
07/23/20 3:50 PM EDTI can swallow fine.SORE throat?Question
07/23/20 3:50 PM EDTNo, it’s fine.Any voice changes?Question
07/23/20 3:50 PM EDTMy voice has been fine.Any swollen lymph nodes?Question
07/23/20 3:52 PM EDTMy lymph nodes seem fine.Are you having any nausea?Question
07/23/20 3:52 PM EDTNo, I haven’t been nauseous at all.Any vomiting?Question
07/23/20 3:53 PM EDTNo.ANY pain in the abdomen?Question
07/23/20 3:53 PM EDTI haven’t really had any stomach problems since I came in with them a while ago.Any constipation?Question
07/23/20 3:53 PM EDTI don’t have that problem.Comprehensive Assessment Tina Jones Shadow Health TranscriptAny diarrhea?Question
07/23/20 3:54 PM EDTI haven’t had any problems with diarrhea.Excessive flatulence?Question
07/23/20 3:54 PM EDTI haven’t been having any gas lately. I had a little when I first started metformin, but I found out I could eat yogurt to help it, and it seems to have worked.flatulence is one of the side effect of metforminEducate
07/23/20 3:55 PM EDTThanks for telling me.Any food intoleranceQuestion
07/23/20 3:56 PM EDTI can eat just about anything.Any burning sensation when you urinate?Question
07/23/20 3:56 PM EDTNo, it doesn’t burn when I pee.Any blood in your urine?Question
07/23/20 3:57 PM EDTNo! That doesn’t sound like it would be good.Are you having any pain right now?Question
07/23/20 3:57 PM EDTI don’t have any pain anywhere.Any vaginal discharge?Question
07/23/20 3:58 PM EDTMy discharge is normal, I think. . . I have a little, and it’s kind of clear, sometimes white-ish.Comprehensive Assessment Tina Jones Shadow Health TranscriptAny vaginal itching?Question
07/23/20 3:58 PM EDTNo, it feels normal.Do you have any problem with your breasts?Question
07/23/20 3:59 PM EDTNo, my breasts feel fine.Any pain in the breasts?Question
07/23/20 3:59 PM EDTNo, my breasts feel fine.Are you having any dizziness/Question
07/23/20 3:59 PM EDTI haven’t been getting dizzy at all.Any lightheadedness?Question
07/23/20 4:00 PM EDTNo, I don’t really get lightheaded.Any tingling?Question
07/23/20 4:00 PM EDTNope, no tingling.Comprehensive Assessment Tina Jones Shadow Health TranscriptAny loss of balance?Question
07/23/20 4:00 PM EDTMy balance is fine.Any changes in sensation?Question
07/23/20 4:00 PM EDTI haven’t noticed any changes.Any seizures?Question
07/23/20 4:01 PM EDTNo, I’ve still never had problems with seizures, fortunately.Do you have memory problems?Question
07/23/20 4:01 PM EDTI think my memory has been fine.Any muscle pain?Question
07/23/20 4:01 PM EDTMy muscles have felt great, especially since I started exercising more.Joint pain?Question
07/23/20 4:02 PM EDTMy joints always seem fine.Comprehensive Assessment Tina Jones Shadow Health TranscriptAny muscle weakness?Question
07/23/20 4:02 PM EDTNo, I haven’t felt weak at all.Any swelling?Question
07/23/20 4:03 PM EDTNothing is swollen. Performed pulse oximetryExam Action
07/24/20 10:01 AM EDT Performed spirometryExam Action
07/24/20 10:01 AM EDT Inspected scalpExam Action
07/24/20 10:01 AM EDT Inspected scalpExam Action
07/24/20 10:01 AM EDT Inspected hair on scalpExam Action
07/24/20 10:01 AM EDT Inspected scalpExam Action
07/24/20 10:01 AM EDT Inspected right eyebrow and orbital areaExam Action
07/24/20 10:02 AM EDT Inspected left eyebrow and orbital areaExam Action
07/24/20 10:02 AM EDT Inspected mouth: Oral mucosa moist.Exam Action
07/24/20 10:02 AM EDT

Subjective Data Collection: 50 of 50 (100.0%)

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Patient Data

Current Health Status

Finding: A confirmed reason for the visit

Finding: Reports needing a pre-employment physical

Pro Tip: Initially establishing a chief complaint allows the patient to express their reason for seeking care, primary concerns, or condition they are presenting with.

Example Question: Can I confirm that you are here for a physical?

Finding: Reports no current acute health problems

Pro Tip: Initially establishing a chief complaint allows the patient to express their reason for seeking care, primary concerns, or condition they are presenting with.

Example Question: Do you have any current health problems?

Finding: Asked about last visit to a healthcare provider

Finding: Last visit to a healthcare provider was 4 months ago

Pro Tip: Establishing a timeline for which healthcare providers Tina has seen will allow you to develop a comprehensive health history.

Example Question: When did you see a healthcare provider?

Finding: Reason for last visit was annual gynecological exam

Pro Tip: Establishing a timeline for which healthcare providers Tina has seen will allow you to develop a comprehensive health history. Asking Tina why she saw a healthcare provider might indicate any recent health concerns or problems.

Example Question: Why did you see a healthcare provider?

Finding: Last general physical examination was 5 months ago when she was prescribed metformin and daily inhaler

Pro Tip: Establishing a timeline for which healthcare providers Tina has seen will allow you to develop a comprehensive health history.

Example Question: When was your last physical exam?

Finding: Asked about current prescription medications

Finding: Reports taking diabetes medication

Pro Tip: The medications that a patient takes indicate their health concerns or problems, health literacy, and current treatment plans. Asking Tina if she has been taking medication for her diabetes will indicate her treatment plan and the degree to which she is following it.

Example Question: Have you been taking medication for your diabetes?

Finding: Reports using a daily inhaler

Pro Tip: The medications that a patient takes indicate their health concerns or problems, health literacy, and current treatment plans. Asking Tina if she still has her inhaler will indicate her treatment plan and the degree to which she is following it.

Example Question: Do you use a daily inhaler?

Finding: Reports taking prescription birth control pills

Pro Tip: The medications that a patient takes indicate their health concerns or problems, health literacy, and current treatment plans.

Example Question: Are you taking any form of birth control?

Finding: Followed up about diabetes medication

Finding: Medication is metformin

Pro Tip: Follow up questions about Tina’s medication history will help you to understand her treatment plan and recent health history.

Example Question: What is the name of your diabetes medication?

Finding: Started taking metformin 5 months ago

Pro Tip: Follow up questions about Tina’s medication history and timeline will help you to understand her treatment plan and recent health history.

Example Question: How long have you been taking metformin?

Finding: Reports that eating probiotic yogurt helps with side effects and they have abated over time

Pro Tip: Follow up questions about Tina’s medication history and timeline will help you to understand her treatment plan and recent health history.

Example Question: Have you noticed any side effects from the metformin?

Finding: Followed up on metformin frequency and dose

Finding: Reports taking metformin twice daily

Pro Tip: Follow up questions about Tina’s medication history and timeline will help you to understand her treatment plan and recent health history.

Example Question: How many times a day do you take metformin?

Finding: Metformin dose is 850 mg

Pro Tip: Follow up questions about Tina’s medication history and timeline will help you to understand her treatment plan and recent health history. Comprehensive Assessment Tina Jones Shadow Health Transcript

Example Question: What is the dose of your metformin?

Finding: Asked about asthma medication

Finding: Reports using Flovent inhaler twice daily

Pro Tip: Asthma exacerbation can result in increased wheezing, shortness of breath, and chest tightness. Asking if Tina’s been using her inhaler more frequently since exacerbation can indicate how she’s been treating her symptoms since exacerbation.

Example Question: How often do you use your daily inhaler?

Finding: Has a Proventil rescue inhaler

Pro Tip: A patient’s medication reveals a current treatment plan and healthcare access. Asking Tina if she has a rescue inhaler for her asthma will indicate her treatment plan and the degree to which she complies with it.

Example Question: Do you have a rescue inhaler?

Finding: Last use of Proventil inhaler was three months ago

Pro Tip: Soliciting a shallow history of a patient’s medication history can reveal recent exacerbation. Asking Tina when she last used her inhaler will indicate when her symptoms most recently required medical treatment.

Example Question: When did you last use your rescue inhaler?

Finding: Has used Proventil inhaler twice in the last year

Pro Tip: Asthma exacerbation can result in increased wheezing, shortness of breath, and chest tightness. Asking if Tina’s been using her inhaler more frequently since exacerbation can indicate how she has been treating her

Comprehensive Health Assessment and Physical Assessment

Patient Details:

Name: VO

Gender- Male

Age: 56 years

African American (Nigerian)

Date of assessment – 4/1/2021

Photographer (occupation)

1. A. PROBLEM LIST
2. Active problems: blurry vision, farsightedness, headache, eye-straining
3. Inactive problems: elevated blood pressure, elevated blood sugar, premature presbyopia,
4. Risk factors: smoking (1.1 pack-years), alcohol intake, diabetes mellitus type II, hypertension, medication (HCTZ), genetic risk/ familial component
5. B. SUBJECTIVE DATA

Chief Complaint – I can’t read very well even with my eye-glasses

History of Presenting Illness: VO is a 56-year-old African American photographer who presents to the clinic with complaints of inability to read very well with or without his eyeglasses. He has been having problems reading small prints that he could read with his glasses about a half-decade ago. Whenever he tries to read newspapers or books at a close range, he develops a moderate frontal headache thereafter for which he has to take over-the-counter pain relievers. He, therefore, has to move the objects at armlength to read them properly.

This problem had been progressively worsening in the past five years. The decision to visit the clinic was prompted by the increased frequency of headaches whenever he tries to watch television at close ‘normal’ distances. He sometimes has to adjust the brightness of his phone and television screen brightness to read and watch television properly.

He denied double vision but reports blurry vision when trying to focus on nearer objects but not far objects. There is no history of excess tearing or eye discharge, eye redness, burning sensation, or itching. There are no eye medications he is using for his symptoms. His last eye exam was 10 years ago and the no significant changes.

Medications:

1. Metoprolol ER Succinate 50mg tablet, Dosage 1 tablet=50mg, Route – PO, frequency -Daily
2. Losartan/HCTZ 100/12.5mg, Dosage- 1 tablet-100/12.5mg, Route – PO, frequency-Daily
3. Aspirin 81mg chewable tablets, Dosage- 1 tablet=81mg, Route-PO, frequency-Daily
4. Metformin 500mg tablets, Dosage- 1 tablet=500mg, Frequency-Daily, Route-PO
5. Vitamin D3 5,000 IU tablet, Dosage 5000 IU – 1 Tablet, route – PO, Frequency- Daily

Allergies: VO is allergic to pollen and dust. He develops a runny rose and watery eyes whenever he is exposed to these allergens. There are no known drug allergies including penicillin and sulfur-based drugs.

Tobacco Use: VO is a known smoker with 1.1 pack-years of tobacco smoking

Alcohol and Drug Use: he is a social drinker. He drinks about two bottles of beer during weekends and social occasions.

Past Medical History:

Childhood Illnesses: he was diagnosed with presbyopia at age 10. No other significant illnesses are reported. He no history of measles, mumps, or poliomyelitis during his childhood

Adult Illnesses: he was diagnosed with hypertension and diabetes mellitus type 2 at age 47. He is not epileptic or asthmatic. There is no history of past surgeries. He reports being hospitalized once in 2012 for 3 days at the time when he was diagnosed with diabetes and hypertension. He has never been diagnosed with or treated for any mental illness. He has one sexual partner with whom he practices safe sex. The last flu shot received was seven months ago. He is seronegative for HIV/AIDS infection

Family History: VO’s father died of prostate cancer at 79, his mother died of coronavirus at 84, his paternal grandfather died of cholera at 96, and the paternal grandmother died at 91 in her sleep and the cause of her death was unknown. His elder brother, 64, suffers from presbyopia, the immediate younger brother, 48, is hypertensive, while other siblings 43 and 48 suffer from Peptic Ulcer Disease (PUD) and hypertension reactively.  He has two children, both boys 14 and 10, who both suffer from presbyopia. The genogram for family history is attached in the appendix section of this paper.

Personal and Social History: VO is married and lives with his wife and children. He enjoys photography as an occupation and during leisure. He studied photography in college for two years. He likes playing with his children after school during his free time. His activities of daily life (ADLs) majorly involve movement from place to place doing photography for his clients. He is not a staunch Christian but is religiously affiliated to the core Christian values and teachings. He never takes coffee or cocoa but prefers soya for his beverages and breakfast. His diet is mainly composed of carbohydrates with the lowest sugar, salt, and plant proteins amounts but he is not a vegan.

He loved colas and French fries in his twenties and thirties but stopped these foods in an attempt to stay ‘fit and healthy’ diet-wise He exercises regularly in the morning as directed by his primary physician but reports that his present condition has not allowed him to work out in the morning because the morning sunlight is not ‘adequate enough to allow him to see properly. He sleeps for a minimum of six hours a day and prefers sleeping early in the night. VO drives with his seat belt on and observes all traffic rules. He prefers seeing a medical doctor whenever he is sick and he does not use traditional therapies and alternative medicine.

Review of Systems:

General: no fever, weight loss of gain, weakness, or fatigue

HEENT: Head – no history of head trauma, lightheadedness, or dizziness; Ears – no ringing in the ears, ear pain, discharge, vertigo, or loss of hearing; Nose – no nasal congestion, irritation, blockage, drainage, bleeding, or stuffiness; Throat – no sore throat, no halitosis, no throat irritation, difficulty or pain during swallowing

Skin: no rashes, itchiness, color changes, dryness, scaly skin, skin moles, or nail spooning.

Neck: no pain, stiffness, lumps, or history of neck trauma

Respiratory: no cough, chest pain, shortness or difficulty in breathing, or chest tightness. The is no history of chest x-ray examination

Cardiovascular: no chest tightness, edema, palpitations, orthopnea, or paroxysmal nocturnal dyspnea

Gastrointestinal: there is no pain or difficulty in swallowing. He has no loss of appetite, nausea, or vomiting. There is no history of heartburn or change in bowel movements or habits. No history of constipation, diarrhea, bloating, or excessive burping. There is no history of melena stool, pain with defecation, or rectal bleeding. He reports no hemorrhoids. He also denies eye yellowing, abdominal pain, or hepatitis infection

Genitourinary: he reports occasional nocturia and urinary frequency. However, the is no urinary retention or incontinence. He has no hematuria or abnormal urethral discharge. He denies perineal and penile itchiness or pain. There is no dysuria, flank pain, suprapubic pain, urinary hesitancy, or urinary urgency. He has no genital ulcers or erectile dysfunction. He reports no weak urinary stream, terminal dribbling, history of UTIs. His last PSA was normal and he was informed that the DRE exam findings during the last checkup were normal; about ten years ago. He also denies a history of scrotal or groin pain or masses

Musculoskeletal: no history of joint pain, redness, stiffness, weakness, or swelling. No muscle weakness or swelling was reported. He denies a history of arthritis and lower back pains.

Psychiatric: no anxiety, depression, or suicidal ideations

Neurologic: no paralysis, numbness, tingling sensations, muscle weakness, syncope, seizures, or tremors. He denies memory or speech problems.

Hematologic: no anemia, easy bruising, nose bleeding, delayed healing, or past history of blood transfusion

Endocrine: no intolerance to heat or cold, no goiter, no excessive thirst or hunger

• OBJECTIVE DATA

PHYSICAL EXAMINATION

General: He is in good general condition, alert, and cooperates well with the examiner. He is not in any obvious respiratory distress. He has his spectacles on but appears to be straining with sight. His skin is dark in color, his eyes are brown, the hair is black.

Nutritional and Vital Signs: Weight = 230lbs, Height -5 feet 4 inches, Blood pressure reading: 125/83 mmHg, Pulse rate – 83bpm, SPO2 saturation – 98% in room air, Respiratory rate = 22 bpm, BMI = 39.50C

Pain assessment-no pain, 0/10

HEENT:

Head – no bruises, no scars, no masses;

Neurological: an examination of cranial nerves I and III – XII essentially normal

Ears: external auditory meatus is clear and clean, no wax impaction, no drainage or discharge. The tympanic membrane is non-erythematous and non-bulging. Weber’s and Rinne’s test revealed no hearing abnormalities bilaterally;

Nose: no discharge, no bleeding, no alar bruises or scars, no allergic shiners, both nares are clear and patent, there is no septal deviation or masses, no polyps or mucous plug seen, no turbinate hypertrophy, the nasal mucosa is pink

Mouth: good oral hygiene, no ulcers, no thrush or bad breath, there are no dentures or missing teeth, there is no ankyloglossia; there are moist mucosal membranes,

Throat & Neck: uvula and hard palate are seen, there is no tonsillar enlargement, there no pharyngeal erythema or tonsilloliths; pharyngeal mucosa is pink

Neck: no neck masses, no neck stiffness or rigidity, thyroid gland not palpable, no jugular venous distention, no cervical lymphadenopathy

Eye Examination:

Inspection: brown eye color, pupil size 3 mm, the pupils are equal round and reactive to light bilaterally, no nystagmus, the extraocular eye movements intact and full; the sclerae are white and anicteric. The conjunctiva is clear. The cornea is clear and the corneal reflex is intact in both eyes. There is no diplopia or orbital and periorbital edema. The eyebrows are rough, kinky, and black. The eyelashes are normally positioned, with no ptosis, fasciculations, redness, or swelling of the eyelids. The eyelids can open wide and close completely without pain or straining. The eyelids are symmetrical

Palpation: no lacrimal gland tenderness, no nodules below the eyelids,

Visual acuity:

Near vision – 20/120 OD, 20/120 OS, and therefore, 20/120 OU at a near distance

Distant vision – 20/200 OU

Ophthalmoscopic examination: there are no hemorrhages, hard exudates, or laser scars. Both discs are cream-colored and margins well defined. The arteriole-venule ratio in both eyes is 3:5 and no venous pulsations are noted in both eyes.

Chest and Lungs Examination: symmetrical chest wall moving with respirations and expands symmetrically bilaterally; the trachea is centrally placed, normal breath sounds, no rhonchi, wheezes or stridor, no egophony or tactile fremitus. No dullness or hyper resonance areas on percussion.

Cardiovascular: Regular rate and rhythms, normoactive precordium, S1, and S2 sound heard, no added sounds, normally placed apex beat.

Abdomen: abdomen is non-distended and non-tender, normoactive bowel sounds and no palpable masses, spleen, and kidneys not palpable, the liver span is 9 cm by percussion. No bruits were heard

Genitourinary: no penile or testicular lesions. No groin mases or hernias. The anal tone was normal, no rectal bleeding, prostate non-tender, the surface is smooth with midline sulcus palpated, no prostate enlargement.

Extremities: no cyanosis, edema, cyanosis, or finger clubbing. Peripheral pulses were present.

Musculoskeletal: no joint deformities, swellings, warmth, redness, or tenderness. There was no limitation in ranges of motion in all joints.

Diagnostics:

Random blood sugar: 162.1 mg/dL

Thyroid function tests ordered and results pending

1. ASSESSMENT:

VO is a 56-year-old African American who presents with a progressively worsening inability to read near writings and blurry vision for the past five years. He was diagnosed with presbyopia at age 12 and there is a positive family history of presbyopia in the first-degree relatives. He visits the clinic today because of the frequent headaches and eye strain associated with the inability to read writings at close distances and eye-straining. He is a known diabetic hypertensive on care since age 47. Physical exam reveals reduced visual acuity in near distances. His presentation and past history are consistent with functional presbyopia worsened with the advancing age.

His presbyopia is suggested by the reduction in acuity at near and normal acuity at distant examinations. There is a familial component of his presbyopia as his two sons and his brother suffer from presbyopia. His symptomatology including straining while reading blurry vision, and difficulty reading near objects highly suggest presbyopia (Ball et al., 2018). Other possible differential diagnoses for his presentation include hypermetropia, astigmatism, diabetic retinopathy, and obesity. VO is nearly morbidly obese with a BMI of 39.5.

Hypermetropia, also known as hyperopia, presents with farsightedness. The strain to read near objects causes headaches from eye-straining. However, hyperopia is common in adults but is not related to advanced age. Blurry vision is common in both hyperopia and presbyopia as seen in this patient but the blurry vision in hyperopia can occur at any distance (Cunha et al., 2018).

The patient has been diabetic for the past eight years. The quality of the management of his diabetes is not known. The possibility of diabetic retinopathy cannot be ruled despite the inconclusive retinal physical eye exam. Astigmatism is also a possibility in VO as suggested by the presence of blurry vision. A further ophthalmologic exam is required to distinguish astigmatism, diabetic retinopathy, hyperopia in this patient.

1. Plan:

Treatment: the mainstay of VO’s management would be prescription lenses. VO’s treatment would include multifocal contact lenses for his presbyopia. In addition to his glasses, he would receive these multifocal contact lenses that would adjust for any over-correction of the near distance deficits. Assessment of additional magnification power (ADD) required and refraction error would direct the selection of specific lenses (Grzybowski et al., 2020) best for this patient. Multifocal type of lenses would be advantageous over monovision lenses in that there would be a reduction in contrast sensitivity with the multifocal approach (Akella & Juthani, 2018).

Patient Education: the patient would be educated about the application and usage of the lenses. He would also be made aware of the potential adverse events that would warrant an emergency revisit to the clinic. Patient education about lifestyle modification such as weight reduction and promotion of physical exercise would help in the management of his comorbidities such as diabetes, hypertension, and obesity.  He would be advised on how to use his lenses when reading books, newspapers at close distances. This would prevent occasional headaches associated with eye-straining. Self-monitoring and management of blood sugar and blood pressure at home would be highly encouraged to avoid occult elevated blood sugar and pressures that would worsen his optic health in absence of medical care.

Health Maintenance: His health maintenance would include continued treatment of diabetes and hypertension. Measurement of the HbA1c would assess the quality of control of his blood sugars in the past 3 months. Elevated A1c would warrant adjustment of his hypoglycemic drugs. Maintenance of his blood pressure levels within the normal ranges will be important for the best response to the nonpharmacological management of presbyopia. Assessment of his diuretics as contributing factor to the worsening of his presbyopia (Fricke et al., 2018). Diuretics have been associated with the maintenance of presbyopia (Gordon Schanzlin New Vision Institute, 2017).  Family-based care is also an important aspect of VO’s care and treatment. Some of his first-degree have been diagnosed with presbyopia. Assessment of the impacts on mental health would be necessary to promote family-centered care. Evaluation of family roles would help in promoting medication adherence. The need for family counseling would be assessed

Follow-up: the patient would be seen again in two weeks to assess his adaptation to new lenses and the need for adjustments. Expected adverse events would include dizziness, nausea, and poor assessment of deaths by the patient. These adverse events usually disappear after two to three weeks of management by contact lenses.

Referral: VO would be referred to an ophthalmologist for specific eye treatment and evaluation. He would be referred to a nutritionist for dietary management, obesity control, and dietary control of elevated blood pressure.

Appendix 1: Genogram

References

• Akella, S. S., & Juthani, V. V. (2018). Extended depth of focus intraocular lenses for presbyopia. Current Opinion in Ophthalmology, 29(4), 318–322. https://doi.org/10.1097/icu.0000000000000490
• Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2018). Seidel’s guide to physical examination: An interprofessional approach (9th ed.). Mosby.
• Cunha, C. C., Berezovsky, A., Furtado, J. M., Ferraz, N. N., Fernandes, A. G., Muñoz, S., Watanabe, S. S., Sacai, P. Y., Cypel, M., Mitsuhiro, M. H., Morales, P. H., Vasconcelos, G. C., Cohen, M. J., Campos, M., Cohen, J. M., Belfort, R., Jr, & Salomão, S. R. (2018). Presbyopia and ocular conditions causing near vision impairment in older adults from the Brazilian Amazon Region. American Journal of Ophthalmology, 196, 72–81. https://doi.org/10.1016/j.ajo.2018.08.012
• Fricke, T. R., Tahhan, N., Resnikoff, S., Papas, E., Burnett, A., Ho, S. M., Naduvilath, T., & Naidoo, K. S. (2018). The global prevalence of presbyopia and vision impairment from uncorrected presbyopia. Ophthalmology, 125(10), 1492–1499. https://doi.org/10.1016/j.ophtha.2018.04.013
• Gordon Schanzlin New Vision Institute. (2017, June 9). Presbyopia. Gwsvision.Com. https://www.gwsvision.com/aging-vision/presbyopia/
• Grzybowski, A., Markeviciute, A., & Zemaitiene, R. (2020). A review of pharmacological presbyopia treatment. Asia-Pacific Journal of Ophthalmology (Philadelphia, Pa.), 9(3), 226–233. https://doi.org/10.1097/APO.0000000000000297