C.D is a 55-year-old African American male who presents to his primary care provider with a 2-day history of a headache and chest pressure. Allergic RhinitisDepressionHypothyroidism Father died at age 49 from AMI: had HTNMother has DM and HTNBrother died at age 20 from complications of CFTwo younger sisters are A&W The patient has been married for 25 years and lives with his wife and two children. The patient is an air traffic controller at the local airport. He has smoked a pack of cigarettes a day for the past 15 years. He drinks several beers every evening after work to relax. He does not pay particular attention to sodium, fat, or carbohydrates in the foods he eats. He admits to “salting almost everything he eats, sometimes even before tasting it.” He denies ever having dieted or exercised. Zyrtec 10 mg daily Penicillin States that his overall health has been fair to good during the past year.Weight has increased by approximately 30 pounds in the last 12 months.States he has been having some occasional chest pressure and headaches for the past 2 days. Shortness of breath at rest, headaches, nocturia, nosebleeds, and hemoptysis.Reports some shortness of breath with activity, especially when climbing stairs and that breathing difficulties are getting worse.Denies any nausea, vomiting, diarrhea, or blood in stool.Self treats for occasional right knee pain with OTC Ibuprofen.Denies any genitourinary symptoms. B/P 190/120, HR 73, RR 18, T. 98.8 F., Ht 6’1”, Wt 240 lbs. TMs intact and clear throughoutNo nasal drainageNo exudates or erythema in oropharynxPERRLAFunduscopy reveals mild arteriolar narrowing without nicking, hemorrhages, exudates, or papilledema Supple without masses or bruitsThyroid normalNo lymphadenopathy Mild basilar crackles bilaterallyNo wheezes RRRNo murmurs or rubs Soft and non-distendedNo masses, bruits, or organomegalyNormal bowel sounds Moves all extremities well No sensory or motor abnormalitiesCN’s II-XII intactDTR’s = 2+Muscle tone=5/5 throughout Develop an evidence-based management plan.Include any pertinent diagnostics.Describe the patient education plan.Include cultural and lifespan considerations.Provide information on health promotion or health care maintenance needs.Describe the follow-up and referral for this patient.Prepare a 3–5-page paper (not including the title page or reference page). Before finalizing your work, you should:be sure to (as displayed above); to make sure you have included everything necessary; andutilize and to minimize errors.Your writing Assignment should:follow the conventions of (correct grammar, punctuation, etc.);be , , and , as well as ;display and ; anduse format as outlined in the

Title: Evidence-based Management Plan for C.D: A Case of Hypertension and Chest Pressure

Introduction:

This paper presents a case study of C.D, a 55-year-old African American male who presents with a 2-day history of headache and chest pressure. This patient has a complex medical history, including a family history of cardiovascular disease, smoking, alcohol consumption, poor dietary habits, and sedentary lifestyle. The primary objective of this paper is to develop an evidence-based management plan for C.D, considering the relevant diagnostics, patient education, cultural and lifespan considerations, health promotion, and follow-up and referrals.

Management Plan:

1. Diagnostics:

To assess C.D’s cardiovascular health and identify the underlying causes of his symptoms, the following diagnostics are recommended:

a. Comprehensive Blood Tests: This should include a lipid panel, fasting glucose, hemoglobin A1c, renal function tests, thyroid function tests, and liver function tests.

b. Electrocardiogram (ECG): An ECG will help evaluate C.D’s heart rhythm, detect any abnormal electrical activity, and determine if there are any ischemic changes suggestive of a recent or ongoing myocardial infarction.

c. Echocardiogram: An echocardiogram is recommended to assess C.D’s cardiac structure and function, including the evaluation of left ventricular hypertrophy, valvular abnormalities, and ejection fraction.

d. Chest X-ray: A chest X-ray can help identify any pulmonary pathologies, such as pulmonary congestion or effusion, which may contribute to C.D’s symptoms.

e. Ambulatory Blood Pressure Monitoring (ABPM): ABPM is recommended to evaluate C.D’s blood pressure throughout a 24-hour period and assess for any masked hypertension or non-dipping patterns.

2. Patient Education:

a. Hypertension Management: C.D should be educated about the importance of blood pressure control to prevent cardiovascular complications. He should be informed about recommended lifestyle modifications, including dietary changes (reducing sodium intake, adopting a heart-healthy diet), weight reduction, smoking cessation, and regular physical activity.

b. Medication Adherence: C.D should receive education regarding the importance of taking prescribed medications as directed. This includes understanding the benefits, side effects, and potential drug interactions. It is crucial to emphasize the need for long-term medication adherence to achieve optimal blood pressure control.

c. Diet and Nutrition: C.D should receive guidance on adopting a healthy diet, including reducing sodium intake, increasing consumption of fruits, vegetables, and whole grains, and limiting alcohol consumption. He should be educated about the impact of excessive salt intake on blood pressure and the benefits of a low-sodium diet.

d. Smoking Cessation: Given C.D’s smoking habit, it is essential to provide smoking cessation counseling and resources to help him quit smoking. This should include information on nicotine replacement therapy and behavioral support programs.

3. Cultural and Lifespan Considerations:

C.D’s cultural background and age should be considered in developing the management plan. African Americans have a higher incidence and prevalence of hypertension and related complications. This group often faces unique challenges in accessing healthcare and may have cultural preferences regarding diet, exercise, and traditional remedies. It is important to incorporate cultural competency and respect C.D’s beliefs and preferences while providing evidence-based care.

4. Health Promotion and Care Maintenance:

a. Weight Management: C.D should be encouraged to achieve and maintain a healthy body weight through a combination of dietary modifications and regular physical activity. Weight reduction can significantly improve blood pressure control and overall cardiovascular health.

b. Regular Exercise: C.D should be advised to engage in regular aerobic exercise, such as brisk walking, cycling, or swimming, for at least 150 minutes per week, as recommended by current guidelines. Exercise helps lower blood pressure, improve cardiovascular fitness, and reduce overall cardiovascular risk.

c. Regular Follow-up: C.D should be scheduled for regular follow-up visits to monitor his blood pressure, evaluate the effectiveness of the management plan, and adjust medications if necessary. These visits also provide an opportunity to reinforce patient education, assess adherence, and address any concerns or side effects.

5. Referral:

Considering C.D’s elevated blood pressure, family history of premature cardiovascular disease, and his symptoms of chest pressure, referral to a cardiologist or hypertension specialist for further evaluation and management is recommended. A specialist will help optimize C.D’s treatment plan and address any additional cardiac concerns.

Conclusion:

To effectively manage C.D’s hypertension and chest pressure, an evidence-based management plan is crucial. This plan should include thorough diagnostics, patient education on hypertension management, cultural and lifespan considerations, health promotion strategies, and appropriate follow-up and referral. By implementing this comprehensive management plan, healthcare providers can assist C.D in achieving optimal cardiovascular health and lowering his risk of future complications.