THE DOMINO EFFECT OF
NON-ADHERENCE
EXACERBATION OF CHRONIC
HYPERTENSION IN A 52 YR
OLD MAN
• Patient Name: Darrell Johnson
• Age: 52 years old (Typical demographic for this case)
• Gender: Male
• Race/Ethnicity: African American (often specified to highlight hypertension risk)
• Chief Complaint (CC): "I'm here to get a refill on my blood pressure medicine,
but I've been getting these headaches lately."
History of Present Illness (HPI):
Darrell Johnson is a 52-year-old African American male presenting to the clinic for a
medication refill and evaluation of new-onset headaches. He reports that he ran out of
his Lisinopril "about a week ago" and has not taken any blood pressure medication
since. Concurrently, he has developed bifrontal, throbbing headaches over the past 4-5
days. He rates the pain as 4/10 on average, but notes it peaks at 6/10 in the mornings.
He denies photophobia, phonophobia, or nausea associated with the headaches. He has
tried over-the-counter Tylenol with minimal relief.
He also reports feeling more tired than usual and short of breath when doing yard work,
which he attributes to "being out of shape." He denies chest pain, palpitations, or
syncope.
, 2. Review of Systems (ROS)
• General: Reports fatigue and decreased energy over the past week. Denies fever,
chills, or night sweats.
• HEENT: Reports headaches as described in HPI. Denies vision changes, blurred
vision, diplopia, tinnitus, or dizziness.
• Cardiovascular: Reports some mild dyspnea on exertion (raking leaves). Denies
orthopnea, PND, chest pain, or palpitations.
• Respiratory: Denies cough, wheezing, or shortness of breath at rest.
• Gastrointestinal: Denies nausea, vomiting, diarrhea, or abdominal pain.
• Musculoskeletal: Denies joint pain or swelling.
• Neurological: Denies focal weakness, numbness, tingling, or speech difficulties.
3. Physical Examination (PE)
• Vitals:
o BP: 162/98 mmHg (Right arm, seated) - Critical Finding
o HR: 88 bpm, regular
o RR: 16 breaths/min
o Temp: 98.4°F (36.9°C) oral
o O2 Sat: 97% on room air
o BMI: 32.5 (Obese Class I)
• General: Alert, oriented, well-nourished male in no acute distress, though
appears tired.
• HEENT: Normocephalic, atraumatic. Fundoscopic exam: Optic discs sharp, no
hemorrhages, exudates, or papilledema.
NON-ADHERENCE
EXACERBATION OF CHRONIC
HYPERTENSION IN A 52 YR
OLD MAN
• Patient Name: Darrell Johnson
• Age: 52 years old (Typical demographic for this case)
• Gender: Male
• Race/Ethnicity: African American (often specified to highlight hypertension risk)
• Chief Complaint (CC): "I'm here to get a refill on my blood pressure medicine,
but I've been getting these headaches lately."
History of Present Illness (HPI):
Darrell Johnson is a 52-year-old African American male presenting to the clinic for a
medication refill and evaluation of new-onset headaches. He reports that he ran out of
his Lisinopril "about a week ago" and has not taken any blood pressure medication
since. Concurrently, he has developed bifrontal, throbbing headaches over the past 4-5
days. He rates the pain as 4/10 on average, but notes it peaks at 6/10 in the mornings.
He denies photophobia, phonophobia, or nausea associated with the headaches. He has
tried over-the-counter Tylenol with minimal relief.
He also reports feeling more tired than usual and short of breath when doing yard work,
which he attributes to "being out of shape." He denies chest pain, palpitations, or
syncope.
, 2. Review of Systems (ROS)
• General: Reports fatigue and decreased energy over the past week. Denies fever,
chills, or night sweats.
• HEENT: Reports headaches as described in HPI. Denies vision changes, blurred
vision, diplopia, tinnitus, or dizziness.
• Cardiovascular: Reports some mild dyspnea on exertion (raking leaves). Denies
orthopnea, PND, chest pain, or palpitations.
• Respiratory: Denies cough, wheezing, or shortness of breath at rest.
• Gastrointestinal: Denies nausea, vomiting, diarrhea, or abdominal pain.
• Musculoskeletal: Denies joint pain or swelling.
• Neurological: Denies focal weakness, numbness, tingling, or speech difficulties.
3. Physical Examination (PE)
• Vitals:
o BP: 162/98 mmHg (Right arm, seated) - Critical Finding
o HR: 88 bpm, regular
o RR: 16 breaths/min
o Temp: 98.4°F (36.9°C) oral
o O2 Sat: 97% on room air
o BMI: 32.5 (Obese Class I)
• General: Alert, oriented, well-nourished male in no acute distress, though
appears tired.
• HEENT: Normocephalic, atraumatic. Fundoscopic exam: Optic discs sharp, no
hemorrhages, exudates, or papilledema.
