Analysis of Primary Care Cases: Diagnosis, Treatment, and Rationale

This assignment presents a series of primary care case studies, each addressing a different patient scenario with specific symptoms and medical histories. The cases cover a range of conditions, including a patient with hypertension, headaches, and blurred vision; a homeless patient with a furuncle; a young woman experiencing fatigue, weight gain, and potential depression; an elderly man with memory issues and frequent urination; and an elderly man with a recent fall and alcohol use. For each case, the student provides diagnoses, plans of care, and rationales for the proposed treatments, supported by scholarly references. The analysis includes diagnostic tests, treatment options, and considerations for patient management, reflecting a comprehensive understanding of primary care principles and practices.

Lecture DB instructions
 Length: A minimum of 200 words each post not including references
 Citations: At least one high-level scholarly reference in APA from within the
last 5 years
 The Red words are the questions that are to be answered to address the
prompt.
 Please keep each Week separated with the reference under the answers
 A good resource book for this is Clinical Guidelines in Primary Care 2nd
edition by Amelie Hollier
Week 4
A 61-year-old Black male with a history of hypertension presents to your
clinic for complaints of headaches and blurred vision x 4 days. He denies
any weakness, numbness, chest pain, shortness of breath, palpitations, or
recent, illicit drug use. He states he has been compliant with his
medications (hydrochlorothiazide and metoprolol), and he took his meds
this morning.
His V/S include: B/P 190/100, P- 90, T- 98.9, R- 22. Recent labs show that
TC- 260, LDL-190, HDL- 35, Trig- 320. He did not return for these results
and did not start any new meds.
1. What are your diagnoses
The blood pressure is 190/100 Hg, which above the normal range and
of 140/80, however, any increase of the diastolic pressure has to be
addressed with emergency case. The patient’s total cholesterol is
around 260 mg/dl, which is above the normal range of older people
with hypertension. The HDL is also at borderline 35mg/dl. The
triglycerides are also high. The high blood pressure in the body can
lead to increase of body fat, arterial stiffening accumulation of
visceral fat (Kim & Kim, 2013). The headaches and blurred vision
along with the high cholesterol. Therefore, the patient is suffering
from high cholesterol, and has a possibility of coronary heart disease
as well as diabetes. The drugs which are currently administered to
him could also cause dizziness and headache as a side effect.
2. and plan of care for this patient. Remember to include your
rationales.

The rationale is to reduce the blood pressure and diagnose the cause
of dizziness by checking the blood sugar level and plan of care of the
above symptoms are: 1) He is advised to go blood sugar test, 2) The
patient is advised to take medications which have are calcium
channel blockers like diltiazem (Tiazac) as it goes well with the
people who have African lineage.3) The patient is advised to have
food with lesser salt intake, avoiding alcohol and adapt light diet with
lower amount of fat content.4) Light physical activity.
References:
Kim, H. S., & Kim, D. G. (2013). Effect of long-term resistance exercise on
body composition, blood lipid factors, and vascular compliance in the
hypertensive elderly men. Journal of exercise rehabilitation, 9(2),
271-7.
Week 5
A 52 year old female presents to your free clinic. She states that she is
currently homeless and usually sleeps in the park. She states is has a large
lump on her shoulder and thinks she has a spider bite. You determine that
it is a Furuncle. You also notice a couple of additional small open lesions.
1. What else is going on here?
The patient may be possibly suffering from Carbuncle, which is a
bacterial infection caused by Staphylococcus aureus. From the
background of the patient it could be understood that patient is not
situated in a hygienic condition. Which can be primarily cause of the
development of the bacteria. One of the condition that can cause is
diabetes mellitus (Jain, 2013). Bad liver condition can also be the
contributing factor the lesions.
2. How will you proceed with treatment?
The current symptom of Carbuncle can be caused due to many
factors, and to understand that some lab tests can be organized to
further understand the problem of the patient. The blood sugar test
can be done to understand the probability of diabetes mellitus. For
the immediate treatment, the lesions are washed with warm water
and warm compress has to be done so that the pus is pushed out. By
understanding and analyzing the nature of the lesion, further
antibiotics like amoxicillin and ibuprofen has been advised. The
patient is advised to maintain proper hygiene and care so that the
situation does not aggravate (Ibler & Kromann, 2014).
References:

Ibler, K. S., & Kromann, C. B. (2014). Recurrent furunculosis–challenges and
management: a review. Clinical, cosmetic and investigational
dermatology, 7, 59.
Jain, A. K. C. (2013). Carbuncle in Diabetics-Our Experience. Pain, 10, 66-67.
Week 6
A 28 year old female presents for complaints of fatigue, increased
sleeping, and weight gain. She states she has had depression off and on
since she was 17. She denies any other health problems and has never
taken any prescription medication, including anything for depression.
1. What are your differentials?
The woman is complaining of increased sleep, weight gain and
fatigue, furthermore the woman has complained of depression on
and off since she was 17 years old. This case can be an indication of
thyroid gland dysregulation and possibility due to hypothyroidism.
Due to the dysregulation of the thyroid hormone there can be
possibility of oversleeping, increase fatigue and depression. In
addition to this it could further increase the blood sugar level as well
as disrupt the menstrual cycle as well as the fertility of the lady (Urmi
et al., 2015).
2. What laboratory tests could you perform?
It is recommended that the patient goes through the Thyroid
Stimulating Hormone or TSH test as well T4 which is the thyroxine
test.
It is also advisable for the patient to go for blood sugar test, in case
there is an increase of blood sugar level, due to weight gain.
3. How would be your treatment plan?
After the lab reports are revealed, if the tests are positive for
Hypothyroidism, levothyroxine could be given. Any anomaly in the
menstrual cycle has to be addressed and further treatment can be
advised for the patient.
References:
Urmi, S. J., Begum, S. R., Fariduddin, M., Begum, S. A., Mahmud, T.,
Banu, J., ... & Khanam, A. (2015). Hypothyroidism and its Effect
on Menstrual Pattern and Fertility. Mymensingh medical journal:
MMJ, 24(4), 765-769.

Week 7
A 75 year old male presents at your clinic accompanied by his daughter.
He states that he is going to the bathroom “a lot” and doesn’t like it. His
daughter states that he sometimes doesn’t remember where the bathroom
is and asks the same question several times without seeming to notice.
1. What diagnostic tests will you perform?
The patient is aged and has a pattern of forgetfulness, urge of
urination, moreover the patient is unware of the repetitive question
that he has already asked. Frequent urine inconsistency and
forgetfulness can be linked to dementia or Alzheimer’s disease
(Ogama et al., 2013). Therefore, it is advisable to the daughter of the
patient to carry out an PET (Positron Emission Topography) scan, and
if it is not possible then MRI scan. The PET scan is advisable as it can
detect the beta amyloids plaques better with new technological
development.
2. What will be your plan of treatment?
The treatment can include cholinesterase inhibitor like donepezil or
rivastigmine. The patient has to be kept any proper care. The
patients diet should include fresh vegetables and fruits, or fiber rich
diet so that constipation can be avoided which is a side effects of the
medication.
References:
Ogama, N., Yoshida, M., Nakai, T., Niida, S., Toba, K., & Sakurai, T.
(2016). Frontal white matter hyperintensity predicts lower
urinary tract dysfunction in older adults with amnestic mild
cognitive impairment and A lzheimer's disease. Geriatrics &
gerontology international, 16(2), 167-174.
Week 8
Mr. Smith is a 65 year old male that is accompanied by his wife to your
clinic. He is following up after an ER visit for a fall at home that resulted in
6 stitches to his forehead. He admits that he had a few drinks that night
before tripping over his dog. His wife adds that he has “a few drinks” every
night.
1. How will you proceed with Mr. Smith?

Drinking habits in elderly people can cause poor health and poor
cognition that can lack of mental and physical coordination among
older people. This can increase chances of tripping and falling among
older people because of the increased sensitivity. Alcohol intake
remains the cause of substance abuse among the older people in US
(Kuerbis et al., 2014). Therefore, some diagnostic tests have to be
performed along with medications. The pattern of alcohol intake has
to be addressed, this includes social, family and prior history of
alcohol abuse. Furthermore, the current medications have to be
analyzed and assessed as there can be many adverse effects in older
people, for example intake of warfarin can lead to severe adverse
effect along with alcohol intake.
2. What diagnostics will you perform?
The CARET or Comoribidity Alcohol Risk Evaluation Tool can be used
to screen the quantity and frequency of the alcohol intake of Mr.
Smith.
3. What will potentially be part of your treatment plan?
If the delirium continues, hospitalization is advised for Mr Smith as it
can cause fatal accidents as well as dependency. Benzodiazepines
are commonly advised withdrawal of alcohol intake and the
administration of the medication has to be in fixed and proper
schedule. Short acting benzodiazepine is advisable in his case as long
acting benzodiazepine can cause increased sedation.
References
Kuerbis, A., Sacco, P., Blazer, D. G., & Moore, A. A. (2014). Substance
abuse among older adults. Clinics in geriatric medicine, 30(3), 629-
54.