Reference no: EM133221208

J.L. (they, them) is a 32-year-old transgender, African-American male who presents to your clinic for their annual exam and removal of their intrauterine device (IUD) so that they may begin trying to conceive. They are a G1P1 whose last pregnancy was 5 years ago. During that pregnancy, they developed gestational diabetes, which turned into Type 2 diabetes mellitus (T2DM) within one year of giving birth. They had a primary cesarean section due to fetal macrosomia. Since their diagnosis of T2DM, J.L. has had very good glycemic control and has lost about 25 lbs. PMH: Type 2 diabetes, HRT PSH: Primary cesarean section; Bilateral Mastectomy MEDS: Metformin ER 1000 mg daily; Testosterone 1mg IM bi-weekly (stopped 3 months ago) SOCIAL HX: Married, lives with wife and 5-year-old son. Works from home doing medical transcription. They do not smoke or drink. ROS: General: Denies fever, chills, fatigue HEENT: Denies headaches, dizziness, visual disturbances, hearing loss, nasal congestion, sore throat, mouth lesions. Resp: Denies cough, congestion, SOA, wheezing. CV: Denies chest pain, palpitations. GI: Denies nausea, vomiting, diarrhea, abdominal pain, loss of appetite, hemorrhoids. GU: Denies urinary burning, urgency, or frequency, denies CVAT. Genital: Denies vaginal itching, discharge, odor. MS: Denies pain, limping, loss of strength. Psychiatric: Denies depression, anxiety, sleep disturbances. Neuro: Denies tingling, weakness, loss of sensation. Endo: Denies increased thirst, urination. PE: General Survey: well-developed, well-nourished 32 yo TG male, in NAD. Vital Signs: Ht 66", Wt 173, BMI 27.9, BP 118/76, HR 78, RR 16, Temp.- 98.2 PO Skin: warm, dry, intact HEENT: head normocephalic; eyes clear without drainage, PERRLA, ear canals clear bilat, tm with good cone of light; nares patent, mucosa pale-pink, no drainage present; no sinus tenderness, throat clear with no redness or exudates Neck: supple, trachea midline, good ROM Lymph Nodes: no swelling or tenderness Thorax and Lungs: respirations even and unlabored, lungs clear to auscultation bilaterally Cardiovascular: S1S2, no murmurs, clicks, or rubs Breasts: No nipple discharge; symmetrical bilaterally; surgical scars present. No axillary adenopathy Abdomen: soft, sl round, BS present, non-tender, no hepatosplenomegaly Genitalia: minimal hair distribution due to shaving, labia majora and minora normal without lesions, no masses, lesions noted externally. Vagina: moist, pink, rugated with good tone. Normal, scant vaginal discharge noted, no odor. Lesions/masses absent. Cervix: pink, multiparous, non-friable without lesions. IUD strings are present. Uterus: Mobile, non-tender, no masses, tenderness, or enlargement. Adnexa: non-palpable. Rectal: no external hemorrhoids present, internal deferred Musculoskeletal: Good ROM, steady gait, no apparent weakness or deficits Psychiatric: Awake, alert, oriented, appropriate Neurologic: Reflexes: elicited, 2+ bilaterally view Here are the items to address 1. What other information is important at this type of visit and this transgender patient's specific needs? 2. What is your plan of care for J.L. today and how will you handle the chronic diseases, health maintenance, and current episodic concern? 3. Name a social determinate of health that this transgender patient may face during their pregnancy and how you can help support them during this time. Include a reference specific to this topic