Question

physiology

CASE #1 A 59-year-old man with type 2 diabetes presents with concerns about high blood pressure (BP). At a recent visit to his dentist he was told his BP was high. He was reclining in the dentist's chair when his BP was taken, but he doesn't remember the exact reading. He has no symptoms. He has never taken medications for high BP. He takes metformin for type 2 diabetes. His BP is measured once at 146/95 mm Hg in the left arm while sitting, Physical exam is unremarkable except for obesity. EKG is unremarkable. BP Measurement Controlling BP in patients with diabetes reduces the risk of cardiovascular events, but the available data are not sufficient to classify this patient with respect to BP status. The reading taken while reclining in the dentist's chair was likely inaccurate. A single reading in the medical clinic, even with correct technique, is not adequate for clinical decision-making because individual BP measurements vary in unpredictable or random ways. The accuracy of BP measurement is affected by patient preparation and positioning, technique, and timing. Before the first reading, the patient should avoid smoking, caffeine, and exercise for at least 30 minutes and should sit quietly in a chair for at least 5 minutes with back supported and feet flat on the floor. An appropriately sized cuff should be placed on the bare upper arm and with the arm supported at heart level. For the first encounter, BP should be recorded in both arms. The arm with the higher reading should be used for subsequent measurements. It is recommended that one use an average of 2 to 3 readings, separated by 1 to 2 minutes, obtained on 2 to 3 separate visits Some of those readings should be performed outside of the clinical setting, either with home BP self-monitoring or 24-hour ambulatory BP monitoring, especially when confirming the diagnosis of sustained hypertension. Note that a clinic BP of 140/90 corresponds to home BP values of 135/85. Multiple BP readings in the clinic and at home allow for classification into one of the following categories. What is the Plan:

Answer 1

Patient name- unknown age-59

Subjective -complaints he have high blood pressure.

Objective -while assessment there was no symptoms of high blood pressure. And also checked left arm once in sitting position shows 146/95mmhg

Assessment

1.type 2 diabetes mellitus disease

2 patient have doubt as high blood pressure

3 obesity

Plan

1.medical therapy as metformin tablet

2.checking of blood pressure one more time while checking patient take rest for 30 minutes avoid caffeine drinks avoid heavy works exercise .

3.obesity was the serious issue regarding all people exercise and diet modification is the only way to change an obese body built to moderate