The House Painter Patient Evaluation & Management Plan

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A 52-year-old male patient who is a house painter presents to the office reporting chronic fatigue and “mild” chest pain. When he is painting, chest pain is relieved after taking a break. He reports that the pain usually lasts 5 minutes or less and occasionally spreads to his left arm before subsiding. The patient was last seen 3 years ago by you, and you recommended diet changes to manage mild hyperlipidemia, but the patient has gained 30 pounds since that time. The patient’s medical history includes anxiety, vasectomy, cholecystectomy, and mild hyperlipidemia. The patient does not smoke or use other tobacco or nicotine products. The patient cares for his wife, who has multiple sclerosis and requires 24-hour care. His daughter and grandson also live with the patient. His daughter assists with the care of his wife, and his job is the major source of income for the family. The initial vital signs are: blood pressure 158/78, heart rate 87, respiratory rate 20, and body mass index 32. As part of the diagnostic work-up, an ECG, lipid levels, cardiac enzymes, and C-reactive protein (CRP) are ordered. The patient reports that he does not have time to “be sick” and says that he needs to take care of everything during this visit so he can return to work and care for his wife. Discuss the following:
What additional information should you obtain about the pain the patient is experiencing?
What additional physical assessment needs to be performed with this patient?
What considerations are important to remember if the patient’s CRP level is elevated?
What differential diagnoses should be considered for the patient?
What patient teaching will be incorporated into the visit to modify the patient’s risk factors?
How will you respond to the patient’s statement that he does not have time to “be sick” and needs to take care of everything during this visit?

 

 

 

 

Sample Solution

 

GCSE War Poem

Tunes of GCSE war “Light Battle” and “Pre-winter Battle” are generally sonnets about war. Alfred Tennyson’s “Light Brigade’s Accusation” composed on fourteenth November 1854 clarifies one thing in the Crimean war. England and France are concerned that Russia will move south, so assaulted Russia in Balaclava. During the war in September 1914, Lawrence Bingyan stated “for fall”, however embraced a one-sided mentality that shows positive and negative outcomes, specifically. . It is a nation.

How about we see the necessities of GCSE’s English writing. Understudies need to recall the “significant substance” of the 15 books of various lengths and various books, Shakespeare plays (the significant thing is code word). With at any rate fiction and dramatization, you realize that you will be blue-penciled – in verse, 13 of the 15 sonnets you recall won’t show up in your proposition. Pick two refrains as tests, think about them, and request that the understudies connect them to a particular subject

Clarify how the exceptional qualities of at any rate two works in Wilfred Owen’s sonnets influence one another and impact their responses. The center highlights of Wilfred Owen’s war verse incorporate misuse of war, dread of war, and the physical impact of war. These highlights can be found in Owen’s correspondence with perusers, verse ‘Darce and Decolm Est’ pulling in perusers’ feelings to warriors and ‘Destiny to youth of predetermination’. These sonnets interface and investigate understanding

“Maryal Mountain in this sonnet” clarifies the normal picture.

Maybe the most popular contemporary use of this sentence is the title of the sonnet “Dulce et Decorum est” by British artist Wilfred Owen during the First World War. Owen’s verse depicts the gas assault during the First World War and is one of his numerous enemy of war sonnets that were not reported until the finish of the war. In the last scarcely any lines of this sonnet, Horatian phrases are communicated as “antiquated untruths”. Individuals accept and utilize the first of that sonnet to clarify that Owen is attempting to mock the sonnet by Jessie Pope (who applauded the war and enlisted in a basic enthusiastic verse). “Little accomplice” who is energetic about charging and shooting. Like “telephone”

The primary sonnet mirrors the picture of war that the vast majority know well. This sonnet “Flanders Battlefield” is presumably the most well known and mainstream war sonnet. It was first distributed in British ‘punch’ magazine in December 1915. Very quickly, this sonnet represents the penance of all the battle in World War I. “Flanders Battlefield” was made by a specialist and instructor of Canada, John McCrea who worked in the South African War and the First World War. He was moved to the clinical group and alloted to a French clinic. He was dynamic in 1918 and kicked the bucket of pneumonia. His sonnet assortment “Flanders Field” and other verse assortments were distributed in 1919. This sonnet is still piece of a commemoration in Canada and different nations.

 

 

 

 

 

 

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