John Bell by Abigail Michener

John Bell

abigailmichener — 2022-01-27 18:00:52 UTC

Gender: Male
DOB: 01/10/1946
Address: 934 Bridgewater Street Big Lake, AR 99574
Patient ID: 4465
Age: 72 years
Insurance: BC/BS of Arknansas

Follow-up Appointment

abigailmichener — 2022-01-27 18:02:00 UTC

Facility: Memorial Hospital
Intake Nurse: Abigail Michener RN
Clinical Provider: Elizabeth Statton, MD
Date of follow up: 1/27/2022

Health History

abigailmichener — 2022-01-27 18:04:48 UTC

1. Type 2 Diabetes
2. Gout
3. Hypertension
4. High Cholesterol

Current Medications

abigailmichener — 2022-01-27 18:06:34 UTC

1. Allopurinol 300 mg
2. Amiodipine 5 mg
3. Atacand hct 3.2-12.5 mg
4. Cilostazol 100 mg
5. Vytorin 10-20 mg
6. Glimepiride 4 mg
7. Actos 30 mg
8. Furosemide 40 mg
9. Klor - con m10

Type 2 Diabetes (T2D)

abigailmichener — 2022-01-27 18:22:10 UTC

Type 2 diabetes is a result of the body not being able to process or use sugar in the body as fuel. As a result, the body has to much sugar circulating in the blood stream.
High blood sugar levels may lead to disorders of the circulatory, nervous or immune system. These disorders can lead to lack of perfusing vital organs. It's important that you monitor for symptoms, such as, numbness or tingling, color and temperature of extremeties, blurred vision, slow-healing sores, and nausea or vomitting because they may indicate complications related to type 2 diabetes.

Type 2 Diabetes (T2D) Treatment

abigailmichener — 2022-01-27 18:22:58 UTC

After being diagnosed with type 2 diabetes, it's important to monitor A1C levels twice a year.
A1C levels: a blood test that measures your average blood sugar level for the last 2-3 months. Currently, your A1C is 6.0%.
Target A1C goals for individuals with T2D is below 7%.

Management of diabetes: we encourage healthy eating, regular exercise, weight loss, medication or insulin therapy, and blood sugar monitoring.

Healthy Eating Goals

abigailmichener — 2022-01-27 18:39:18 UTC

To meet our healthy eating goals, we encourage individuals to:
1. create a schedule for meals and snacks
2. smaller portion sizes
3. High-fiber foods: fruits, nonstarchy vegetables such as, asparagus, spinach, beans, artichoke
4. Whole grains: brown rice, oatmeal, and whole wheat bread
5. Low-fat dairy products: yogurt and cottage cheese,
6. Low-fat meat products: turkey and chicken breast

Physical Activity Goals

abigailmichener — 2022-01-27 18:45:46 UTC

Statistics show that losing weight and exercising can help manage Type 2 Diabetes. Exercise is encouraged to help lose weight and help lower blood sugar levels.
1. Aerobic exercise: walking, swimming, biking or running for 30 mins a day, 4 times a week.
2. Resistance Exercise: weightlifting, yoga, and calisthenics; aim for 2-3 times a week.
3. Weight loss: helps control blood sugar levels, cholesterol, triglycerides, and blood pressure.

Monitoring Blood Sugar Levels

abigailmichener — 2022-01-27 19:02:28 UTC

It's important to monitor blood sugar levels regularly.
Monitor blood sugar levels: once a day and before or after exercise.
Desired blood sugar level: 70-100

Monitor for hypoglycemia (low blood sugar): blood sugar below < 70 mg/dL
Hypoglycemia symptoms: fatigue, paleness, shaky, sweating, hunger, confusion, or irritable
IF EXPERIENCING SYMPTOMS: EAT OR DRINK apple juice or crackers and recheck blood sugar in 15 minutes.

Monitor for hyperglycemia (high blood sugar): Blood sugar above < 125 mg/dL
Hyperglycemia symptoms: nausea and vomiting, dry mouth, fruity breath, shortness of breath, weakness, or confusion.
IF EXPERIENCING SYMPTOMS: SEEK MEDICAL ATTENTION OR ADMINISTER INSULIN AS DIRECTED BY PROVIDER.

Diabetes Medication

abigailmichener — 2022-01-27 19:11:43 UTC

Medication can be prescribed if an individual is unable to maintain blood sugar levels with diet and exercise.

Sulfonylureas are a class of drugs that aims to help your body to secrete more insulin

GLIMEPIRIDE (Amaryl): is a type of sulfonylureas drug. Used to lower and regulate blood sugar levels by helping the body to secrete more insulin.

Dosage: 4 mg by mouth once a day in the morning

Storage: closed container at room temperature

Side effects: low blood sugar and weight gain

references

abigailmichener — 2022-01-27 19:16:28 UTC

Mayo Clinic. (2021, January 20). Type 2 diabetes - Diagnosis and treatment - Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/type-2-diabetes/diagnosis-treatment/drc-20351199

Hypertension (HTN)

abigailmichener — 2022-01-27 19:17:41 UTC

Hypertension is a medical condition that means "high blood pressure." Meaning, the force of blood in your blood vessels is higher than normal.

Blood pressure consists of two numbers, systolic and diastolic numbers.
Systolic: the upper number, measures the force of blood on the artery walls when the heartbeats
Diastolic: the bottom number, measures the force of blood on the artery walls in between heartbeats.

High Blood pressure puts an individual at risk for various life-threatening complications and/or diseases, such as,
1. Heart attack
2. Stroke
3. Heart Failure
4. Kidney Failure
5. Vision loss
6. Sexual dysfunction
7. Angina (chest pain)
8. Peripheral arterial disease (PAD) -atherosclerosis

Blood pressure numbers

abigailmichener — 2022-01-27 20:32:30 UTC

To properly monitor your blood pressure, it's important to know what is normal, low or high numbers.

Upper number = SYSTOLIC, Lower number = DIASTOLIC; will be presented as 120 mmHg / 80 mmHg

Normal blood pressure: less than or equal to 120 mmHg / 80 mmHg

Elevated blood pressure: 120-129 mmHg / 80 mmHg

Stage 1 Hypertension: 130-139 mmHg / 80-89 mmHg

Stage 2 Hypetension: >140 mmHg / 90 mmHg

Hypertensive Crisis: >180 mmHg / 120 mmHg

Managing High Blood Pressure

abigailmichener — 2022-01-27 20:46:19 UTC

By adopting a heart-healthy lifestyle, you can reduce blood pressure, prevent complications, enhance the use of blood pressure medications, and prolong your life expectancy.

1. Well balanced diet: fruits, vegetables, whole grains, low-fat dairy, skinless meat and fish
2. Limit sodium intake, red meat and sugary drinks
3. Limit alcohol
4. Exercise; walking, swimming, biking, etc.
5. Manage stress: yoga, breathing exercises
6. Maintain health weight
7. Quit smoking
8. Medication adherence
9. Monitor blood pressure regularly

Gout

abigailmichener — 2022-01-27 21:22:42 UTC

Gout is a medical condition that commonly affects individuals with obesity, heart failure, diabetes, hypertension, kidney disease, or a family history of gout.

At risk for Gout related to the history of hypertension and diabetes.

Gout is a result of extra uric acid in the body that creates sharp crystals. This causes swelling and inflammation in the joints.

Characteristics:
1. located in one or more joints
2. commonly located in the big toe, knees, ankles, feet, hands, wrist or elbows.
3. "gout attacks" last a week or two

Symptoms:
1. intense pain in joints
2. redness
3. stiffness
4. swelling
5. tenderness to light touch
6. warmth in the area

Managing Gout

abigailmichener — 2022-01-27 21:45:10 UTC

There are pharmacological and nonpharmacological treatments to prevent and manage gout attacks.

Prevention of Gout Attacks:
1. Drink a lot of water, avoid dehydration
2. Exercise regularly
3. Allopurinol by mouth: a medication taken to reduce the production of uric acid
4. Limit foods high in purine:
1. Alcohol
2. Red meat, beef, and liver
3. Shellfish
4. Gravy
5. Fructose: honey, agave, fruit juices, mangos

Managing Gout Attacks:
1. NSAIDS: Ibuprofen and Advil, reduces pain and swelling
2. Colchicine: take within 24 hours of first symptoms of gout. Reduces inflammation and pain.
3. Corticosteroids: relieve pain and swelling
4. Elevating affected joints
5. Applying ice on joints for 20 minutes on and 20 minutes on
6. Limit activity and stress on joints

High Cholesterol

abigailmichener — 2022-01-27 22:11:57 UTC

High Cholesterol is a result of high levels of fatty substances in the blood that make it challenging for blood to flow regularly through the body.

High Cholesterol is diagnosed by a lipid panel that measures
1. Total Cholesterol: > 200 mg/dL
2. LDL cholesterol: "bad" cholesterol: > 70 mg/dL
3. HDL cholesterol: "good" cholesterol: > 50-59 mg/dL
4. Triglycerides: >150 mg/dL

High levels of cholesterol are commonly linked to
1. High intake of Fatty foods
2. Inactivity
3. Obesity
4. Diabetes
5. Chronic kidney disease
6. HIV/AIDS
7. Hypothyroidism
8. Lupus

High levels of Cholesterol puts you at risk for:
1. Atherosclerosis
2. Chest pain
3. Heart Attack
4. Stroke

Managing High Cholesterol

abigailmichener — 2022-01-28 18:44:54 UTC

To prevent further complications its important to prevent and manage high cholesterol levels.

Preventing High Cholesterol:
1. Limit salt intake
2. Limit fat intake
3. Weight loss
4. Quit smoking
5. Exercise daily
6. Managing stress

Managing High Cholesterol:
1. Lifestyle changes; healthy diet, exercise, etc.
2. Vytorin - medication used to lower "bad" cholesterol

Follow up visit

abigailmichener — 2022-01-28 19:25:15 UTC

With a history of diabetes, hypertension, and high cholesterol, it is important we assess the client's lifestyle changes and goals.
Statistics show that the most beneficial lifestyle changes include losing weight. To lose weight it's imperative to incorporate other lifestyle changes, such as a healthy diet and exercise.
Statistics reveal that losing weight is beneficial for secreting more insulin to manage diabetes, reducing blood pressure and cholesterol levels.
On the last visit, weight was 200 lbs, on assessment, new weight is 192 lbs. Which is good, working towards his goal of losing 25 pounds.

Vital signs/Labs

abigailmichener — 2022-01-28 19:34:37 UTC

According to the given vital signs, Mr. Bell is considered overweight for his height, this places him at an increased risk for all 4 diseases that he has. It is so important to focus on weight loss.

HEIGHT: 5'5
WEIGHT: 192 LBS
BP: 148/90
HR: 88 BPM
BMI: 33.3

According to the given lab results, all of his labs are contingent on the diseases that he suffers from. It's important to focus on lowering these levels through a healthy diet. A healthy diet plan will be provided to help guide healthier choices, in order to, lower fasting blood glucose, cholesterol and lose weight.

LAB RESULTS:
HgB A1C: 6.0%
Fasting blood glucose: 138-145 mg/dL
Total Cholesterol: 202 mg/dL

Reference

abigailmichener — 2022-01-28 19:36:18 UTC

Mayo Clinic. (2021b, July 20). High cholesterol - Diagnosis and treatment - Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/high-blood-cholesterol/diagnosis-treatment/drc-20350806

Reference

abigailmichener — 2022-01-28 19:36:46 UTC

Cleveland Clinic. (2022). Gout: What Is It, Symptoms, Causes, Treatment. https://my.clevelandclinic.org/health/diseases/4755-gout

Reference

abigailmichener — 2022-01-28 19:37:20 UTC

The American Heart Association. (2022). The Facts About High Blood Pressure. Www.Heart.Org. https://www.heart.org/en/health-topics/high-blood-pressure/the-facts-about-high-blood-pressure

Ozempic.com

abigailmichener — 2022-01-30 20:38:11 UTC

This website offers alternative management tips and strategies. This resource provides education on a medication called Ozempic.
This is a resource you should utilize and discuss with your provider to see if its an alternative that would benefit the management of your Type 2 Diabetes.

Not only does the website provide education and uses of Ozempic, but it also offers support programs that are encouraged to use and connect with others suffering from type 2 Diabetes.

Support groups are a great outlet to discuss feelings, concerns, and doubts about your type 2 diabetes diagnosis. It can help you feel less alone in suffering and offer more ways to manage your diagnosis.

The website offers a source called "Lifestyle tips and videos" this source provides videos of recommended exercises and lifestyle changes that can help manage type 2 diabetes.

Link and resource provided: https://www.ozempic.com/lifestyle-tips/what-is-type-2-diabetes.html?modal=isi&&utm_source=google&utm_medium=cpc&utm_term=type2%20diabetes&utm_campaign=New+5+BMM+Shared+TRE+Type+2+General&mkwid=s-dc_pcrid_571010177954_pkw_type2%20diabetes_pmt_p_slid__product_&pgrid=131019857883&ptaid=kwd-273086513&gclid=Cj0KCQiAi9mPBhCJARIsAHchl1xqCpZryqcXABQtv8iwu719t8IDxJx8XNUotfTn690WRz9xA42JZbcaAqbhEALw_wcB&gclsrc=aw.ds

Benchmark Physical therapy

abigailmichener — 2022-01-30 21:06:02 UTC

Physical therapy is going to be a core part of managing all of your health diagnoses.

It is recommended through our facility to utilize "benchmark physical therapy" a link and paper copy of the resource will be provided.

Benchmark Physical Therapy allows you to find a location closest to you and accepts medicare that covers physical and occupational telehealth therapy.

Choosing a physical therapy that provides telehealth therapy is beneficial for those who don't have easy access to transportation.

Benchmark Physical Therapy Link:
https://benchmark.urpt.com/