Liam Fitzgerald Telehealth Follow Up Sick Visit: Management of Cardiovascular Conditions Patient Objective Data Collection

During the appointment, his ankles were examined for any abnormalities. Here’s what was observed:

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Right Ankle:
– No visible abnormalities such as swelling, visible mass, irregular alignment, discoloration, or joint deformity were found.

Left Ankle:
– Similar to the right ankle, no visible abnormalities were detected.

Additionally, the ankles were palpated, which means they were touched to check for tenderness, warmth, erythema (redness), and edema (swelling).

Left Ankle Palpation:
– No abnormalities were found, but tenderness, warmth, erythema, and edema were assessed.

Right Ankle Palpation:
– Similar to the left ankle, no abnormalities were detected, but tenderness, warmth, erythema, and edema were assessed.

Furthermore, a pitting test was conducted on both ankles to check for edema severity:

Left Ankle Pitting Test:
– No pitting was observed.

Right Ankle Pitting Test:
– Similarly, no pitting was observed.

In addition to the physical examination, patient education and empathy were emphasized during the interview. Here are some key points discussed:

1. Swelling and Weight Gain:
– Mr. Fitzgerald mentioned experiencing swelling and rapid weight gain. It was emphasized that gaining weight could worsen heart problems, and he was advised to pay attention to signs like swelling and weight gain, which could indicate worsening heart failure.

2. Taking Diuretics:
– It was noted that Mr. Fitzgerald should take his prescribed medications, such as furosemide and potassium chloride, when experiencing symptoms like swelling and weight gain. This would help control symptoms and maintain cardiovascular health.

3. Diet Adherence:
– Although not directly discussed in the interview, it was highlighted that adhering to a low-sodium diet is crucial for cardiovascular health. Non-adherence to the diet can exacerbate congestive heart failure, as seen in Mr. Fitzgerald’s case after consuming high-sodium foods at a recent party.

4. Waking Up at Night:
– While Mr. Fitzgerald mentioned waking up frequently at night to urinate, this issue was not followed up during the interview. However, it was emphasized that disruptions to sleep due to nocturia (nighttime urination) should be addressed, and if needed, medication timing should be adjusted to minimize nocturia.

Noah Caputo school age sick visit dermatology shadow health Subjective data

Overall, the objective data collection and patient education aimed to manage Mr. Fitzgerald’s cardiovascular conditions effectively.