Solution for QID #22265: History of Present Illness J.B. is an overweight, 58-year | StudyHelpMe

History of Present Illness J.B. is an overweight, 58-year-old man who has had swelling in his left foot and ankle and pain in his left calf for six days. The pain has been getting worse for the past 24 hours. The patient ranks the pain as 8/10. He has made an appointment today with his PCP.   Past Medical History • Previous episode of DVT at age 54; treated with warfarin for 1 year • Diagnosed with diabetes mellitus type 2, 5 years ago A preliminary diagnosis of DVT is made and the patient is admitted to the hospital for a thorough clinical workup.   Family History • Father died at age 63 from myocardial infarction • Mother alive at age 80 with diabetes mellitus type 2 • Brother, age 56, alive and healthy • No family history of venous thromboembolic disease reported Social History   • Patient is single and lives alone • Works as dean of pharmacy school, 11 years • 28 pack-year smoking history, currently smokes 1 pack per day • Drinks 3-4 beers/day during the week and a 6-pack/day on weekends • No history of illicit drug use   Physical Examination and Laboratory Tests J.B. is a pleasant, overweight, white male in moderate acute distress from leg pain. Vital Signs BP 130/80; P 110; RR 16; T 99.8°F; Ht 5'10"; Wt 245 lb; SaO2 98% on room air. • No clubbing or cyanosis • Left foot and ankle swollen • Left calf swollen to twice normal size • No tenderness, pain, swelling, or redness, right lower extremity   Abnormal Lab Blood Test results: Glucose, fasting = 160 mg/dL Cholesterol= 280mg/dL with HDL= 30 mg/dL and LDL = 152 mg/dL, Triglycerides =160mg/dL Specialized Serum Lab Testing: Homocysteine= 91 micromol/L and Protein C deficiency   Doppler Ultrasound • Left lower extremity shows no flow of the left posterior tibial vein • Normal flow demonstrated within the left common femoral and iliac veins • Right lower extremity shows normal flow of the deep venous system from the level of the common femoral to posterior tibial vein     1.      What treatment would you recommend for J.B.'s acute condition? 2.      What other long-term treatments would you recommend for J. B.? 3.      What lifestyle changes would you recommend? 4.      Trace normal blood flow using the names of the veins from the left posterior tibial vein to the lungs. 5.      Complications of J.B.'s ailment included development of a pulmonary embolism, heart attack or stroke. Of these complications, explain why these could occur and why the development of the PE is most common.