Address one social determinant of the health

Reference no: EM133508664

Case: HPI: A 50-y-old Spanish-speaking female who is bilingual returns to your office for a follow-up BP check. She is a schoolteacher and has been your patient for many years. She arrives 45 min late for her appointment. At her previous visit 4 weeks ago, her BP was 160/90 mm Hg on atenolol 50 mg QD (Tenormin, beta-blocker, max dose 100 mg QD), and you increased the atenolol to 75 mg QD at that time.

Today she feels well, and her BP is 140/85 mm Hg on 2 measurements and her HR is 50 bpm.

Labs: CBC (WNL), Creatinine 2.0 mg/dl (normal range 0.5-1.3 mg/dl), potassium 3.8 MEQ/L (nml range 3.5-5 MEQ/L), and a 24 h urine protein of 1.3 g (normal <150 mg/d), similar to her previous lab results 6 month ago.

Allergies: NKDA

Family History: Father (deceased 85 y/o CVA); Mother (deceased 91 y/o MI)

Physical Exam

Vitals: BP 140/85, HR 50, RR 18, Wt 132 lbs, Ht 5'1"
HEENT: PERRL, Funduscopic exam notes cotton wool spots present.
Respiratory: Lungs were clear bilaterally with good aeration.
Cardiac: RRR, S1/S2 auscultated. 2+ pitting edema bilaterally.
Abdominal: Unremarkable
Integumentary: Intact.
Vascular: Capillary refill +3
Complete the following:

Four appropriate differential diagnoses and rationales with references. For each differential diagnosis, explain why this is an appropriate differential and how it was/would be ruled in or out. Support your answers with references.
Pick one differential and create a SOAP plan of care for that patient.
Plans must include Pharmacology, Non-Pharmacology, Labs/Diagnostics, Referrals/Interprofessional Communications, Patient Education (10-15 individual items minimum) and follow up.
Make sure to pick one health maintenance item for this patient (primary or secondary) and explain to the patient why this is important.

Address one social determinant of the health this patient may face during your visit. How will you help the patient overcome this obstacle to health care?

Reference no: EM133508664

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