Reference no: EM133841878

Question 

JS is a 58-year-old man who presents to the primary care office for an annual well exam. His blood pressure (BP) reads 152/94 mmHg at the beginning of the visit. He states that he occasionally has had a high BP reading.

History

JS an accountant, shares that he has felt fine but also describes his office environment as one of high stress. He states that he feels worried during the day trying to get his work completed and meet business expectations. He notes that he has a short temper and gets frustrated with traffic on the way home. He is married, has a good relationship with his wife, and has two grown children. JS denies having headaches, chest pain, blurred vision, or dyspnea. He takes his dog for a walk after work to manage his stress level. He denies feeling down, depressed, or hopeless. He denies a history of depression. He is not a smoker, does not take prescribed medication, and denies use of prescription medications not prescribed to him. JS occasionally takes Tylenol or ibuprofen for "aches and pains," and has one to two drinks of alcohol at night. He denies a past medical history for conditions that may contribute to hypertension, including obstructive sleep apnea, kidney disease, and endocrine disorders. He has never been hospitalized. A family history reveals that both of his parents are alive and have hypertension, hyperlipidemia, and heart disease. He has an older brother who recently completed treatment for melanoma. He feels safe in his home and has never been a victim of violence.

Physical Examination

JS has the following vital signs: 98.7°F, pulse 78, respirations 16, BP 152/94 mmHg (right arm), BP 150/94 mmHg (left arm), and a pain rating of 0. He has a body mass index of 30. Head, eyes, ears, nose, and throat exam is normal, including retinal exam. Heart rate and rhythm are regular, and lungs are clear to auscultation bilaterally. Carotid arteries are without bruits. The thyroid is smooth, nonenlarged, and without nodules or tenderness. The abdomen is soft, nontender, and nondistended, with no organomegaly. Peripheral pulses are 2+ bilateral. Cap refill is brisk. No lower extremity edema is noted.

1. Identify primary diagnosis

2. Identify the components of a general survey used to appraise signs of illness and wellness.

3. Differentiate the types of pain and associated signs and symptoms.

4. Evaluate normal and abnormal findings related to vital signs and the general survey.