Liam Fitzgerald Telehealth Follow Up Sick Visit Shadow Health Transcript: Management of Cardiovascular Conditions Patient
Hello, my name is xx, and I will talk with you first and then examine you.
Table of Contents
Greetings!
April 20, 2023, 5:41 PM Eastern Daylight Time (EDT)
Hi there. Can you hear me?
Query:
April 20, 2023, 5:41 PM EDT
Yes, I can hear you clearly. Are you in a suitable place for a telehealth visit?
Query:
April 20, 2023, 5:42 PM EDT
Yes, this is a good spot for us to chat. Do you understand that this visit is private and confidential?
Query:
April 20, 2023, 5:43 PM EDT
Yes, I grasp that this visit is confidential. [AUDIO COMING SOON] What brings you here today?
Query:
April 20, 2023, 5:44 PM EDT
I’m fine, just here for my regular telehealth follow-up. When was your last hospital visit?
Query:
April 20, 2023, 5:47 PM EDT
Six months ago, I was in the hospital for my heart failure symptoms. When were you diagnosed with heart failure?
Query:
April 20, 2023, 5:48 PM EDT
I was diagnosed with heart failure… two years ago now. What symptoms are you currently experiencing?
Query:
April 20, 2023, 5:48 PM EDT
I don’t really have any symptoms, just here for my follow-up. I’m doing okay. Are you using any medications?
Query:
April 20, 2023, 5:49 PM EDT
My regular heart meds are carvedilol, candesartan, spironolactone, and an aspirin. I also have some heart meds that I take as needed—furosemide, potassium chloride tablets, and nitroglycerin. For my cholesterol, I take atorvastatin and fish oil. What are the dosages of your medications?
Query:
April 20, 2023, 5:50 PM EDT
We’ll need to go down the list since I have regular heart medications, as needed heart medications, and cholesterol medications. What is the dosage of your heart medications?
Query:
April 20, 2023, 5:51 PM EDT
The carvedilol is 12.5 milligrams, the candesartan is 32 milligrams, the spironolactone is 12.5 milligrams, and the aspirin is an 81 mg EC tablet. Then I take some as needed heart failure medications. What is the dosage of your cholesterol medications?
Query:
April 20, 2023, 5:53 PM EDT
Let’s see, the atorvastatin is 40 mg, and the fish oil is 1000 mg. I take them both every day. What is your medical history?
Query:
April 20, 2023, 5:53 PM EDT
That’s quite a list. I have heart failure, coronary artery disease, high blood pressure, high cholesterol, and I had a heart attack a while back. When were you diagnosed with coronary artery disease?
Query:
April 20, 2023, 5:55 PM EDT
I was diagnosed with it five years ago, at the time of my heart attack. When were you diagnosed with high blood pressure?
Query:
April 20, 2023, 5:55 PM EDT
I’ve had high blood pressure for some time now. I was diagnosed at 38 but didn’t manage it much then. It’s better now though. How do you control your blood pressure?
Query:
April 20, 2023, 5:56 PM EDT
I’m on a few heart medicines, but the carvedilol is the one for blood pressure. Any family history of heart problems?
Query:
April 20, 2023, 5:57 PM EDT
Yes, heart issues are common in my family. My mom has high blood pressure and high cholesterol, and my dad passed away from a heart issue at 75. He also had high blood pressure and had open-heart surgery. What is your diet like?
Query:
April 20, 2023, 5:58 PM EDT
I stick to a low-sodium diet as much as possible. For breakfast, I have oatmeal with berries, and lunch is usually homemade soup or pasta with grilled chicken and veggies. Dinner includes fish or grilled chicken with more veggies and brown rice. Snacks are air-popped popcorn or an apple with almond butter. It’s not very exciting, but it’s what I need to do. A healthy diet is good for your health.
Education:
April 20, 2023, 5:58 PM EDT
Okay, thanks. Do you exercise?
Query:
April 20, 2023, 5:59 PM EDT
Yes, I do tai chi regularly. Exercise is good for your health.
Education:
April 20, 2023, 5:59 PM EDT
Got it. Thanks. Any allergies?
Query:
April 20, 2023, 5:59 PM EDT
No, I don’t have any allergies. Are your immunizations current?
Query:
April 20, 2023, 6:00 PM EDT
I think so, yes. Do you miss doses of your medication?
Query:
April 20, 2023, 6:00 PM EDT
No, I’m good about taking my medicine. It’s good to take medications as prescribed.
Education:
April 20, 2023, 6:01 PM EDT
Gotcha. Have you ever had a heart attack?
Query:
April 20, 2023, 6:01 PM EDT
Yes, I’ve had a heart attack. When did you last have a heart attack?
Query:
April 20, 2023, 6:02 PM EDT
It was five years ago. What were the symptoms of your heart attack?
Query:
April 20, 2023, 6:03 PM EDT
The main thing I remember was intense discomfort in my chest. Any history of hospitalizations?
Query:
April 20, 2023, 6:03 PM EDT
Yes, I’ve had a few. Two years ago, I was diagnosed with heart failure. Six months ago, I had some issues with my heart again. How does your heart failure affect you?
Query:
April 20, 2023, 6:04 PM EDT
It’s mostly asymptomatic. Do you drink?
Query:
April 20, 2023, 6:05 PM EDT
Yes, occasionally. How often do you drink?
Query:
April 20, 2023, 6:05 PM EDT
Not very often these days, just on special occasions. I used to drink more before my heart attack. Too much alcohol consumption is not good for your health.
Education:
April 20, 2023, 6:08 PM EDT
Alright then. Thanks. Do you smoke?
Query:
April 20, 2023, 6:08 PM EDT
I used to. When did you last smoke?
Query:
April 20, 2023, 6:10
PM EDT
I quit after my heart attack. I still get cravings, so I use nicotine gum. Smoking is not good for your health.
Education:
April 20, 2023, 6:10 PM EDT
Ah, I see. Have you ever had an EKG test?
Query:
April 20, 2023, 6:11 PM EDT
Yes, six months ago during my hospitalization for heart failure. Do you know your blood pressure number?
Query:
April 20, 2023, 6:12 PM EDT
Today it was 155 over 95. A little higher than normal. Have you lost weight?
Query:
April 20, 2023, 6:14 PM EDT
No, I’ve actually gained some. Gaining weight will worsen your heart problems.
Education:
April 20, 2023, 6:15 PM EDT
Got it. Thanks. How much weight have you gained?
Query:
April 20, 2023, 6:16 PM EDT
About four or five pounds. Any swelling?
Query:
April 20, 2023, 6:16 PM EDT
Yes, in my feet and ankles. Any chest pain?
Query:
April 20, 2023, 6:18 PM EDT
No, none at all. Any palpitations?
Query:
April 20, 2023, 6:19 PM EDT
No palpitations. What caused your weight gain?
Query:
April 20, 2023, 6:20 PM EDT
I’m not sure. Is your appetite fine?
Query:
April 20, 2023, 6:20 PM EDT
Yes, it’s normal. What heart problems do you have?
Query:
April 20, 2023, 6:21 PM EDT
I have coronary artery disease, heart failure, high cholesterol, high blood pressure, and a history of heart attack. Do you take caffeine?
Query:
April 20, 2023, 6:23 PM EDT
I drink decaf. How often do you exercise?
Query:
April 20, 2023, 6:23 PM EDT
Three times a week, doing tai chi. Any skin problems?
Query:
April 20, 2023, 6:24 PM EDT
No, my skin is normal. Any fatigue?
Query:
April 20, 2023, 6:24 PM EDT
I’m not tired. What is your occupation?
Query:
April 20, 2023, 6:25 PM EDT
Liam Fitzgerald Telehealth Follow Up Sick Visit Shadow Health Transcript: Management of Cardiovascular Conditions Patient
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Hi, my name is xx and I will interview you and later examine you
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Greet |
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Hi there.
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Can you hear me?
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Yeah, I can hear you clearly.
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Are you in an appropriate environment for a telehealth visit?
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This is a fine place for us to talk.
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Do you understand that this telehealth visit is confidential?
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Yup, I understand that this visit is private and confidential. [AUDIO COMING SOON]
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What brings you here today?
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I’m OK, just here for my regular telehealth follow-up.
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When was your last hospital visit?
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Six months ago I was in the hospital for my heart failure symptoms.
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When were you diagnosed with heart failure?
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I was diagnosed with heart failure . . . two years ago now.
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What symptoms do you currently have? (Clarified to Do you know what symptoms are you experiencing?.)
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I don’t really have any symptoms, just here for my follow-up. I’m doing OK. (Clarified to if I know what my symptoms are.)
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Are you using any medications?
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My regular heart meds are carvedilol, candesartan, spironolactone, and an aspirin. I have some heart meds that I take as needed too — furosemide, a potassium chloride tablets, and nitroglycerin. For my cholesterol I take atorvastatin and some fish oil.
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What are the dosages of your medications?
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We’re going to have to go down the list since I have regular heart medications, as needed heart medications, and cholesterol medications.
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What is the dosage of your heart medications?
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The carvedilol is 12.5 milligrams, the candesartan is 32 milligrams, the spironolactone is 12.5 milligrams, and the aspirin is an 81 mg EC tablet. And then I take some as needed heart failure medications.
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What is the dosage of your cholesterol medications?
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Hm, let’s see. I take the atorvastatin — it’s 40 mg — and the omega-3 fatty acid fish oil, it’s 1000 mg. I take them both everyday.
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What is your medical history?
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That’s a long list, let’s see . . . Well I have heart failure, that’s the big one. And I have coronary artery disease, high blood pressure, high cholesterol, and I had a heart attack a while back.
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When were you diagnosed with coronary artery disease?
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I was diagnosed with it five years ago, at the time of my heart attack.
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When were you diagnosed with high blood pressure?
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I’ve had high blood pressure for some time now. I was diagnosed at 38 but didn’t try to manage it much. It’s better now though.
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What do you use for your high blood pressure? (Clarified to How do you control your blood pressure?.)
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I’m on a few heart medicines, but the carvedilol is the one for blood pressure. (Clarified to how I control my blood pressure.)
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Any family history pf heart problems?
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Yeah, heart issues run in the family. Mom’s alive, but she has high blood pressure and high cholesterol. Dad passed at 75 from a heart thing, not sure what it was, and he also had high blood pressure . . . oh and he had open heart surgery too.
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What is your diet like? Liam Fitzgerald Telehealth Follow Up Sick Visit Shadow Health Transcript: Management of Cardiovascular Conditions Patient
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Well I’m on a low-sodium diet and I try to follow it. For breakfast I have oatmeal with some berries. Lunch is usually some soup, I try to do homemade ones, or some pasta with grilled chicken and vegetables. I’ll have a salad sometimes. Dinner is some fish or grilled chicken with some more vegetables, and some brown rice. If I want a snack, it’s air popped, no salt popcorn, or an apple with no salt almond butter. It’s not very exciting, but it’s what I need to do.
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Great. healthy diet is good for your health
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OK, thanks.
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Do you exercise?
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Yeah, I exercise regularly. I do tai chi.
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Great. Exercise is good for your health Liam Fitzgerald Telehealth Follow Up Sick Visit Shadow Health Transcript: Management of Cardiovascular Conditions Patient
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Educate |
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Got it. Thanks.
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Any allergies?
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No, I don’t have allergies.
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Are your immunizations current?
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I believe I’m up to date.
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Have you missed any medications? (Clarified to Do you miss doses of your medication?.)
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No. I’m good about taking my medicine. (Clarified to if I miss doses of my medication.)
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Great, it is good to take medications as prescribed
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Educate |
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Gotcha.
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have you ever had a heart attack?
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Yes, I have had a heart attack.
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When did you last have a heart attack?
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My heart attack was five years ago.
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What are the symptoms of your heart attack?
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The main thing I remember was really intense discomfort in my chest.
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Any history of hospitalizations?
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I’ve had a few hospital stays. Five years ago I had a heart attack and they did surgery. Two years ago I had some issues with my heart and went back in and they diagnosed me with heart failure. Six months ago was the most recent time, my heart again. I wasn’t feeling great, but they took care of me and I was OK.
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How have heart problems affected your life? (Clarified to How does your heart failure affect you?.)
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It doesn’t, really — it’s asymptomatic most of the time. (Clarified to how my heart failure affects me.)
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Do you drink?
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Yeah, I drink some.
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How often do you drink?
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I don’t really drink very often these days, just on special occasions. I used to have one or two beers a night, but I had to cut down after my heart attack. I’ll have that non-alcoholic stuff sometimes, it’s not half bad, but I’d just rather stick with the real thing if I’m going to have a drink.
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Too much alcohol consumption is not good for your health
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Alright then. Thanks.
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Do you smoke
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I used to smoke.
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When did you last smoke?
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I quit smoking after my heart attack. I still get cravings though so I use the nicotine gum.
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Great. Smoking is not good for your health
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Ah, I see.
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Have you ever had an EKG test?
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Yeah, when I was hospitalized six months ago for heart failure stuff, they did an EKG and an echocardiogram.
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What is your blood pressure number? (Clarified to Do you know your blood pressure number?.)
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Today it was 155 over 95. A little higher than normal. (Clarified to if I know my blood pressure number.)
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Any weight issues? (Clarified to Have you lost weight?.)
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No, I’ve actually gained some. (Clarified to if I have lost weight.)
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Gaining weight will only worsen your heart problems
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Got it. Thanks.
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How much weight have you gained?
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About four or five pounds.
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Any swelling?
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Yeah, I have some swelling right now.
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Where is the swelling located?
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In my feet and ankles.
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Any chest pain?
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No, my chest hasn’t been hurting.
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Any palpitations?
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I don’t have any palpitations at all.
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What caused our weight gain?
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I don’t know, really.
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Have you been eating more? (Clarified to Is your appetite fine?.)
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My appetite’s been the same, pretty normal. [AUDIO COMING SOON] (Clarified to if my appetite is okay.)
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Do you monitor your heart problems? (Clarified to What heart problems do you have?.) Liam Fitzgerald Telehealth Follow Up Sick Visit Shadow Health Transcript: Management of Cardiovascular Conditions Patient
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I have a little swelling right now, if that counts. If you mean what heart conditions I have — I have coronary artery disease, heart failure, high cholesterol, high blood pressure, and I had a heart attack. (Clarified to what heart problems I have.)
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Do you take caffeine?
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I drink decaf.
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How often do you exercise?
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I do tai chi three times a week.
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Any skin problems?
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No, my skin is normal, same as ever.
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Any fatigue?
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I’m feeling OK — not tired.
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What is your occupation?
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I’m retired now, but I worked as a truck driver for the postal service.
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What is your living situation?
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My home environment is good. I live in a one-story house with my daughter Claire, her husband Mark, and my grandson, Callum.
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Any urination issues?
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No issues with going to the bathroom, but I do wake up needing to pee at night.
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Any weakness?
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I’m no Thor, but I can still open pickle jars when needed.
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Any breathing problems?
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I haven’t had any issues with my breathing.
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Are you sexually active?
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Yeah, things are just fine in the bedroom with my lady, Susan.
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move the camera so your ankles are visible on the screen
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Sure, hold on, let me move this thing.
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Inspected left ankle: Edema is present on inspection of bilateral ankles without erythema or streaking
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Inspected right ankle: Edema is present on inspection of bilateral ankles without erythema or streaking Liam Fitzgerald Telehealth Follow Up Sick Visit Shadow Health Transcript: Management of Cardiovascular Conditions Patient
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Exam Action |
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move the camera so your ankles are visible on the screen, press your finger into the inner boney part of the ankle and hold for 1-2 seconds.
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Sure, hold on, let me move this thing.
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Palpated right ankle: On palpation, there is 1+ pitting edema bilaterally without tenderness or warmth to palpation
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Palpated left ankle: On palpation, there is 1+ pitting edema bilaterally without tenderness or warmth to palpation
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Hello. I am going to educate you about your medications
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Sounds good.
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maintain normal activity level, bur discontinue exercise if you experience chest pain
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That sounds good. I’ll stop exercising and call the cardiologist if I get symptoms.
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Adhere to a fluid volume restriction of 1.5 L per day
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Will do. I am very good about my fluid restrictions.
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Avoid drinking alcohol
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Alright, I’ll lay off the alcohol.
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Avoid drinking caffeinated beverages
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OK, no caffeine, but is decaf fine?
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No
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Sounds good, I’ll be careful even with decaf.
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Eat lean meat, whole grains, and fresh fruits and vegetables and season your food with spices instead of salt
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That’s a smart trick. OK, I’ll do that.
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Ask your provider for a referral to a clinical dietitian
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OK, that’s a good tip.
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Adhere to your low-sodium diet, and pay attention to labels to avoid foods high in sodium
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Sounds good. I’ll avoid those high-sodium foods, but what foods should I look at the labels for again?
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All foods
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Alright, I’ll be careful to read all the labels then.
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After consuming a meal high in sodium, watch for signs and symptoms of a worsening condition and take your diuretic as directed.
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That sounds like a plan . . . but how long should I wait after experiencing symptoms before I take the furosemide and potassium chloride?
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30 minutes
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OK, I’ll watch out for those signs and symptoms carefully.
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Test for swelling by performing a pitting edema test
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I’ll look out for that, then . . . though, how do I know if the swelling is related to my CHF and not something else, like standing for long time?
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Watch out for fatigue
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OK, that’s good to know.
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Look out for signs of fluid overload, like weight gain, fatigue during activity
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I’ll look out for symptoms.
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Go to the hospital if your condition worsens Liam Fitzgerald Telehealth Follow Up Sick Visit Shadow Health Transcript: Management of Cardiovascular Conditions Patient
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I definitely will.
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Follow up with your cardiologist
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I’ll call my cardiologist if that happens.
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Set a reminder for your medications
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Alright. I’ll let my girlfriend and my daughter know . . . but if I take the medication as needed, how will I know if I need a reminder?
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You girlfriend and daughter can remind you to take your medications
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Thanks, those are good suggestions.
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Take furosemide with the potassium chloride to maintain adequate potassium
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I’ll do that, then.
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Take the furosemide with potassium chloride tablet for edema even if you have minor swelling
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I will!
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Beware of symptoms that indicate worsening condition
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Sounds good. I’ll keep an eye out for when to take those meds.
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Thanks for listening, Goodbye
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Alright. Thank you for your help. Liam Fitzgerald Telehealth Follow Up Sick Visit Shadow Health Transcript: Management of Cardiovascular Conditions Patient
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