Primary Care Physician: Management of Chronic Conditions

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Migraine

Migraine is a pulsing sensation believed to cause a headache on one side of the head. The symptoms include:

  • Vomiting
  • Numbness
  • Nausea
  • Difficulty in speaking.

The physical assessment findings include:

  • Fever
  • Weight loss
  • Myalgia
  • Malaise
  • Impairment of judgment.

The factors that can confirm the diagnosis of a migraine are:

  • Severe headache
  • Nausea or vomiting
  • Aggravation of routine physical activities such as walking stairs.
  • Photophobia

The diagnostics of treating a migraine is finding the best over-the-counter soluble painkillers that can be absorbed quickly by the body. Suppository capsules are used when patients are vomiting or experiencing nausea (May & Schulte, 2016). The patients can use acupuncture and Transcranial Magnetic Stimulation (TMS) that involve delivering a magnetic pulse on the skin by placing an electrical device on the head.

Hypertension

It is a condition where the blood force is higher than the pressure in the artery walls. It is blood pressure above 140/90. Hypertension has no definite symptoms, but when untreated, it causes severe symptoms such as:

  • Chest pains
  • Severe headache
  • Fatigue
  • Irregular heartbeat
  • Blood in the urine.

The physical assessment finding in high blood pressure include:

  • Enlarged kidneys
  • Increased heart size
  • Bruits and precordial heave
  • Arrhythmias and increased heart rate
  • Delayed peripheral arterial pulsations.

The criteria for hypertension diagnosis include the following confirming factors:

  • Stroke
  • Heart failure
  • Myocardial infarction
  • Palpitation.

High blood pressure requires a diagnosis when it goes beyond the average systolic blood pressure of 140 mmHg.

The care plan involves a regular check of the blood pressure using a testing kit. The typical therapeutic treatment of hypertension includes weight loss or engaging in physical activities, reduced potassium and sodium intake, and dietary change (Kjeldsen, 2018). Education elements of reducing high pressure include managing stress, reducing alcohol and smoking, eating healthy, and monitoring pressure at home.

Chronic back pain

It is physical pain or discomfort occurring on the back and the spine.

Common symptoms include:

  • Muscle spasms
  • Tightness in the lower back
  • Stinging session and itchiness
  • Burning pain on the spine can spread to the thighs and feet.
  • Numbness on the lower part of the body.

The most potential exam finding in chronic back pain include:

  • Numbness
  • Tingling sensation in the arms and legs
  • Pain in the backbone and ligaments

The diagnostic criteria for chronic back pain include:

  • Radiating pain coming from the leg and the lumbar region.
  • Intense pain in the lower back that lasts more than 72 hours.

The diagnosis element of treating back pain include taking OTC painkillers, resting, and taking prescribed medication. Some of the therapeutic elements include the use of ultrasounds, traction, and Transcutaneous electrical nerve stimulation (TENS) (Lee & Kang, 2016). The educational elements include the use of ice or heat, surgery, exercise, and alternative medication.

Type 2 Diabetes

It is a long-lasting condition that affects the processing of blood sugar in the body.

Some of the symptoms include:

  • Frequent urination
  • Weight loss
  • Increased thirst and hunger
  • Fatigue
  • Frequent infections and sores that heal slowly.

Most patients have a common physical examination, unless they get complications which result into:

  • Colored skin patches
  • Discoloration around the neck and groin
  • Balanitis (swelling of the glans)
  • Blurred vision
  • Yeast infections.

The confirming factors for diagnosis include:

  • Excessive weight loss,
  • Increased blood level of more than 200 mg/Dl,
  • Excessive thirst,
  • Urination.

The diagnostic elements include monitoring the blood glucose level by taking the AIC test and Glucose tolerance test. The therapeutic element includes: controlling blood pressure in patients to prevent cardiovascular and microvascular disease (CVD) (Chatterjee et al., 2017). Educational elements include increased physical activities, eating healthy, and limiting salt, alcohol, and smoking.

Dyslipidaemia

It is elevated lipids (fats) or cholesterol in the blood.

The common symptoms include:

  • Swelling of the feet and ankles
  • Exhaustion
  • Chest tightness
  • Breathing difficulties
  • Cold sweats.

The physical assessment finding includes:

  • Claudication
  • Heart attack
  • Angina
  • Stroke

The diagnostic criteria include elevated cholesterol levels, low-density lipoprotein (LDL), and non-high-density lipoprotein (non- HDL).

The diagnostic elements include testing the level of triglycerides, HDL in the blood to determine if the levels are high or low. The therapeutics approaches include reverse cholesterol transport (RCT) pathways, antisense oligonucleotides (ASOs), and modulating HDL (Kopin & Lowenstein, 2017). The educational approaches include physical exercise, taking triglyceride-lowering drugs, and eating low-fat food.

Diverticulitis

It is the infection of the digestive tract, mainly the small pouches.

The common symptoms include:

  • Fever
  • Vomiting and nausea
  • Constipation
  • Pain in the lower abdomen
  • Tenderness in the abdomen.

The physical examination finding includes:

  • Tachycardia
  • Guarding and tenderness of the abdomen
  • Palpable mass presence in the body
  • Pain in the lower body
  • Bloating, bleeding, and diarrhoea.

The factors that confirm the diagnosis include bleeding in the colon, patients passing black stool with blood strains, pain in the abdomen, consistent fever, and constipation.

This condition’s diagnosis includes taking a stool test and CT scan of the pelvis and abdomen to identify the infected pouches. The therapeutics treatment includes intravenous therapy, which involves delivering medication and fluids directly to the veins and taking antibiotics and penicillin to kill the bacteria (Young-Fadok, 2018). The educational treatment includes changing the diet, resting, and drinking clear liquids like water ginger tea.

Asthma

It is a condition where the lungs or airways get inflamed, making it difficult to breathe.

The common symptoms include:

  • A raised heartbeat
  • Coughing
  • Fainting
  • The blue coloration of the lips and fingers
  • Drowsiness.

The physical examination findings include:

  • Swelling of the throat and nose
  • Allergies on the skin
  • Chest pain and tightness
  • Physical Exhaustion.

The factors that confirm the diagnosis of these conditions include:

  • Recurring dry cough.
  • Shortness of a patient’s breath.
  • Tightness of the chest.

The diagnostic plan of care for patients includes knowing and avoiding triggers that can cause asthma, getting an action plan to control asthma, avoiding smoking (Yang et al., 2017). The therapeutics care for asthma includes palliative care which is oxygen therapy. The educational element includes taking long-term control medications which are taken daily, such as inhaled corticosteroids.

Depression

It is a condition where a patient lacks interest in any activity and has low moods.

The common symptoms include:

  • Sadness
  • Lack of appetite
  • Lack of concentration
  • Anxiety and mood swings
  • Loss of interest in any activity and general discomfort.

The physical assessment findings include:

  • Loss of energy or fatigue
  • Weight loss
  • Guilt or feeling worthless
  • Reduction of physical movements and slow decision making
  • Suicidal thoughts

Factors that confirm the diagnosis of the conditions include:

  • Depressed moods that are recurrent
  • Significant loss of weight almost 5% within a short period
  • Loss of interest in pleasurable things
  • Lack of sleep or insomnia.

The diagnostic elements in patient care include taking a screening test using the Zung scale. The therapeutic elements include cognitive behavioural therapy, psychotherapy, and electroconvulsive therapy (Patel, 2017). The education elements of care include taking antidepressants, anxiolytic, and antipsychotic prescription.

Osteoporosis

It is a condition in which human bones become brittle and weak.

The common symptoms include:

  • Loss of the average height
  • Fractured vertebra
  • Back pain
  • Stooped posture
  • Breaking of bones.

Some of the physical assessments include:

  • Breaking bones in the hips, wrist, and spine
  • Permanent pain to the body
  • Loss of weight
  • Hunched posture

The factors that confirm the diagnosis of the conditions include:

  • Fracture on the wrists and hips
  • Back pain,
  • Loss of significant weight.

The diagnosis of the conditions involves taking a bone density scan to measure the bones’ mineral density. Denosumab is recommended for therapeutic treatments, and physical exercise and a healthy diet are recommended to make the bones stronger (Sözen et al., 2017). Taking antacid, vitamins, and dietary supplements are recommended in the educational treatment.

References

Chatterjee, S., Khunti, K., & Davies, M. J. (2017). Type 2 diabetes. The Lancet, 389(10085), 2239-2251.

Kjeldsen, S. E. (2018). Hypertension and cardiovascular risk: General aspects. Pharmacological Research, 129, 95-99.

Kopin, L., & Lowenstein, C. J. (2017). Dyslipidemia. Annals of Internal Medicine, 167(11), ITC81-ITC96.

Lee, J. S., & Kang, S. J. (2016). The effects of strength exercise and walking on lumbar function, pain level, and body composition in chronic back pain patients. Journal of Exercise Rehabilitation, 12(5), 463.

May, A., & Schulte, L. H. (2016). Chronic migraine: Risk factors, mechanisms and treatment. Nature Reviews Neurology, 12(8), 455.

Patel, V. (2017). Talking sensibly about depression. PLoS Medicine, 14(4), e1002257.

Sözen, T., Özışık, L., & Başaran, N. Ç. (2017). An overview and management of osteoporosis. European Journal of Rheumatology, 4(1), 46.

Yang, I. V., Lozupone, C. A., & Schwartz, D. A. (2017). The environment, epigenome, and asthma. Journal of Allergy and Clinical Immunology, 140(1), 14-23.

Young-Fadok, T. M. (2018). Diverticulitis. New England Journal of Medicine, 379(17), 1635-1642.

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