Order ID 53563633773 Type Essay Writer Level Masters Style APA Sources/References 4 Perfect Number of Pages to Order 5-10 Pages Description/Paper Instructions
SUBJECTIVE
Maxwell is a 70‐year‐old homosexual African American male and retired corporate lawyer who first came to the health maintenance organization 3 years ago. At that time, he had not been to a primary care provider since he retired from full‐time work at age 60. Maxwell continues to consult and does occasional part‐time work for his previous law firm. He admits to a sedentary lifestyle, a weight gain of 25 pounds within the past 2 years, and occasional fatigue and headache.
Past medical history: None significant.
Past surgical history: Significant for a tonsillectomy at the age of 7.
Family history: Significant for thyroid disease, hypertension, coronary artery disease, Type 2 diabetes mellitus, hyperlipidemia, and obesity. Father died from a myocardial infarction at age 69.
OBJECTIVE
VISIT THREE YEARS AGO
Vital signs: 220 lbs with a height of 6 ft 1 inch and a body mass index of 29. Blood pressure: 140/88;
radial pulse: 78; temperature: 98.7°F; respiratory rate: 16.
Physical examination: Significant for acanthosis nigricans and central adiposity.
Diagnostic test results: Fasting lipids revealed a total cholesterol of 182, a low‐density lipoprotein level of 106, a high‐density lipoprotein level of 57, and a triglyceride level of 95. His fasting blood glucose was 95, and the Hemoglobin A1c was 5.6. His thyroid‐stimulating hormone level was 8.0 mU/L. A routine electrocardiogram documented normal sinus rhythm and rate.
Diagnoses: Hypertension and hyperthyroid disease.
Plan: The patient is started on hydrochlorothiazide 25 mg, aspirin 81 mg, and Norvasc 2.5 mg by mouth daily and levothyroxine 0.50 mcg by mouth daily. He is counseled regarding lifestyle modifications, inclusive of preparing and eating a low‐sodium and low‐fat diet. Maxwell was encouraged to start a routine exercise program of at least 30 minutes of modest aerobic activity such as walking as if to catch a bus. He was also encouraged to lose 5–7% of his body weight. These lifestyle modifications have proven effective in diabetes prevention and maintenance, as well as in control of blood pressure and lipid levels. The patient is informed regarding the mechanism of action of the medications, duration of action, contraindications, and adverse effects. The patient is also instructed to take the levothyroxine on an empty stomach first thing in the morning.
THREE‐MONTH FOLLOW‐UP VISIT
Vital signs: Blood pressure of 128/76.
Diagnostic test results: Thyroid‐stimulating hormone level is 4.50. Basic metabolic panel: blood urea nitrogen level of 14; creatinine level of 0.98; sodium level of 137; potassium level of 3.8; and a chloride level of 104.
Plan: The patient was given a list of potassium‐containing foods and reminded to eat 1 or 2 items daily due to his low potassium level. He is instructed to continue to take his medications.
TODAY’S VISIT
SUBJECTIVE
Maxwell has been very busy in his semi‐retirement and has not been in for a physical examination or labwork for more than 2 years. Now he presents with complaints of extreme fatigue for the past 2 months and low libido. He states that he feels fatigued all the time, and sleep does not seem to relieve it. He is able to work around the house, but has cut back on his legal work and has limited socialization and participation in outside activities due to fatigue. He reports sleeping for 8–10 hours a night, with his sleep interrupted by a need to go to the bathroom at least twice. He awakens fatigued.
Sexually, he has a morning erection but not as strongly as in previous months. He has limited sexual desire. He is able to have an erection with intercourse, but it is less of an erection than pre-viously. He states that he has been in a monogamous relationship for the past 2 years. He admits to a 15‐pound weight gain over the past 2 years. He reports that he experiences occasional consti-pation and some cold intolerance. He reports feeling “shaky” on occasion, especially when he has not eaten in a while. He denies fever, night sweats, and tobacco or drug use and reports socially drinking several glasses of red wine per week.
Past medical history: Remains significant for hypertension and hypothyroidism.
Past surgical history: Remains the same.
Family history: Unchanged.
Medications: Hydrochlorothiazide 25 mg by mouth daily, Norvasc 2.5 mg by mouth daily, levothy-roxine 0.50 mcg by mouth daily, aspirin 81 mg by mouth daily, multivitamin, 1 capsule and fish oil capsules, 2000 mg by mouth daily. There are no known drug allergies and no known food allergies.
OBJECTIVE
Vital signs: Temperature: 98.6°F; radial pulse: 76; blood pressure: 134/80; oxygen saturation: 99%; height: 6 ft 1 inch; weight: 235 lbs (15‐lb weight gain); body mass index: 31. Physical exam is unre-markable except for the following findings:
Skin: Poor skin turgor; acanthosis nigricans.
Mouth: Dry oral mucosa.
Cardiac: NSR, No ectopy.
Respiratory: CTA bilaterally.
Abdomen: Central adiposity.
Lymph: No significant lymphadenopathy.
Rectal: Hemoccult negative for occult blood.
CRITICAL THINKING
Which diagnostic studies should be considered to assist with or confirm the diagnosis?
___FIT test
___Complete blood count
___Thiamine
___Iron studies
___Complete metabolic panel
___Rapid HIV test
___HIV viral load test
___HbA1c
___Thyroid‐stimulating hormone___Testosterone
___Urine analysis
___Tuberculosis testing
___Urine microalbumin/creatinine ratio
___FSH and LH
___Prolactin
___Chest X‐rayWhat is the most likely differential diagnosis and why?
___HIV and/or AIDS
___Pernicious anemia
___Hypothyroidism uncontrolled
___Secondary hypogonadism
___Diabetes mellitus
What is the plan of treatment?
What is the plan for referrals and follow‐up?
Does the patient’s psychosocial history impact how you might treat him?
What if this patient were a premenopausal female?
What if the patient were over the age of 80?
Are there standardized guidelines that should be used to assess and treat this patient?
RUBRIC
QUALITY OF RESPONSE NO RESPONSE POOR / UNSATISFACTORY SATISFACTORY GOOD EXCELLENT Content (worth a maximum of 50% of the total points) Zero points: Student failed to submit the final paper. 20 points out of 50: The essay illustrates poor understanding of the relevant material by failing to address or incorrectly addressing the relevant content; failing to identify or inaccurately explaining/defining key concepts/ideas; ignoring or incorrectly explaining key points/claims and the reasoning behind them; and/or incorrectly or inappropriately using terminology; and elements of the response are lacking. 30 points out of 50: The essay illustrates a rudimentary understanding of the relevant material by mentioning but not full explaining the relevant content; identifying some of the key concepts/ideas though failing to fully or accurately explain many of them; using terminology, though sometimes inaccurately or inappropriately; and/or incorporating some key claims/points but failing to explain the reasoning behind them or doing so inaccurately. Elements of the required response may also be lacking. 40 points out of 50: The essay illustrates solid understanding of the relevant material by correctly addressing most of the relevant content; identifying and explaining most of the key concepts/ideas; using correct terminology; explaining the reasoning behind most of the key points/claims; and/or where necessary or useful, substantiating some points with accurate examples. The answer is complete. 50 points: The essay illustrates exemplary understanding of the relevant material by thoroughly and correctly addressing the relevant content; identifying and explaining all of the key concepts/ideas; using correct terminology explaining the reasoning behind key points/claims and substantiating, as necessary/useful, points with several accurate and illuminating examples. No aspects of the required answer are missing. Use of Sources (worth a maximum of 20% of the total points). Zero points: Student failed to include citations and/or references. Or the student failed to submit a final paper. 5 out 20 points: Sources are seldom cited to support statements and/or format of citations are not recognizable as APA 6th Edition format. There are major errors in the formation of the references and citations. And/or there is a major reliance on highly questionable. The Student fails to provide an adequate synthesis of research collected for the paper. 10 out 20 points: References to scholarly sources are occasionally given; many statements seem unsubstantiated. Frequent errors in APA 6th Edition format, leaving the reader confused about the source of the information. There are significant errors of the formation in the references and citations. And/or there is a significant use of highly questionable sources. 15 out 20 points: Credible Scholarly sources are used effectively support claims and are, for the most part, clear and fairly represented. APA 6th Edition is used with only a few minor errors. There are minor errors in reference and/or citations. And/or there is some use of questionable sources. 20 points: Credible scholarly sources are used to give compelling evidence to support claims and are clearly and fairly represented. APA 6th Edition format is used accurately and consistently. The student uses above the maximum required references in the development of the assignment. Grammar (worth maximum of 20% of total points) Zero points: Student failed to submit the final paper. 5 points out of 20: The paper does not communicate ideas/points clearly due to inappropriate use of terminology and vague language; thoughts and sentences are disjointed or incomprehensible; organization lacking; and/or numerous grammatical, spelling/punctuation errors 10 points out 20: The paper is often unclear and difficult to follow due to some inappropriate terminology and/or vague language; ideas may be fragmented, wandering and/or repetitive; poor organization; and/or some grammatical, spelling, punctuation errors 15 points out of 20: The paper is mostly clear as a result of appropriate use of terminology and minimal vagueness; no tangents and no repetition; fairly good organization; almost perfect grammar, spelling, punctuation, and word usage. 20 points: The paper is clear, concise, and a pleasure to read as a result of appropriate and precise use of terminology; total coherence of thoughts and presentation and logical organization; and the essay is error free. Structure of the Paper (worth 10% of total points) Zero points: Student failed to submit the final paper. 3 points out of 10: Student needs to develop better formatting skills. The paper omits significant structural elements required for and APA 6th edition paper. Formatting of the paper has major flaws. The paper does not conform to APA 6th edition requirements whatsoever. 5 points out of 10: Appearance of final paper demonstrates the student’s limited ability to format the paper. There are significant errors in formatting and/or the total omission of major components of an APA 6th edition paper. They can include the omission of the cover page, abstract, and page numbers. Additionally the page has major formatting issues with spacing or paragraph formation. Font size might not conform to size requirements. The student also significantly writes too large or too short of and paper 7 points out of 10: Research paper presents an above-average use of formatting skills. The paper has slight errors within the paper. This can include small errors or omissions with the cover page, abstract, page number, and headers. There could be also slight formatting issues with the document spacing or the font Additionally the paper might slightly exceed or undershoot the specific number of required written pages for the assignment. 10 points: Student provides a high-caliber, formatted paper. This includes an APA 6th edition cover page, abstract, page number, headers and is double spaced in 12’ Times Roman Font. Additionally, the paper conforms to the specific number of required written pages and neither goes over or under the specified length of the paper. GET THIS PROJECT NOW BY CLICKING ON THIS LINK TO PLACE THE ORDER
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