Management Plan
Management Plan for a 41 years old female, Hispanic-American decent who presents to the clinic for a well visit assessment; assessment reveal she is at risk for the following :
• hypertension (bp 134/74);
• breast cancer (first degree family member mom 63 and 1st cousin 44 being diagnosed and early menses at 10.5; latte pregnancy 33; mammogram result pending);
• prediabetes A1c 6.4
• cardiovascular disease due to hyperlipidemia
Use the expert diagnosis provided to create a pertinent, comprehensive, evidenced-based management plan.
Address the following criteria in the plan:
1.) Diagnostic tests;
2.) Medications (write out a complete order, even for OTC meds);
3.) Suggested consults/referrals
4.) Patient education;
5.) Follow-up, including time interval and specific symptoms to prompt a return visit sooner;
6.) Provide rationales for each intervention and include at least 3 references to support your plan. Clinical practice guidelines should be utilized as applicable. (Evidence of Academic Integrity Issues will result in a grade of 0.)
Patient Presentation
A 41-year-old Hispanic-American female presents for a well-visit assessment with risk factors for hypertension, breast cancer, prediabetes, and cardiovascular disease.
Diagnostic Tests
- Complete Metabolic Panel (CMP) to assess renal function, liver function, electrolytes, and glucose metabolism.
- Lipid Panel to evaluate cholesterol levels and cardiovascular risk.
- Thyroid Stimulating Hormone (TSH) to rule out thyroid dysfunction, which can impact metabolism.
- Urinalysis to assess for proteinuria, hematuria, or other abnormalities.
- Mammogram (pending) to screen for breast cancer.
- Ultrasound of breasts if mammogram is inconclusive.
- Genetic counseling to assess familial risk of breast cancer and consider genetic testing (BRCA1/BRCA2).
Medications
- Lifestyle modifications are the cornerstone of management.
- Metformin 500 mg PO BID: Initiate metformin to manage prediabetes and reduce cardiovascular risk.
- Lisinopril 10 mg PO daily: Start antihypertensive medication to manage blood pressure.
- Statin therapy: Consider initiating statin therapy based on lipid profile results and global risk assessment. Options include atorvastatin, rosuvastatin, or pravastatin.
- Low-dose aspirin 81 mg PO daily: Consider aspirin for primary prevention of cardiovascular disease based on risk assessment.
Suggested Consults/Referrals
- Referral to a registered dietitian for personalized nutrition counseling and weight management.
- Referral to a breast specialist for further evaluation and management of breast cancer risk.
- Referral to a cardiologist for comprehensive cardiovascular risk assessment and management.
Patient Education
- Importance of lifestyle modifications: Emphasize the role of diet, exercise, weight management, smoking cessation, and stress management in preventing and managing chronic diseases.
- Adherence to medication regimen: Explain the importance of taking medications as prescribed and potential side effects.
- Self-monitoring of blood pressure and blood glucose: Teach patients how to monitor blood pressure and glucose levels at home and the importance of regular follow-up.
- Breast self-awareness: Educate the patient about breast self-examination and the importance of regular mammograms.
- Healthy eating: Provide dietary guidelines emphasizing fruits, vegetables, whole grains, lean protein, and low-fat dairy products.
- Physical activity: Encourage at least 150 minutes of moderate-intensity exercise per week.
Follow-Up
- Follow-up in 3 months to assess blood pressure, blood glucose, and lipid levels.
- Mammogram results and follow-up with breast specialist as recommended.
- Return sooner if:
- Blood pressure is consistently above 140/90 mmHg
- Symptoms of hypoglycemia or hyperglycemia develop
- Chest pain, shortness of breath, or other signs of heart problems occur
- Changes in breast tissue or nipple discharge
Rationales and Evidence
- Early identification and management of risk factors for hypertension, breast cancer, prediabetes, and cardiovascular disease are crucial for preventing complications.
- Lifestyle modifications are the cornerstone of management and have been shown to improve overall health outcomes.
- Medications are used to achieve target blood pressure, blood glucose, and lipid levels.
- Regular follow-up allows for monitoring of treatment effectiveness and early detection of complications.
References:
- American Heart Association. (2017). 2017 AHA/ACC Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: An Update of the JNC 8 Guideline. Journal of the American College of Cardiology, 70(21), 2948-3013.
- American Diabetes Association. (2022). Standards of Medical Care in Diabetes – 2022. Diabetes Care, 45(Supplement 1), S1-S206.
- American Cancer Society. (2023). Breast Cancer Facts & Figures. Atlanta: American Cancer Society.