Mr. X, a 42-year-old male presents to your primary care practice today complaining of low back pain.
History – Mr. X states that he has had chronic low back pain since he had a skiing accident about 10 years ago. Three days ago, he felt a pulling sensation in his lower back after moving some boxes. The pain intensity increased over the subsequent 24 hours and is now steady, aching in nature, at 3-4 out of 10. Mr. X also has Type2 diabetes, which is well controlled on metformin with a HGA1c of 5.6. He has a history of DVT 4 months ago for which he takes Coumadin, INR is WNL. He is followed by a specialist for this problem. He recently started taking two OTC products; kava kava for what he describes as “anxiety” and CoEnzyme Q10 on the advice of a friend.
Social – Mr. X is a smoker, 1 pack per week for 15 years. No alcohol or drug use. He is employed as an accountant and has medical insurance. He is divorced.
PE/ROS – Complains of low back stiffness and pain on movement with occasional spasms related to moving in certain directions. You note he has mild difficulty getting onto the exam table but gait is normal. He denies weakness/numbness/tingling of legs, no radiation, no change in bowel or bladder habits. BMI 27. All range of motion of the back is decreased by 25%. Straight leg lift is negative bilaterally, DTR intact. All other systems WNL.
Metformin 1000mg ER one tab daily – Type II Diabetes controlled
Coumadin 5 mg. daily – Hx of DVT – Controlled
Kava Kava 50 mg. tid – Self-medication for anxiety
CoQ10 – 200 mg. daily. – Self-medication for unknown reason
Provide a diagnosis for the patient and your rationale for the diagnosis
Provide a treatment plan specifically for this patient, pharmacologic and non-pharmacologic.
Comment on the use of OTC products in relation to Mr. X’s current chronic and acute disease diagnoses and medications. Include drug-drug interactions and side effect profiles.
Provide an education plan for Mr. X
Present this Assignment as a PowerPoint presentation with between 12 and 16 slides (not including opening slide and resource slide).
"Rails got together with one another in a railroad" Does that would ever occur? On the off chance that so we should perceive how it could occur. It is smarter to extricate something up to justifiable level before it will be clarified. What are financial standards? Financial standards mean how social exercises consolidate with monetary circumstances and carry a yield with a procedure of blend results. Who are military pioneers? we should take it with a basic definition as " pioneers who lead their subordinates in war zones just as in other military exercises". These two terms will be clarified further with an incredible blend of these two meet simply like rails in a railroad. Try not to get mistook for what have referenced previously. Does ever rails meets in a railroad? The appropriate response is "yes". In any case, how? Those are running on "Tie pillars" and the hole filled by them just as joining "rails" with one another with a deferent way. Military pioneers and socio-economy going on two deferent ways and those two interface with one another with the way of life of human from the earliest starting point of human race. For what reason do we need war? Is it significant? No we needn't bother with war. In any case, as referenced before from the earliest starting point of our race war is there. We can't transform it except if all the individuals perspective gets same. So as long as it would never occur, we should avoid it or play it safe for that injury called war. So we are here for that. That is the thing that we are accomplishing for more noteworthy's benefit of our race. In the method for moving towards, military people additionally should live. For that they require a reasonable conservative help from general society. With the advancement of the human method for living, deferent societies, deferent monetary foundations come and deferent perspective creates inside human mind. At that point it comes to better approach for socio-economy. Time by time it impacts with the military moreover. In past the hole between military pioneers and subordinates bigger than now. Be that as it may, as referenced before time is deferent at this point. The hole between military pioneers and subordinates decreasing in view of those supporters instructive foundation and efficient foundation is superior to the past. Because of that it could be difficult to keep up the administration with subordinates musings. Is it that much hard? 2. In the start of Training of officials and mariners it turns out to be practically same since they all originate from same society and practically same foundations. Now and then their instructive foundations draw nearer than the past. So mariners begins to think like "for what reason do we tail them, they are practically same like us". At that point they begin to believe that "alright, we should call them as sir and we should do what they state on the off chance that it is simple for us to do". This hypothesis may smidgen legitimate for land bases during harmony period. In any case, it isn't legitimate for a combat zone. Except if mariners won't tune in to requests or mariners quit accepting on their pioneer, surely it would be the finish for their entire lives. Not lining pioneers will wind up with a compensation from military individual's lives. Prior days mariners didn't had a lot of time to think on issues that way. Be that as it may, presently the time is unique. Every one of them have a lot of time to be without anyone else to think unreservedly. So as pioneers the individuals who still have long approach to travel through this way must be very worry on this issue. There are a few different ways to defeat these difficulties. Yet, before that it is smarter to dive deep down on such difficulties. First issue is the brain and musings. A few mariners have great instructive foundation. For a model GCE Advance level finished by the two mariners and officials even the outcomes is extraordinary. The two mariners and official's family foundations are practically same. With regards to some maritime regular citizens of sports pools their family foundations are higher than officials. So quite possibly a few mariners get such a view by means of them. Simultaneously information on mariners and officials could be the equivalent in mariner's specialization. Economy is another issue. It may not reasonable for notice what is going to state straightaway. Without utilizing the careful word it could clarify as the monetary help given by the administration for military people month to month. With the goal that hole additionally could be an issue. Mariners may thing we as a whole get the equivalent from government for what reason do we serve them like slaves? That additionally an issue of their psyche, following a pioneer isn't servitude. In any case, sadly a few mariners think that way and they do whatever it takes not to pursue requests of officials some of the time. During the preparation time frame mariners and officials moves together in some circumstance. Yet, that is for well comprehension of mariner's life for officials for a superior order. Simultaneously a few mariners may misunderstand that and they may imagine that we as a whole have prepared together, so for what reason do we pursue them.so how do youthful officials order them? 3. The appropriate response is basic; administration doesn't rely upon socio-economy or another issue that I had talked about previously. So to defeat each one of those issues, First officials must think as their self as pioneer just as go about as pioneers. During our school period do we ever consider socio-economy or some other issue when a few of us go about as administrator Or class screens? Right then and there we just think as that I'm the pioneer. That is the way we lead. In sports that we plays, is there a socio-economy for group pioneers? At those circumstance, it likewise a sort of ordering when you control or move your group. Is there a socio-economy for creatures when they make one of them as pioneers and tail him? Authority just relies upon initiative nothing else. In any case, in combat zone you should be the best chief most importantly of them. So for that youthful official must develop their initiative characteristics to confront the wrecked personalities of mariners. With the improvement and globalization of the world, authority turned into a significant subject to talk about. So there by snatch smart thoughts and find out about authority characteristics from what every one of the officials being prepared. As a recommending it is smarter to redesign officials preparing plan with more administration building characteristics. Simultaneously embed "for what reason do mariners need to pursue orders, what is the result and who is a genuine pioneer" for mariners preparing plan. By that toward the finish of the preparation there will be a superior comprehension and it will be anything but difficult to direction in the event that you are a decent pioneer without the obstruction of socio-economy or some other pertinent issue. 4. This talk gazed with "Rails got together with one another in a railroad". Be that as it may, if those rails contacted together the train called "pioneer who directions for triumph" would not run, with the goal that's the reason it utilizes "Tie shafts". Those tie light emissions must make with thought of authority. Gain from Lieutenant General Denzil Kobbekeduwa just as from Hitler and that is the main way you can lead your subordinates. Make them trust you and be a genuine model for them. Every one of the officials and mariners of Sri Lanka Navy brought into the world with soul of a blue whale and a heart of a lion. Every one of you serving for mother Sri Lanka must recall what your identity is. Youthful officials, we are the future, don't simply attempt to be pioneers of lions, simply recall you are the pioneers of lions by your heart. That is the main response for any sort of issue even what it called as a socio-economy.>GET ANSWER