Prevention Diagnosis Prevention Case Study Marvin is

Prevention Diagnosis Prevention Case Study Marvin is a 54 y/o white male who presents for a check up and a BP check. He says that he is feeling well. He has been keeping records of his blood pressure over the last 6 months and reports that they are 130-140 on the top and 70-80 on the bottom. He denies chest pain or lower extremity edema. He saw the nephrologist 4 months ago, who thought his BP was controlled and no medicine changes were made [he is to follow up in December]; he saw the cardiologist 2 months ago—echo showed LVH, and an EF of 55%–cardiology saw no evidence of CHF or valvular heart disease [he is to follow up in 6 months]; both specialists told him to lose more weight. He sees his sleep management provider every year and wears his CPAP regularly. PMH—HTN, Dyslipidemia, CAD, Obesity, OSA, Rosacea, Proteinuria [secondary to renovascular hypertension]; LVH; B12 Deficiency; Vitamin D deficiency Surgeries—none; heart cath for occluded RCA at the age of 40 Allergies—none; Medications—Norvasc 5 mg daily, Lisinopril 40 mg daily, ASA 81 mg daily, Crestor 40 mg daily, Doxycycline 100 mg daily [rosacea], B12 1000 mcg daily, Vitamin D3 1000 IU daily; Salmon Oil 1000 mg daily Health Maintenance—flu shot in fall of 2016; his chicken pox titer was negative at his last office visit with you; cannot remember when he has a tetanus shot; never had a colonoscopy. FH—mother is 76 and is alive and well; father is deceased—complications of alcohol [deceased at age 78]; he has 3 siblings—all alive and well Social—Marvin lives in Plano and owns a technology company. He is divorced and has 2 children—aged 16 and 14 [both alive and well]. He quit smoking 2 years ago [after smoking 1 ppd for 30 years]. He drinks moderately—he admits to about 3 alcoholic drinks per day. He rides his bike most days of the week—40 to 50 minutes a day. He lifts weights 2 times per week. He says that he has been overweight for about 12 years—he recently lost 60 pounds. He acknowledges that his weight is contributing to his health problems. He is in a monogamous relationship for the past 3 years—uses condoms for birth control. He says that his girlfriend is a good influence on him—as she exercises and eats healthy—her good habits helped him lose 50 pounds over the last 6 months. Physical Exam: 98-70-16 138/76 Height: 6’3″ Weight 350 pounds Marvin is a Caucasian male with large neck and truncal obesity. He has mild plethora of his cheeks—remainder of the skin is unremarkable. Neck—no JVD, no thyromegaly Lungs—he has a barrel chest, lungs are clear to auscultation Heart—S1S2 RRR, PMI in 5thICS mid-clavicular line; no pedal edema Abdomen—soft, no organomegaly; marked truncal obesity Extremities—no clubbing, no cyanosis, no edema Prevention Diagnosis A. Risk Profile: 1. Age/Gender/Race risks- 2. Personal/Family risks- B. Prevention Needs: 1. Screening Needs: 2. Counseling Needs: 3. Chemoprophylaxis/Immunizations: C. Prevention Deficits: D. Screening Deficit- E. Counseling Deficit- F. Chemoprophylaxis/Immunizations Deficit- G. Obesity Management Plan [1 pg. maximum]

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