Who should the NP refer this patient? Past medical/surgical history: he has no surgical history.And

 Who should the NP refer this patient? Past medical/surgical history: he has no surgical history.Andrew is a 42-year-old African-American male who presents with BP 160/92 and morning headaches. Andrew reports headaches upon arriving approximately 2 times per week. This morning prompted his coming to the office for evaluation, as he felt some lightheadedness and chest tightness resolved following his shower. He has never been told that his blood pressure was high, but he has not been seen in the office for six years. His last visit was for bronchitis and treatment with antibiotics.Family history: His father is deceased at age 65 from an acute MI; one brother died at age 50 with acute MI, following abdominal aortic aneurysm surgery. He has four other siblings in good health.Social history: He has been dealing with several life issues including the death of a child and a reduction in his work hours at a local manufacturing plant. He smokes two packs of cigarettes per day, lives a sedentary life outside of work, and is overweight at 6’2″ and 255 pounds (BMI = 33). He reports generally good health. His Smoking history is 44 years. He is married and has three remaining children, age 12, 15, and 17. His oldest son was killed in a car accident to months ago. He drinks moderately, generally 2- 3 beers 4-5 times per week. He reports drinking more heavily on the weekends. He and his wife are active in their church. He is a high school graduate in makes approximately 50,000 annually. His wife has a full-time position that supplements the family income to proximately 90,000. For three months, his business has experienced a downturn; and there have been mandatory furlough days, which I required to their family spending to be seriously curtailed, although they are able to meet the financial obligations at this time.Medications: He is on no prescription medications at this time. Andrew takes the daily aspirin and a multivitamin, but no prescription medications.Allergies: No known allergies. He reports being lactose intolerant.ObjectiveGeneral: Patient appears older than his stated age; frowning.Vital signs: BP on arrival is 188/92. After 20 minutes, repeat BP is 180/90. P: 94; R: 20; T:98.2 F. HEENT: Cranial nerves intact. EENT exam negative.Neck: No lymphadenopathy.Skin: Skin warm and dry.Respiratory: Lung sounds vesicular over peripheral fields; harsh, bronchial breath sounds in upper lobes bilaterally; moist cough audible; no adventitious breath sounds.Cardiovascular: No jugular venous distention at 30 agree elevation. Heart sounds strong 3/4; grade 2/6 systolic murmur at left sternal border, intercostal space (ICS). Abdominal and peripheral vascular assessments negative; pedal and post tibial pulses 2+/4+.Abdomen: Tender over right upper quadrant. Tympany predominates. Liver border WNL, spleen and kidneys nonpalpable.Neuromuscular: Romberg’s sign negative; gait relax and symmetrical; no pronator drift. Full ROM all extremities.Diagnostic Test ResultsECG: Non-specific T wave changes; no evidence of acute ischemiaTroponin: <0.4.CBC: Slightly elevated RBC's, otherwise WNLElectrolytes: WNLTotal cholesterol: 240HDL: 58LDL: 166Triglycerides: 196 Health Science Science Nursing NURSING 513 Share QuestionEmailCopy link Comments (0)