Managing a 62-Year-Old African American Female’s Health Concerns: Prioritization and Patient Education

QUESTION

62-year-old African American female presents to the clinic with a list of concerns that she would like to address during the visit. She is scheduled for a 15-minute, episodic visit.

Medication refills of:
o  Metformin (Glucophage) 850 mg PO BID

o  Simvastatin (Zocor) 10 mg PO daily

o  Lisinopril/hydrochlorothiazide (Zestoretic) 10/12.5 mg PO daily

o  Naproxen (Naprosyn) 500 mg PO BID

• Right knee pain
• Cold symptoms
• Chest pain with cough
• Brown toenails
• A mole that she would like to get checked out

What are your priorities in managing this patient today? Select 3 problems to address and prioritize them.

Which ROS would you cover and why ?

Objective: Vitals: Blood Pressure: R 170/90 L 175/94 mmHg, Heart Rate: 98 bpm, Temperature: 102.0 °F (Oral), Respiration Rate: 25 breaths per minute, Pulse Oximetry 93% on room air, Glucose: 218 mg/dL nonfasting, Height: 5′ 6″, Weight: 247 lb, BMI 39.9 kg/m2

1. How are you going to explain to her the things that you are addressing today?
2. What are some options of what you are going to do about her other concerns?
3. What about her pain?
4. When do you want to see her back? and why?

ANSWER

Managing a 62-Year-Old African American Female’s Health Concerns: Prioritization and Patient Education

Introduction

A 62-year-old African American female presents to the clinic with multiple health concerns during a 15-minute episodic visit. The primary goal is to prioritize and address the most pressing issues while ensuring patient understanding and providing appropriate follow-up care. This essay will outline the priorities in managing this patient, discuss the relevant review of systems (ROS), explain the chosen priorities to the patient, explore options for addressing her other concerns, address her pain, and determine the timing for her next appointment.

Priorities in Managing the Patient

Given the time constraints of the visit, it is essential to prioritize the patient’s concerns and address the most urgent issues. Three priorities for management could be as follows:

Chest Pain with Cough: Chest pain associated with coughing can indicate a respiratory or cardiac issue. It is crucial to assess the severity, duration, and associated symptoms. This complaint requires immediate attention to evaluate potential cardiac causes and initiate appropriate management.

Cold Symptoms: Cold symptoms can be indicative of an upper respiratory tract infection. While generally not life-threatening, they can cause discomfort and impair daily functioning. Assessing the severity of symptoms and providing symptomatic relief or guidance on when to seek further medical attention is necessary.

Right Knee Pain: Right knee pain may affect the patient’s mobility and quality of life. It is important to evaluate the cause, consider the patient’s medical history, perform a physical examination, and determine appropriate management options.

Review of Systems (ROS) to Cover

The ROS should focus on areas relevant to the patient’s presenting concerns. In this case, the following ROS may be covered:

Respiratory: Assess for associated symptoms with the cough, such as shortness of breath or wheezing, to evaluate potential underlying respiratory conditions.

Dermatological: Inquire about the characteristics of the mole that the patient would like to get checked out, such as changes in size, shape, color, or any associated symptoms that may raise concern for malignancy.

Musculoskeletal: Evaluate the duration, severity, aggravating factors, and limitations caused by the right knee pain to determine the appropriate course of action.

Explaining the Chosen Priorities

Clear and concise communication is essential to ensure patient understanding. When explaining the priorities, it is important to provide a brief rationale for each:

Chest Pain with Cough: Express the need to evaluate potential cardiac causes of chest pain and assess for any respiratory issues contributing to the symptomatology. Explain the significance of timely evaluation to ensure appropriate management and mitigate any potential risks.

Cold Symptoms: Educate the patient on the self-limiting nature of colds and the importance of managing symptoms. Provide guidance on over-the-counter medications for symptom relief and indications for seeking further medical attention if symptoms worsen or persist.

Right Knee Pain: Highlight the impact of knee pain on daily activities and quality of life. Explain the importance of determining the cause to implement appropriate treatment options and potentially improve mobility and functionality.

Options for Addressing Other Concerns

For the patient’s remaining concerns, offer options that balance the limited time available with their importance and potential impact on the patient’s health. These may include:

Brown Toenails: Provide basic advice on proper foot hygiene, nail care, and footwear selection. Recommend over-the-counter antifungal medications or suggest a future dedicated appointment for a thorough evaluation if the condition persists or worsens.

Mole Examination: Emphasize the significance of assessing any changes in moles, such as irregular borders, changes in size or color, or associated symptoms. Offer a referral to a dermatologist for further evaluation if deemed necessary during the visit.

Addressing Pain

To address the patient’s pain, a comprehensive approach is essential. Assess the severity, duration, and impact of the pain, and consider non-pharmacological interventions such as physical therapy, weight management, and lifestyle modifications. Prescribing analgesics, including nonsteroidal anti-inflammatory drugs (NSAIDs), should be done judiciously, considering the patient’s comorbidities and potential drug interactions.

Timing for the Next Appointment

Given the patient’s multiple concerns and chronic conditions, it is advisable to schedule a follow-up appointment within a reasonable timeframe, such as 2-4 weeks, depending on the severity of the conditions and the need for ongoing management and monitoring. This allows for further evaluation of the patient’s progress, adjustment of treatment plans if needed, and addressing any new concerns that may arise.

Conclusion

Managing a 62-year-old African American female with multiple concerns requires prioritization, effective communication, and consideration of the patient’s overall health. By addressing the most pressing issues first, providing patient education on the chosen priorities, offering options for addressing other concerns, and implementing appropriate pain management strategies, healthcare professionals can ensure comprehensive and patient-centered care. Scheduling a timely follow-up appointment allows for ongoing evaluation and management of the patient’s conditions.