Reference no: EM133853920

Case study

You are seeing a 48 year-old Hispanic female, who had not seen any health care provider in several years. She had been having some chest pain about a month ago and went to the emergency room because she thought she was having a heart attack. At the emergency room, they did an EKG, Lab work and she was admitted overnight. Her labs from the ER are as follows.: Blood sugar of 250 Hemoglobin A1c 8.6 BP 142/92 LDL 160 HDL 20 BUN normal Creatinine normal Liver enzymes normal She has a cardiology consultation. Normal exam. Echocardiogram normal. Stress test normal. She was advised to establish care with the primary care provider You are seeing her for the first time today. And review of the EHR. , Prior to going into the room, you reviewed her chart and discovered the following information: Patient name - Cecelia Lopez Summary and background : 48 year-old Hispanic female Her 30-year-old daughter (who is a single mother with two children) lives with her in the two bedroom apartment. Employed at Amazon fulfillment center - works 3P-11 P shift-often works overtime. Social history : DOB -9/22 Hispanic female Occupation -Amazon package fulfillment Single, never married Not sexually active Gravida 1, para 1 Caffeine intake - two 20 oz cups of coffee in a.m., two 20 oz Pepsi's at work No exercise Smoked two packs a day for 10 years. Quit 10 years ago, uses no tobacco. No alcohol use No recreational drug use Family history: Mother 66 living. Diabetes, obesity. Father died at 32 yo auto accident Current medication : None PMH : None Immunizations : No records available -says she thinks she's had all her shots. Doesn't get a flu shot- " afraid of getting the flu" Today's visit - new patient to establish: Weight- 227 pounds Height - 5'4" Vitals -temp. 98.6, pulse.- 76, respirations-12, BP 142/92 As you enter the room, you introduce yourself to Cecelia. She is warm and friendly. She tells you she is scared. She thought she was having a heart attack and she went to the ER. They told her that her heart was fine, but she is still afraid. She still has chest pain from time to time. She confine in you that she is very stressed. She barely has enough money to meet her needs. Her 30 year-old daughter and her two grandchildren live with her. Her daughter does not work. She is supporting all of them. They told her at the hospital that she has diabetes, and she is scared. She is going to die. She worries if she dies, who will take care of her daughter and grandchildren? She doesn't exercise. She works 3 to 11 PM at a local Amazon fulfillment center and often works overtime. She is tired all the time. She gets home from work anytime from midnight to 3 AM depending on the day and she gets up at 7 AM each day to make breakfast for her grandchildren. HPI: Cecelia presents today for ER follow up and to establish care. Physical exam : Normal ? What are the top three priority diagnoses (in order) at today's visit? List them in order of priority.