Dyslipidemia
F. T. is a 56-year-old woman who comes into the clinic to establish care. She has not seen a primary care provider in the last eleven months and needs refills on all of her medications. She is somewhat agitated and argumentative about getting her labs drawn and cannot understand why the provider just won’t refill her prescriptions. She denies any acute changes in health, chest pain, unilateral weakness, numbness/tingling, vision changes, bowel or urinary problems, and has not been to the GYN in fourteen years because she states that she has already gone through the change. She denies bilateral lower extremity edema, however, she does have shortness of breath when she walks in the park, but she rarely exercises and states that she
No scalp lesions. Dry eyes with conjunctival injection. Mild exophthalmos. Dry nasal mucosa. Marked cracking and bleeding of her lips with erosions of the mucosa. She has a large ulceration of the mucosa at the bite margin on the left. She has some scattered ulcerations on her hard and soft palette. She has difficulty opening her mouth because of pain. Tonsils not enlarged. No visible exudate. SKIN: She has some mild ecchymosis on her skin and some erythema, she has some patches but no obvious skin breakdown. She had some fissuring in the buttocks crease. PULMONARY: Clear to precussion and auscultation, bilaterally. CARDIOVASCULAR: No murmurs or gallops noted. ABDOMEN: Soft, non-tender, protuberant, no organomegaly, and positive bowel sounds. NORALOGIC EXAME: Cranial nerves ii – xii are grossly intact, diffuse hyporeflexia. MUSCULAR SKELETAL: Erosive destructive changes in elbows, wrist, and hands consistent with rheumatoid arthritis. Has had bilateral total knee replacements with stovepipe legs and perimalledal pitting edema 1+. I feel no pulse distally in either leg. PHYCIATRIC: Patient is a little anxious about these new symptoms and there significance. We discussed her situation and I offered her psychiatric services, she refused for now.
A review of her medical records indicates that she has not had any significant health events, such as falls or hospitalization since her last visit. She suffers from chronic stable hypothyroid, chronic DM which is mange with medication and chronic neuropathy.
The patient tells me she has type 2 diabetes, diagnosed approximately six or seven years ago. She has been on the same medication regimen for about the last year. The latest medication to be added was Januvia 100 mg daily. Prior to that, she has been on metformin ER 2000 mg daily, as well as glyburide 10 mg daily. She does check her glucose levels regularly. She tells me her morning glucose, two hours after eating a "sugary cereal" was 187. She admits that she does not make the best diet choices regularly. She tells me she has been to diabetes education as well as nutrition education and she struggles with making those
At today’s visit she is accompanied by her son and husband. She is awake, alert but confused. She follow some simple commands, she is not able to express most of her needs. The husband reports that the patient suffers from depression and she is not on any medication. The son reports that the patient appetite is poor to fair. He state that she started Megace a few weeks ago and her weight is now 86 lb from 82 lbs. The husband states that the patient ambulates with an unsteady gait and often forgets to use her walker. He states that the patient often speak to her decease relative, refused showers. The patient has not had any recent falls. The patient denies pain, shortness of breath and dysphagia. Her PPS is 50%, Fast 7c, able to perform some
Based off these measurements, M.G has hypertension and if not taken care of, her blood pressure could lead to a hypertensive crisis. During M.G’s physical her lab results showed her fasting blood sugar to be 200 mg/dl, total cholesterol 280 mg/dl, HDL cholesterol 30 mg/dl, LDL cholesterol 180 mg/dl, and triglycerides 200 mg/dl. Normal levels for fasting blood sugar are100 mg/dl or less, good total cholesterol is below 200 mg/dl, LDL cholesterol levels best for people at risk of heart disease are below 100 mg/dl, HDL cholesterol levels of 60 mg/dl and above are good, and lastly triglyceride levels below 150 mg/dl are considered good. When comparing M.G’s level’s to normal levels you notice that her fasting blood sugar is double the normal amount, and her total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides levels are all considered high/poor. With looking specifically at M.G’s fasting blood sugar, you can see her levels are well pass being considered pre diabetes, and are we'll over the diabetes standard level of 126 mg/dl. Overall, M.G’s poor lab results verify her diagnosis of type 2 diabetes and show how serious her condition is, especially if it is not
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
The patient is a 44-year-old female who I saw for her physical in June 18, 2015. At that point, she was complaining of epigastric pain that radiated into her back. I did ask her to start Prilosec over the counter, daily. Initially, we had called her and she reported that this was helpful, although now, she reports that at the same time, she had a cold and she was more focused on the cold than the epigastric pain. Subsequently, she states her pain really has not changed and she continues to have epigastric pain, which does radiate to her mid-back. Her bowel movements have been soft, she has been somewhat nauseous, but no vomiting. She has not see any blood in her stools. She does think
Michael did not experienced any choking episodes throughout the past year. Supports were effective. Refer to SLP for complete report.
As important as medication therapy is, there seems to be gender disparities with the management of lipid lowering medication therapy. Women are not being as aggressively treated as their male counterparts, despite the higher baseline levels of LDL cholesterol. In Addition, women are not as likely to continue the lipid lowering therapy in the long term due possibly to the side effects of continued therapy. Providers need to increase their awareness of the cardiovascular risks of women, including addressing the barriers of assessment, lipid screening, and targeted therapies, especially for those most at risk. (Rodriguez, 2016)
Hyperlipidemia means there is cholesterol in the blood. Cholesterol is made by the liver, cholesterol is healthy to have to provide people with brain functioning, store vitamins, and hormone production. Having too much of bad cholesterol in the body however is a bad thing High density lipoprotein (HDL) is the good cholesterol that carries all of the excess cholesterol into the liver where it can be removed. Low-density lipoprotein (LDL) is just the opposite it causes cholesterol to build and back up cholesterol in the blood.
A 50 years old female patient, with a history of tobacco use, alcohol consumption and bleeding disorder, presents to the clinic stating insomnia, fatigue, and unusual mood changes. The patient reports waking up several times at night sweating that lasts for several minutes and having difficulty going back to sleep. For the last year, she has experience irregular periods and denies heavy blood flow. She reports smoking 3-5 cigarettes/day, which is lower than the amount she said during her last
Per medical records (2008-2014), the claimant had a history of multiple medical issues, including migraines, right hand tremors, alcohol abuse, obesity, gastro-esophageal reflux disease (GERD), nausea, abdominal pain, endometriosis and degenerative changes in the left knee. In 2014, she was evaluated for hip
L.V. is a 51-year-old Hispanic female. She is 5’4 height and 150 lbs. Patient denies pain, discomfort, or chest pain during physical assessment. Patient is allergic to Aspirin she states that she gets rashes when she takes it. She was diagnosed with thyroid cancer 5 years ago and got her thyroid glands surgically removed. Patient denies the use of tobacco and drinks 2-3 beers on special occasions. Patient works for an American Restaurant as a server, she’s been serving for over ten years. Patient states that she’ll be getting her first colonoscopy next month and she just recently got her yearly mammogram done and results were normal. Immunizations are up to date and she gets the flu shot every year. Patient has four daughters and has been happily married for 20 years. Patient denies using glasses or contacts she visits her optometrist every year and has never had a problem with her vision.
Common Health Conditions with Implications for Women: Case Study Number One Assessment: 1. Hypercholesterolemia: The most likely diagnosis for the patient in case study number one is hypercholesterolemia because her total cholesterol level and low-density lipoproteins (LDL) are elevated (Stone et al., 2014). Differentials: a. Metabolic syndrome: This differential should be considered due to age, gender, and race (Ferri, 2017).
Patient also, has history of hypertension, GERD, morbid obesity, anemia, and depression. She reported that the past few months, she has been feeling very weak and overall generalized deconditioning. Her ability to care for herself including her activities of daily living (ADLs), and her basic physical needs (like bathing, grooming, ambulation, meal preparation, transportation, errands, and housekeeping), had decreased, and cannot consistently carry them out.