This case focuses on your next patient with you and Carla George, a nursing student with whom you are working.Moreover, you are in a clinic which has students from multiple disciplines, including medical, nursing, nutrition, social work, and pharmacy students, who all work side-by-side to provide care for uninsured or underinsured residents of the local urban underserved community.

your next patient with you and Carla George, a nursing student with whom you are working.

You are working in a free clinic staffed by student volunteers.In addition,  the clinic has students from multiple disciplines, including medical, nursing, nutrition, social work, and pharmacy students, who all work side-by-side to provide care for uninsured or underinsured residents of the local urban underserved community.

Dr. Gabriela Medel, your supervising family medicine preceptor, discusses your next patient with you and Carla George, a nursing student with whom you are working.

Dr. Medel tells you and Carla, “Mr. Jose Martin is a 54-year-old male who is new to the clinic and has not received medical care in over 10 years.”

your next patient with you and Carla George

Week 4 DQ

Submission Details:

 

•  post your initial response to the Discussion Area by Day 3. •First and foremost, please make sure you are using scholarly references and they should not be older than 5 years.Finally, your posts/references must be in APA format.

 

Case Scenario

You are working in a free clinic staffed by student volunteers.Moreover,  the clinic has students from multiple disciplines, including medical, nursing, nutrition, social work, and pharmacy students, who all work side-by-side to provide care for uninsured or underinsured residents of the local urban underserved community.

Dr. Gabriela Medel, your supervising family medicine preceptor, discusses your next patient with you and Carla George, a nursing student with whom you are working.

Dr. Medel tells you and Carla, ”

Mr. Jose Martin is a 54-year-old male

who is new to the clinic and has not received medical care in over 10 years.”

Carla offers to take Mr. Martin’s blood pressure.

 

Carla George reports to you and Dr. Medel, “The patient blood pressure is 150/85 mmHg in his right arm, and his pulse is 80 beats per minute. So it appears that we will be considering whether Mr. Martin has hypertension or not.”

You recall that you recently read an article about hypertension in a patient

 

, and that guidelines for its definition and treatment have changed over time. You mention this, and Dr. Medel responds, “For many years, we defined blood pressures between 120-139/80-89 as ‘prehypertensive.’ Blood pressures in this range were recognized to put people at higher risk of cardiovascular events, and physicians were supposed to give patients with prehypertension guidance on making changes to their diet and exercise to prevent the development of hypertension.

“Unfortunately, physicians and patients often disregarded this label. More recent guidelines, from the American College of Cardiology (ACC) and the American Heart Association (AHA), now define blood pressures of 130/80 or greater as hypertensive, which could push physicians and patients to focus more on the importance of lifestyle changes.”

You ask Dr. Medel

“Am I recalling correctly that the AAFP (American Academy of Family Physicians) did not endorse these guidelines? How do you decide which guidelines to follow in your practice if organizations disagree?”

Dr. Medel replies, “That is one of the challenging things about clinical practice. After reviewing these guidelines, I chose to adopt them into my clinical practice. The AAFP pointed out that these guidelines did not fully address the risk of harms with lower blood pressure goals, and so I am more cautious about the potential downsides of lower blood pressures than the ACC/AHA guidelines suggest (especially in groups such as older adults, who are particularly at risk of adverse events from medications). I am also always cautious about conflicts of interest, which was another concern of the AAFP, and will be looking out for further studies that may change these recommendations once again.”

 

PATIENT HISTORY

Firstly, It’s time for you to see Mr. Martin. You go to his examination room, introduce yourself, and ask, “How can I help you today?”

The patient  tells you that he came because his wife, Milagros, encouraged him to get “checked out.”

The patient has not been to a doctor for over 10 years.Moreover,  he says he has been feeling completely fine.Further,  He works as a taxi driver for 12-hour shifts, six days a week, so he doesn’t have much time to go to doctors. In addition, his employer does not offer health insurance.However, mr. Martin states that the nursing student and Clara George seemed concerned about his blood pressure reading today.

“Is my blood pressure too high?” he asks.

“It does seem to be a little high but I’d like to ask you some more questions about your health, examine you, and also recheck your blood pressure before coming to any conclusions.”

You proceed with your interview making sure to include all the questions you just discussed with Dr. Medel and afterward write the following note in the electronic medical record:

 

Past Medical History

Mr. Martin denies any history of hypertension, hypercholesterolemia, or diabetes.Further,  he denies any history of kidney disease, eye problems, peripheral vascular disease, heart disease, or strokes.Moreover,  no history of gout or arthritis.Further,  his last vaccinations were over 10 years ago, and he has not had any preventive services for his age. He denies other medical problems.

Medications

None. Denies use of complementary or herbal remedies.

Past Surgical History

None.

Social History

Mr. Martin speaks English and Spanish.Moreover,  he is married to his wife and has one daughter, age 16.Further,  he and his family moved here from the Dominican Republic 10 years ago.In addition,  mr .Martin works as a taxi driver for 12-hour shifts, six days a week.

However, his wife works as a seamstress

Sadly, they are both uninsured.However,  his daughter gets her medical care in her high school clinic.Moreover,  he and his family live in a two-bedroom apartment near the clinic The man is sexually active with his wife only.Further,  he does not drink alcohol or use recreational drugs.Moreover, he does not smoke.In addition,  the patient has good emotional support from his family and friends. He admits to occasional financial stressors, but his family is never short of food or clothing. However, his daughter may be going to college soon and his rent continues to increase annually, which worries him.

Diet History

Mr. Martin states that he eats a lot of fast food during his long and busy taxi shifts.Moreover,  he eats better when he is at home.Finally,  his wife makes “chicken without the skin, rice, beans, plantains, yuca, and the occasional marinated pork.”

Family History

His mother, age 73, has high cholesterol and diabetes.Sadly,  his father passed away of a heart attack at age 64.In addition to, he has no siblings.

ROS:

Constitutional

Mr. Martin reports that he has gained 20 pounds in the past five years.In connection,  he also denies malaise or fatigue.

Head, Ears, Eyes, Nose, and Throat

Also he denies headaches or vision problems.

Lungs

Moreover, he denies shortness of breath or other breathing problems.

Heart

In addition, he denies any chest pain, palpitations, fainting, or murmurs.

Abdomen

Also, he denies any abdominal concerns.

Genitourinary

Further, he denies any urinary problems or erectile dysfunction.

Extremities

Moreover, he denies leg swelling, pain or cramping, or varicose veins.

Neurologic

Lastly, he denies any weakness, tremors, or other neurologic concerns.