PDA

View Full Version : CC: "Been told that has stage 1 hypertension at an employee health screening last month"



Janis.Y.Chen
Wed 20th April '16, 11:32pm
D.C. is a 44-year-old black man who presents to his primary care provider concerned about high BP. At an employee health screening last month he was told he had stage 1 hypertension. His medical history is significant for allergic rhinitis. His BP was 144/84 and 146/86 mm Hg last year during an employee health screening at work. D.C.’s father had hypertension and died of an MI at age 54. His mother had diabetes and hypertension and died of a stroke at age 68. D.C. smokes one pack per day of cigarettes and thinks his BP is high because of job-related stress. He does not believe that he really has hypertension. D.C. does not engage in any regular exercise and does not restrict his diet in any way, although he knows he should lose weight.


Physical examination shows he is 175 cm tall, weighs 108 kg (body mass index [BMI], 35.2 kg/m2 ), BP is 148/88 mm Hg (left arm) and 146/86 mm Hg (right arm) while sitting, heart rate is 80 beats/minute. Six months ago, his BP values were 152/88 mm Hg and 150/84 mm Hg when he was seen by his primary-care provider for allergic rhinitis. Funduscopic examination reveals mild arterial narrowing and arteriove- nous nicking, with no exudates or hemorrhages. The other physical examination findings are essentially normal.


D.C.’s fasting laboratory serum values are as follows:
Blood urea nitrogen (BUN), 24 mg/dL Creatinine, 1.0 mg/dL
Glucose, 105 mg/dL
Potassium, 4.4 mEq/L
Uric acid, 6.5 mg/dL
Total cholesterol, 196 mg/dL
Low-density lipoprotein cholesterol (LDL-C), 141 mg/dL High-density lipoprotein cholesterol (HDL-C), 32 mg/dL Triglycerides, 170 mg/dL

Janis.Y.Chen
Thu 21st April '16, 9:52pm
Subjective data lists:
1.Been told that has stage 1 hypertension at an employee health screening last month
2.Allergic rhinitis
3.His BP was 144/84 and 146/86 mm Hg last year during an employee health screening at work
4.D.C.’s father had hypertension and died of an MI at age 54
5.His mother had diabetes and hypertension and died of a stroke at age 68
6.D.C. smokes one pack per day of cigarettes
7.This patient thinks his BP is high because of job-related stress and he does not believe that he really has hypertension
8.D.C. does not engage in any regular exercise and does not restrict his diet in any way
9.The patient knows he should lose weight

Objective data list:
10.175 cm tall, weight 108 kg, BMI 35.2
11.BP 148/88 mm Hg (left arm), 146/86 (right arm), while sitting.
12.BP values were 152/88 mm Hg and 150/84 mm Hg when he was seen by his primary-care provider for allergic rhinitis
13.HR 80 bpm
14.Funduscopic examination reveals mild arterial narrowing and arteriove- nous nicking, with no exudates or hemorrhages