Hypertension (Asymptomatic)/Palpitations /skipping beats

var dngJsonData = {“HPI”: [{“checkBoxes” : {“sentence” : “Patient presenting for evaluation of {ENTRY}.”,”label” : “Main Symptoms”,”options” : [{“label” : “Hypertension”,”value” : “hypertension”},{“label” : “Asymptomatic Hypertension”,”value” : “asymptomatic hypertension”},{“label” : “Chest Pain”,”value” : “chest pain”},{“label” : “Chest Pressure”,”value” : “chest pressure”},{“label” : “Chest Wall Pain”,”value” : “chest wall pain”},{“label” : “SOB”,”value” : “shortness of breath”},{“label” : “Nausea”,”value” : “nausea”},{“label” : “Vomiting”,”value” : “vomiting”},{“label” : “Diaphoresis”,”value” : “diaphoresis”},{“label” : “Cough”,”value” : “cough”},{“label” : “Abd Pain”,”value” : “abdominal pain”},{“label” : “GERD”,”value” : “GERD”},{“label” : “Palpitations”,”value” : “palpitations”}]}},{“textArea” : {“sentence” : “{ENTRY}”,”label” : “”,”value” : “***for palpitation only Patient does not feel the heart is skipping beats or beating irregularly. Patient states that just feels that it is beating harder than usual. Denies any orthopnea, dyspnea with exertion, peripheral edema. There is no history of excessive caffeine use or other stimulants. *** Patient has a history of hyperthyroidism however is being managed conservatively. Patient has annual thyroid testing and is due for her next screen in 2 months. Patient is not currently on any thyroid medications. No symptoms such as headache, vision change, numbness/tingling/weakness, chest pain, shortness of breath, peripheral edema, or change in urinary output. Has noted gradually feeling more winded with yardwork but states he is able to tolerate 4 to 5 hours of work at a time and seems to do okay. He denies any known history of thyroid disease”}},{“timeFrame” : {“sentence” : “Onset of symptoms was {ENTRY} ago.”,”label” : “Onset of Symptoms”}},{“checkBoxes” : {“sentence” : “Patient {ENTRY}.”,”label” : “HTN History?”,”options” : [{“label” : “Has Hx of HTN”,”value” : “has a history of hypertension”},{“label” : “No Hx of HTN”,”value” : “has no history of hypertension”},{“label” : “Compliant with Meds”,”value” : “is compliant with medications”},{“label” : “Non Compliant”,”value” : “is non-compliant with medications”},{“label” : “Not on Meds”,”value” : “is not on medications”},{“label” : “History if MI or CVA or aortic or intracranial aneurysms”,”value” : “history if MI or CVA or “},{“label” : “No history if MI or CVA or aortic or intracranial aneurysms”,”value” : “no history if MI or CVA or aortic or intracranial aneurysms”},{“label” : “History of diabetic”,”value” : “history of diabetic”},{“label” : “No history of diabetic”,”value” : “no history of diabetic”}]}},{“checkBoxes” : {“sentence” : “Patient has associated symptoms of {ENTRY}.”,”label” : “Associated Symptoms”,”options” : [{“label” : “Chest Pain”,”value” : “chest pain”},{“label” : “Nausea”,”value” : “nausea”},{“label” : “Vomiting”,”value” : “vomiting”},{“label” : “Diaphoresis”,”value” : “diaphoresis”},{“label” : “SOB”,”value” : “shortness of breath”},{“label” : “Lightheadedness”,”value” : “lightheadedness”},{“label” : “Abd Pain”,”value” : “abdominal pain”},{“label” : “Belching”,”value” : “belching”},{“label” : “Abd Discomfort”,”value” : “abd discomfort”},{“label” : “Leg Swelling”,”value” : “leg swelling”},{“label” : “Leg Pain”,”value” : “leg pain”},{“label” : “Headache”,”value” : “headache”},{“label” : “Eye pain, chase in the vision”,”value” : “eye pain, chase in the vision”},{“label” : “Numbness, tingling”,”value” : “numbness, tingling”},{“label” : “Urinary output changes”,”value” : “urinary output changes”}]}},{“checkBoxes” : {“sentence” : “Patient does not have symptoms of {ENTRY}.”,”label” : “Denies Symptoms”,”options” : [{“label” : “Chest Pain”,”value” : “chest pain”},{“label” : “Nausea”,”value” : “nausea”},{“label” : “Vomiting”,”value” : “vomiting”},{“label” : “Diaphoresis”,”value” : “diaphoresis”},{“label” : “SOB”,”value” : “shortness of breath”},{“label” : “Lightheadedness”,”value” : “lightheadedness”},{“label” : “Abd Pain”,”value” : “abdominal pain”},{“label” : “Belching”,”value” : “belching”},{“label” : “Abd Discomfort”,”value” : “abd discomfort”},{“label” : “Leg Swelling”,”value” : “leg swelling”},{“label” : “Leg Pain”,”value” : “leg pain”},{“label” : “Headache”,”value” : “headache”},{“label” : “Eye pain, chase in the vision”,”value” : “eye pain, chase in the vision”},{“label” : “Numbness, tingling”,”value” : “numbness, tingling”},{“label” : “Urinary output changes”,”value” : “urinary output changes”}]}},{“checkBoxes” : {“sentence” : “Treatment prior to arrival includes {ENTRY}.”,”label” : “Treatment Prior to Arrival”,”options” : [{“label” : “None”,”value” : “nothing”},{“label” : “HTN Meds”,”value” : “hypertensive medications”},{“label” : “Rest”,”value” : “rest”},{“label” : “ASA”,”value” : “aspirin”},{“label” : “Nitroglycerin”,”value” : “nitroglycerin”},{“label” : “GERD Meds”,”value” : “acid reflux medications”},{“label” : “OTC Meds”,”value” : “OTC Medications”},{“label” : “W/ Improvement”,”value” : “with improvement”},{“label” : “W/O Improvement”,”value” : “without improvement”}]}},{“checkBoxes” : {“sentence” : “Patient has history of {ENTRY}.”,”label” : “Cardiac Risk Factors”,”options” : [{“label” : “None”,”value” : “none of the major cardiac risk factors”},{“label” : “CAD”,”value” : “coronary artery disease”},{“label” : “HTN”,”value” : “hypertension”},{“label” : “HLD”,”value” : “hyperlipidemia”},{“label” : “Tobacco Use”,”value” : “tobacco use”},{“label” : “Family History”,”value” : “family history of coronary disease”}]}}],”Body”: [{“checkBoxes” : {“sentence” : “Review of Systems: {ENTRY}”,”label” : “”,”options” : [{“label” : “All ROS Negative”,”value” : “All other systems reviewed and are negative”},{“label” : “Vital Signs Reviewed”,”value” : “vital signs reviewed”},{“label” : “No CP”,”value” : “denies chest pain”},{“label” : “No SOB”,”value” : “denies shortness of breath”},{“label” : “No DOE”,”value” : “denies dyspnea on exertion”},{“label” : “No HA”,”value” : “denies headache”},{“label” : “No Vision Changes”,”value” : “denies vision changes”},{“label” : “No Lightheadedness”,”value” : “denies lightheadedness”},{“label” : “No Abd Pain”,”value” : “denies abdominal pain”},{“label” : “No Back Pain”,”value” : “denies back pain”},{“label” : “No Urinary Symptoms”,”value” : “denies urinary symptoms”},{“label” : “No Leg Swelling”,”value” : “denies leg swelling”},{“label” : “No Fever”,”value” : “denies fever”},{“label” : “No Chills/Sweats”,”value” : “denies chills/sweats”},{“label” : “No Wt Gain”,”value” : “denies weight gain”},{“label” : “No Wt Loss”,”value” : “denies weight loss”},{“label” : “No Sore Throat”,”value” : “denies sore throat”},{“label” : “No Cough”,”value” : “denies cough”},{“label” : “No Suicidal Thoughts”,”value” : “denies suicidal thoughts”}]}},{“textArea” : {“sentence” : “{ENTRY}”,”label” : “Physical Exam:”,”value” : “General: Well-developed, well-nourished, no acute distress ENT: Normal external ears, nose, mouth Neck: Full range of motion Chest: Clear to auscultation, normal respiratory effort Cardio: Regular rate and rhythm with normal S1-S2. There is no murmur, gallop, rub. Heart rate is in the 70s on exam Extremities: No edema Neuro: No gross deficits Psych: Normal affect, pleasant,*** mood appears anxious”}},{“checkBoxes” : {“sentence” : “Cardiovascular: {ENTRY}”,”label” : “Cardiovascular Exam:”,”options” : [{“label” : “Normal”,”value” : “Regular rate and rhythm. No murmur. “},{“label” : “Regular Rate”,”value” : “regular rate”},{“label” : “Tachycardia”,”value” : “tachycardia”},{“label” : “Bradycardia”,”value” : “bradycardia”},{“label” : “Irregularly Irregular”,”value” : “irregularly irregular rhythm”},{“label” : “No Murmur”,”value” : “no murmur present”},{“label” : “Murmur”,”value” : “murmur present”},{“label” : “No Gallops or Rubs”,”value” : “no gallops or rubs”},{“label” : “Intact Pulses”,”value” : “intact distal pulses”},{“label” : “Normal Cap Refill”,”value” : “normal capillary refill”}]}},{“checkBoxes” : {“sentence” : “{ENTRY}”,”label” : “Respiratory Exam:”,”options” : [{“label” : “Normal”,”value” : “Lungs clear to auscultation bilaterally. No wheeze, crackles, or rales.”},{“label” : “L Lung Normal”,”value” : “left lung clear”},{“label” : “R Lung Normal”,”value” : “right lung clear”},{“label” : “Left Lung”,”value” : “left lung”},{“label” : “Right Lung”,”value” : “right lung”},{“label” : “Bilateral”,”value” : “bilateral”},{“label” : “Upper”,”value” : “upper lobe”},{“label” : “Middle”,”value” : “middle lobe”},{“label” : “Lower”,”value” : “lower lobe”},{“label” : “Crackles”,”value” : “crackles”},{“label” : “Wheeze”,”value” : “wheeze”},{“label” : “Rales”,”value” : “rales”},{“label” : “Stridor”,”value” : “stridor”},{“label” : “Chest Wall Tenderness”,”value” : “chest wall tenderness”},{“label” : “Accessory Muscle Use”,”value” : “accessory muscle use”},{“label” : “No Accessory Muscle Use”,”value” : “no accessory muscle use”},{“label” : “Respiratory Distress”,”value” : “respiratory distress”},{“label” : “No Respiratory Distress”,”value” : “no respiratory distress”},{“label” : “Speaking in Full Sentences”,”value” : “speaking in full sentence”}]}},{“checkBoxes” : {“sentence” : “Past Medical History: {ENTRY}”,”label” : “Past Medical History”,”options” : [{“label” : “none”,”value” : “none”},{“label” : “HTN”,”value” : “hypertension”},{“label” : “HLD”,”value” : “hyperlipidemia”},{“label” : “DM”,”value” : “diabetes”},{“label” : “hypothyroidism”,”value” : “hypothyroidism”},{“label” : “depression”,”value” : “depression”},{“label” : “anxiety”,”value” : “anxiety”},{“label” : “headaches”,”value” : “headaches”},{“label” : “migraines”,”value” : “migraines”},{“label” : “CAD”,”value” : “CAD”},{“label” : “CHF”,”value” : “CHF”},{“label” : “COPD”,”value” : “COPD”},{“label” : “asthma”,”value” : “asthma”},{“label” : “neck pain”,”value” : “neck pain”},{“label” : “back pain”,”value” : “back pain”},{“label” : “***”,”value” : “***”}]}},{“checkBoxes” : {“sentence” : “Past Surgical History: {ENTRY}”,”label” : “Past Surgical History”,”options” : [{“label” : “none”,”value” : “none”},{“label” : “appendectomy”,”value” : “appendectomy”},{“label” : “cholecystectomy”,”value” : “cholecystectomy”},{“label” : “tonsillectomy”,”value” : “tonsillectomy”},{“label” : “joint replacement”,”value” : “joint replacement”},{“label” : “cesarean section”,”value” : “cesarean section”},{“label” : “hysterectomy”,”value” : “hysterectomy”},{“label” : “CABG”,”value” : “CABG”},{“label” : “stents”,”value” : “stent placement”},{“label” : “***”,”value” : “***”}]}},{“checkBoxes” : {“sentence” : “Social History: {ENTRY}”,”label” : “Social History”,”options” : [{“label” : “no tobacco use”,”value” : “no tobacco use”},{“label” : “tobacco use”,”value” : “tobacco use”},{“label” : “no ETOH use”,”value” : “no alcohol use”},{“label” : “occasional ETOH use”,”value” : “occasional alcohol use”},{“label” : “frequent ETOH use”,”value” : “frequent alcohol use”},{“label” : “drug use”,”value” : “drug use”},{“label” : “no drug use”,”value” : “no drug use”},{“label” : “married”,”value” : “married”},{“label” : “unmarried”,”value” : “unmarried”},{“label” : “sexually active”,”value” : “sexually active”},{“label” : “not sexually active”,”value” : “not sexually active”},{“label” : “***”,”value” : “***”}]}},{“checkBoxes” : {“sentence” : “Family History: {ENTRY}”,”label” : “Family History (most common – can use free text)”,”options” : [{“label” : “Hypertension urgency: ≥180/≥120 mmHg), often a mild headache”,”value” : ” hypertension urgency: ≥180/≥120 mmHg), often a mild headache”},{“label” : “Blood pressure should usually be lowered to <160/<100 mmHg.","value" : "blood pressure should usually be lowered to <160/<100 mmHg."},{"label" : "In the long-term, the blood pressure should usually be reduced further (eg, <140/<90 mmHg or <130/<80 mmHg","value" : "in the long-term, the blood pressure should usually be reduced further (eg, <140/<90 mmHg or <130/<80 mmHg"},{"label" : "In the absence of symptoms, a gradual reduction in pressure is suggested over a period of several hours to several days [7].","value" : "in the absence of symptoms, a gradual reduction in pressure is suggested over a period of several hours to several days [7]."},{"label" : "All patients should be provided a quiet room in which to rest for 30 minutes. If this is not effective, antihypertensive drugs may be given.","value" : "all patients should be provided a quiet room in which to rest for 30 minutes. If this is not effective, antihypertensive drugs may be given."},{"label" : "Oral clonidine (but not intended as long-term therapy) at a dose of 0.1 to 0.2 mg","value" : "oral clonidine (but not intended as long-term therapy) at a dose of 0.1 to 0.2 mg"},{"label" : "Take longer to drop the BP,Oral captopril at a dose of 6.25 or 12.5 mg","value" : "take longer to drop BP,Oral captopril at a dose of 6.25 or 12.5 mg"},{"label" : "Following administration of one of these agents, the patient is observed for a few hours to ascertain a reduction in blood pressure of 20 to 30 mmHg. Thereafter, a longer-acting agent is prescribed, and the patient is sent home to follow-up within a few days. The drop in blood pressure may take relatively longer with captopril a","value" : "following administration of one of these agents, the patient is observed for a few hours to ascertain a reduction in blood pressure of 20 to 30 mmHg. Thereafter, a longer-acting agent is prescribed, and the patient is sent home to follow-up within a few days. The drop in blood pressure may take relatively longer with captopril a"},{"label" : "A potentially safer alternative approach is to forgo these shorter-acting agents and initiate a long-acting agent (eg, amlodipine, chlorthalidone) with follow-up in clinic after one or two days. T","value" : "a potentially safer alternative approach is to forgo these shorter-acting agents and initiate a long-acting agent (eg, amlodipine, chlorthalidone) with follow-up in clinic after one or two days. T"},{"label" : "With BP medication :Increase the dose of existing antihypertensive medications, or add another agent. In many instances, patients receive subtherapeutic doses of antihypertensive agents.","value" : "with BP medication :increase the dose of existing antihypertensive medications, or add another agent. In many instances, patients receive subtherapeutic doses of antihypertensive agents."},{"label" : "With no BP medication: amlodipine plus benazepril ","value" : "with no BP medication: "},{"label" : "HydrOXYzine pamoate (VISTARIL) 25 mg Oral Capsule","value" : "hdrOXYzine pamoate (VISTARIL) 25 mg Oral Capsule"},{"label" : "Lisinopril-hydrochlorothiazide (AKA PRINIZIDE) 20-12.5 mg Oral Tablet     Sig: Take 1 Tab by mouth every day.     Dispense: 30 Tab     Refill: 0","value" : "lisinopril-hydrochlorothiazide (AKA PRINIZIDE) 20-12.5 mg Oral Tablet"},{"label" : "Labetalol 100 mg po x 1","value" : "labetalol 100 mg po x 1"},{"label" : "Lisinopril (PRINIVIL, ZESTRIL) 5 mg tablet","value" : "lisinopril (PRINIVIL, ZESTRIL) 5 mg tablet"}]}},{"textArea" : {"sentence" : "{ENTRY}","label" : "","value" : "Patient is here for evaluation of elevated blood pressure readings. Patient recently transition to a new blood pressure medication and just today started second of 2 medications. Patient is currently asymptomatic. Initial blood pressure elevated, gradually improving throughout her visit. Patient has an unremarkable neurologic exam. No chest pain or shortness of breath. Did wake up with some vague arm discomfort particularly in the left wrist, which has since improved. EKG was obtained revealing no acute abnormalities. She has a comparison EKG and there are no changes. I discussed that the blood pressure will likely take time to normalize. Given that it is improving and is now asymptomatic and do not feel there is any further work-up that is appropriate for the urgent care. Discussed that if there is new or worsening symptoms, ED evaluation is recommended. Patient is comfortable with this plan and will return as needed."}}],"MDM": [{"textArea" : {"sentence" : "{ENTRY}","label" : "","value" : "Patient presenting for evaluation of asymptomatic hypertension. On exam and through history there was no evidence of hypertensive emergency or urgency. Patient without headache, decreased urinary output, vision changes, chest pain, or abnormal symptoms for patient. At this time, most likely diagnosis is essential hypertension without evidence of hypertensive urgency/emergency. Labs and imaging were unlikely to change my management of this patient and I do not believe that further workup is necessary. I have recommended that the patient follow up with primary care to have this reevaluated ASAP (in 24 hours). Elevated blood pressure is not unusual in the UC given the stress of the situation. It would be incorrect to treat the elevation without several subsequent high readings on separate days, in separate situations. Doing so could cause more harm than good. This patient presents with elevated blood pressure. I have discussed with the patient the possible reasons for why there is an elevation in blood pressure today. Patient understands that this may be in part because of anxiety or discomfort related to today's visit. The patient also understands the need for follow-up and repeat blood pressure readings in the future, and that chronic blood pressure without treatment can lead to strokes or heart attacks. Discussed alcohol and sedentary lifestyle have modifiable risk factors for high blood pressure. Patient instructed how to monitor blood pressure, by purchasing the home monitor or by regularly visiting a local pharmacy. Instructed to keep blood pressure diary and follow up. Return to emergency department urgently if new or worsening symptoms develop. *Asymptomatic hypertension: patient presents requesting additional blood pressure medicine. Patient is compliant with current regimen of** atenolol. I will add 1 month supply of lisinopril and recommend patient follow-up with PCP for continued hypertension management. Discussed keeping a blood pressure log and when to hold medicine for hypotension. **Encourage patient to follow-up at County Health Center as it may be faster than seeing primary care doctor in*** Patient denies current complaints, recent epistaxis resolved. EKG chest x-ray,, and lab work-up not indicated at this time becuse a patient is asymptomatic. I discussed that elevated blood pressure, headache, vision change is a concerning collection of symptoms, and brain imaging would be the most effective at ruling out pathology despite a normal neurologic exam. At this time, patient is declining any further testing, would like to monitor the symptoms and the blood pressure at home. The patient is given Tylenol for the headache and states that patient is going to monitor the symptoms for the next 30 minutes to an hour and 30 the ER if it does not improve. patient is offered blood work as well to assess for end-organ damage but is declining this as well. patient is most comfortable with close monitoring at home and will return if the patient changes the mind. I also advised that if her blood pressure still elevated patient can increase her HCTZ to 50 mg today. Patient here for elevated blood pressure readings. He is asymptomatic. He has no symptoms suggesting endorgan damage. He denies any chest pain or shortness of breath. Chest x-ray reveals no cardiomegaly or CHF. EKG reveals no evidence of strain or ischemia. Labs were ordered, currently pending. He has had history of subclinical hyperthyroidism therefore TSH was ordered, renal function will be assessed. . Denies any prior diagnostic studies. Will refer to cardiology for further evaluation. He is currently asymptomatic from this standpoint. He will be prescribed Norvasc, and also encouraged to follow-up with PCP. Indications for emergent reevaluation were discussed. Patient is comfortable with the plan.    "}},{"textArea" : {"sentence" : "{ENTRY}","label" : "","value" : "palpitations Patient is here for evaluation of palpitations. Currently Patient is asymptomatic. There is no history of chest pain or shortness of breath. No findings suggesting acute CHF. EKG reveals sinus rhythm without ectopy or arrhythmia. ***Pt is very anxious in the clinic.*** Patient does have history of hyperthyroidism and is not currently on any medication. No findings on exam suggesting thyroid storm. *** Blood was sent for routine thyroid assessment and patient be notified for any abnormal results. At this time is felt that Patient is stable for discharge. Patients will be following up with the cardiologist. Discussed warning signs that would warrant sooner reevaluation. "}},{"checkBoxes" : {"sentence" : "{ENTRY}.","label" : "Follow Up","options" : [{"label" : "Metoprolol succinate (TOPROL-XL) 25 mg 24 hr tablet; Take 1 tablet by mouth Daily. Dispense: 90 tablet; Refill: 1","value" : "metoprolol succinate (TOPROL-XL) 25 mg 24 hr tablet; Take 1 tablet by mouth Daily. Dispense: 90 tablet; Refill: 1"},{"label" : "","value" : ""},{"label" : "","value" : ""},{"label" : "","value" : ""},{"label" : "CMP","value" : "cmp"},{"label" : "Present to ER with worsening symptoms","value" : "present to ER with new or worsening symptoms"},{"label" : "Follow up with Cardiology","value" : "follow up with cardiology"}]}}]}