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MN585 W10-FINAL PAPER

Paper instructions:Case Study Samuel J. is a 73-year-old male patient, who presents to you for his annual MedicareWellness physical with complaints of ongoing fatigue and…

Paper instructions:Case Study
Samuel J. is a 73-year-old male patient, who presents to you for his annual MedicareWellness physical with complaints of ongoing fatigue and insomnia.At his visit today, Samuel has a weight gain of 15 pounds from the previous visit 6months ago for a urinary tract infection. He also went to an urgent care clinic 4 monthsago and was diagnosed with another UTI, and was treated with antibiotics again. Hecontinues to have occasional nocturia but has no more dysuria, foul odor or otherurinary symptoms. He further expresses concerns over his nighttime insomnia, daytimenapping, slow weight gain, and growing lack of motivation to engage in his hobbies. Heis a Ham radio operator and is a member of a local club. He also plays tennis 1-2 timesa week, but states that he is sometimes short of breath when he plays tennis, especiallywhen it is quite cold. Sometimes his lower legs cramp when he plays tennis or climbsstairs.He has a part-time job at a local big box appliance and tech store which he formerlyenjoyed but now finds less so, even though his work friends are friendly. His wife of 45years died about 18 months ago, and he is often lonely, although he has recently beenthinking about accepting the invitation of a widow in his neighborhood who keeps askinghim over for dinner. He grins when he says this, but says he is truly concerned that he isnot eating properly since his wife had done most of the grocery shopping and cooking,and since her death he mostly eats microwave dinners that he knows are mostly full ofsalt. His own father died at age 75 after complications of a stroke sustained at age 74,and he does not want to end up the same way.He has one daughter, son-in-law and 2 grandsons who lives about 10 miles away fromhim and with whom he enjoys a close relationship. He has a military pension and SocialSecurity income and is covered by Medicare and Tricare supplemental insurance. Hishome is easy to maintain and paid for, and his vehicle is paid for and in good condition.Past medical history: Samuel was diagnosed with hypertension at age 42. He wasdiagnosed with hypogonadism at age 55, BPH at age 65. Hernia surgery age 32 due tomilitary service in which he was a radio operator on a submarine.Family medical history: Hypertension (both parents and siblings), stroke (father), anddiabetes (mother).
Social history: He lives alone, widowed, in a house in the inner city of a majormetropolitan area where air quality is often poor. He attends church regularly. Financesstable, and most of his bills are covered by his Social Security and military retirementincome. His part time job supplements these sources of income. He is on Medicaid andalso has Tricare. Samuel smoked quite a bit for about 5 years during his early Navyyears, but he quit smoking when he his daughter was born. He now has an occasionalbeer or whiskey with his other Navy buddies at the local bar. There is a good bit ofsecond hand smoke at this bar, and the air quality in his city is often poor. He is a Hamradio operator and volunteers in emergency operations. He plays tennis at a localcommunity center once a week.Medications: Furosemide 10mg PO QD; Lisinopril 20 mg QD, Rosuvastatin 20mg QD,Tadalafil 5mg QD, Daily Aspirin 325mg, Daily Multivitamin, Daily Garlic tablet, DailyGingko (for memory).Allergies: Penicillin.Preventive Screenings: Colonoscopy age 60, last visit to urologist was age 65 for BPHand placed on daily tadalafil (Cialis), EKG age 70, Chest x-ray age 70, Pulmonaryfunction test age 65, all wnl.Immunizations: Flu shot: High dose Quadrivalent 3 years ago, PPSV23 age 64, TdapAge 57 when he had a gardening injury, Zostavax 1 dose age 60. He states Uncle Samgave him all kinds of shots when in the military but he is unsure of what these are.OBJECTIVEGeneral: Cooperative, NAD.Vital signs: BP: 142/86, P: 74, R: 18, O2=98% on Room air, Ht 511 Wt 218 (BMI30.4) which is a weight gain of 15 pounds from the previous visit 6 months ago whenseen for a urinary tract infectionLabs:Lipids: Total Cholesterol 204, HDL 48, LDL 139BMP: (Fasting) Glucose 94, sodium (Na+) 140, potassium (K+) 4.0, chloride (Cl) 100,CO2 22, blood urea nitrogen (BUN) 20, creatinine .98.CBC: Hbg 10.1, Hct 35.6Cardiovascular: Carotids +2; pulses without bruits. Regular rate and rhythm, S1 andS2.Respiratory: Lungs clear to auscultation.Musculoskeletal: Full range of motion of the neck and arms.
Please use the information above to respond to the following in a scholarly, writtenpaper format.1. List a minimum of six different diagnosis for your evaluation of Samuel today.2. What are the pertinent positives for each diagnosis from his past medical historyand current labs and presenting symptoms?3. What other items do you need to include in your physical assessment ofSamuel?4. Is Samuels blood pressure considered in control for his age group at this point?Provide reference for this.5. Provide an analysis of Samuels lipid panel with rationale and next stepsincluding other lab tests. Provide reference for this.6. Provide an analysis of Samuels hemoglobin and hematocrit with rationale anddifferential diagnoses and next steps including lab and other diagnostic tests orreferrals. Provide reference for this.7. Provide an analysis of Samuels urinalysis and next steps including lab tests andother diagnostic tests or referrals, with rationale. Provide reference for this.8. What immunizations should Samuel consider at this point?9. According to the USPSTF, what preventive screening tests should be ordered forSamuel? Provide rationale for this based on Samuels age, gender, and pastmedical and social history.10. What dietary guidance should be provided to Samuel?11. Should you consider discussing sexual health with Samuel?12. How should you evaluate Samuels insomnia and fatigue? What are yourdifferential diagnoses for this, provide rationales and references.13. What depression screening should you provide for Samuel? Should you provideSamuel with a referral to counseling at this point, explain why or why not.14. Evaluate Samuels current medications and list your pharmacologicalmanagement for his hypertension, sleep, depression, and weight management.15. Recommend your non-pharmacological management for Samuels hypertension,sleep disorders, weight gain, and depression.16. When should you schedule your next appointment with Samuel, what should youand Samuel accomplish prior to that appointment and what will the goal of thatappointment be?
Your writing assignment should:5 pages, not including the Title Page and Reference Pages5-7 references
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