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

communication put forward by the Semiotician Jarmila Doubravová (Doubbravova, 2002). A popular linguist Guy Cook, (2001) examines advertising as a “parasite discourse”, because it takes over the contents, forms, authors as well as recipients of other discourses (similarly as the literary criticism depends on literature and the Sport News – on sport) (Cook, 2001). In fact, Judith Williamson indirectly builds on the idea of “parasite discourse” by Dyer’s characterization of advertising importance as something that uses the elements of real life and aims to create “new world and new language”. “The main purpose of advertising is not to create a new meaning, but to transform signs of the system that is have already known”, writes Williamson (Williamson, 2010).
Visual portrayals are able to communicate considerably more messages than words and noises, so they are coherently the main field to semiotic analysis of any television advertising. The viewers process and adopt the images more faster and recollect them more than the words (Vyekalova, 2007). The images do not send just important information, but they also serve for creation of mood – the whole emotional influence on the recipient, similarly as music. Mostly, in advertising, dealing with colour, shape, and font, as well as with perception of persons or specific emotions. It is noteworthy to understand that knowing of each of the elements may differ in various cultures and social classes, because the advertisements are formed by the culture and, on the contrary, assist them to form the bind. It is not possible to rely on generally valid symbols, because they are culturally determined. The advertising presents the product in relation with standards related to a supposed lifestyle of a certain social group and the presented products may become symbols of social status on the basis of effective advertising campaign”, psychologist Elena Hradiská points out (Hradiska, 1998).
Advertisement construct, form and manipulate the perception and the behaviour of its consumers and the outside. All the symbols are paying an immeasurable service of presenting and apprehending the culture and the world. Theoretical background clearly immerge the interdisciplinary doctrine w

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