3.2.5 Trisha Knowles

Third-year students were split between the 7-day meal plan and no meal plan at all, eating two times a day or less on campus, eating out at least two to three times week, and eating store-bought food two to three times a week.

PHYSICAL EXAM: Temperature 98.6, Blood pressure 140/90. Pulse 110. Respirations 26. Her lungs are clear, showing mild signs of distress. Heart sounds are normal, irregular rhythm and bradycardia noted. No edema noted in extremities. Patient skin is cool to touch, slightly clammy. EEG shows prolonged QRS wave, with ischemic ST changes and PVCs. Chest radiograph clear.

PHYSICAL EXAM: Temperature 98.6, Blood pressure 140/90. Pulse 110. Respirations 26. Her lungs are clear, showing mild signs of distress. Heart sounds are normal, irregular rhythm and bradycardia

She converses appropriately. Blood pressure 92/60 supine. Blood pressure decreased to 72/50 standing. Pulse is 90 and regular. Weight 113 pounds. She has a normal appearance of her face and does not have a masked appearance of her face. She has good strength throughout her face. She has good strength of her extremities. She has only minimal cogwheel rigidity at the left wrist, but no cogwheel rigidity at the right wrist. She has no tremor of her hands. She moves her extremities freely and with normal speed. She is able to rise on her own from a sitting to a standing position, only minimal bradykinesia of standing. She walks fairly freely and there is a normal cadence of her gait. She did not have dyskinetic movements of her extremities. She is able to walk, including turning without losing her balance. She does not shuffle her feet when walking. She does not have en bloc turning. She has good posture stability

She reports a history of back pain, ovarian cysts excision, and breast tumor. She denies chest pain, shortness of breath, or palpitations. Patient reports that her immunizations and preventive care are up to

Having bad eating habits can cause vastly eating disorders and illnesses. Students attending college that do not eat right are most likely to conceive an illness or become overweight. “An unhealthy diet is a major risk factor for becoming overweight and obese,” (McNight). Freshman 15 is most likely to get to the students that have This is something to think about when it comes to meal plans. The majority of the meal plans offered at any college are high in fats and calories. By consuming all of these foods you are more likely to having this problem.

Patient denies chest pain, SOB, N/V/D. Patient is a current tobacco user, denies use of alcohol or illicit

P., Ilich, J. Z., Dutton, G. R., Panton, L. B., & Abood, D. A. (2009). The freshman weight gain phenomenon revisited. Nutrition Reviews, 67(2), 83-94. doi:10.1111/j.1753-4887.2008.00143.x

In the case study it discusses a patient, Mrs. Harris, who is a 72 year old and is complaining of fatigue and swelling in her feet. Mrs. Harris also expresses her concern on the swelling, as some days she is unable to put her shoes on despite proper elevation. She also states walking to her mailbox can be challenging because it causes her to feel more tired and to have shortness of breath, also known as dyspnea. Mrs. Harris is currently taking medication for high blood pressure, hypertension; and is also drinking approximately 8-12 glasses of wine a week. While examining Mrs. Harris it’s clear she is a little overweight and has swollen ankles. Upon listening to Mrs. Harris’s breathing, crackles are heard. Therefore, Mrs. Harris seems to have congestive heart failure.

Robert is a freshman in college and like many freshmen. He is fairly smart with a 3.0 gpa so far and is taking honor type classes. His goals include going for the dean list and getting more money for college so that he may further his education after he receives his bachelors. He may not be well known but he has enough friends who are interested in the same things as him. While not in school, Robert is either involved with the engineering club or is doing community service for his city. Robert is also trying to find a job to help sustain his college work while also finding an internship for engineering while trying to receive his degree. Even though Robert is enjoying his college life, he, like many other freshmen’s, has been hit by an epidemic that is known as the freshmen fifteen. Robert has never had to deal with weight issues as he was not much of an eater but was able to maintain a healthy weight according to doctors. However, because of his love for fast food now, his weight has increased and has caused him to have body image issues. Now, Robert wants to lose the weight but not give up on fast foods. In order for Robert to lose weight, he must watch calorie intake and outtake, eat smaller portions, and adapt to healthier food.

The patient is a 64-year-old, African-American female with a body mass index (BMI) of 51.31. She has a medical history of type 2 diabetes mellitus, asthma, hypertension, and history of gastric bypass surgery in 2014. She lives alone in a one-storey apartment. Her walking is limited to household distances and occasional walks outside her apartment. She reports avoiding walking outside due to fear of falling and shortness of breath. Her blood sugar

7. A 56-year-old patient who has no previous history of hypertension or other health problems

This is a patient with a past history of hypertension, hyperlipidemia, diabetes, CAD and congestive heart failure who presented initially complaining of chest discomfort in the upper left side of her chest which was thought could be consistent with angina. The patient's initial workup showed the blood pressure was elevated at 193/77. The EKG had nonspecific changes. The chest x-ray had no acute disease. The troponin was negative.

The final three diseases that we were able to narrow down after considering our patient’s complaints, symptoms and test results were Type 1 and Type 2 Diabetes Mellitus and Hypothyroidism. The elevated A1C, glucose and insulin levels pointed to one of the two types of diabetes. The normal thyroid panel results helped us to rule out Hypothyroidism, which we originally thought could be the problem because of her matching symptoms of remarkable fatigue, weight gain and dry skin. The dry skin, weight gain, and recent fatigue also pointed to Diabetes, along with her other key symptoms, blurred vision, thirst, and appetite. After ruling out Hypothyroidism, we had to determine whether our patient had Type 1 or Type 2 Diabetes. To determine between the two, we compared the insulin and glucose levels of our patient to the levels of both types of Diabetes, and researched vital differences between the two types. Type 1 Diabetes normally does not have enough insulin being made because of viral or immune damage to the Islets of Langerhans. Our patient had a high insulin level. Type 1 Diabetes is usually diagnosed before age 30 (Saladin, 2014). With our patient being 55, age was another strong determinate that led us to look more closely at Type 2 Diabetes. Type 2 Diabetes is not the lack of insulin, which matched the result of high insulin levels, but insulin resistance by the hormones target cells. It is normal for the patient’s insulin level to be high at the start of the disease and

Family History: The patient’s mother has diabetes and is still alive, his father medical and past history is unknown, and he has no siblings.