What are the key questions to ask during the history of present illness (HPI) for an African American patient with obesity, hypertension (HTN), hyperlipidemia, and diabetes mellitus (DM)?

Key HPI Questions for African American Patients with Obesity, HTN, Hyperlipidemia, and DM

A comprehensive HPI assessment for African American patients with obesity, hypertension, hyperlipidemia, and diabetes should focus on identifying modifiable risk factors, medication adherence, lifestyle factors, and social determinants of health that contribute to cardiovascular disease risk.

Disease-Specific Questions

Hypertension Assessment

• Ask about duration of hypertension, highest recorded blood pressure readings, and any symptoms of target organ damage (headaches, vision changes, chest pain, shortness of breath, edema) 1
• Inquire about previous antihypertensive medications, their effectiveness, and any side effects experienced 1
• Ask about salt intake and dietary patterns that may contribute to hypertension 1
• Determine if the patient has experienced symptoms of hypertensive urgency or emergency 1
• Inquire about home blood pressure monitoring practices and typical readings 1

Diabetes Assessment

• Ask about duration of diabetes, most recent A1C values, and frequency of blood glucose monitoring 1
• Inquire about symptoms of hyperglycemia (polyuria, polydipsia, polyphagia, blurred vision) 1
• Ask about hypoglycemic episodes, their frequency, severity, and precipitating factors 2
• Determine if the patient has experienced any diabetes-related complications (neuropathy, retinopathy, nephropathy) 1
• Ask about current diabetes medications and adherence patterns 2

Hyperlipidemia Assessment

• Ask about duration of hyperlipidemia and most recent lipid panel results 1
• Inquire about current lipid-lowering medications and any side effects (particularly muscle pain) 1
• Determine family history of premature cardiovascular disease or hyperlipidemia 1

Obesity Assessment

• Ask about weight history, including maximum weight, weight fluctuations, and previous weight loss attempts 1
• Inquire about dietary patterns, portion sizes, and emotional eating triggers 1
• Ask about physical activity levels, barriers to exercise, and preferred forms of activity 1
• Determine if the patient has experienced weight-related complications (sleep apnea, joint pain) 1

Medication and Treatment History

• Ask about all current medications, including over-the-counter drugs and supplements 1
• Inquire about medication adherence patterns and any barriers to taking medications as prescribed 3
• Ask about medication affordability and insurance coverage for prescriptions 1
• Determine if the patient has experienced any adverse effects from current medications 2

Social Determinants of Health

• Ask about access to healthy foods, food security, and neighborhood safety for physical activity 1
• Inquire about transportation access to healthcare appointments 1
• Ask about social support systems for health management 4
• Determine education level and health literacy regarding their conditions 1
• Ask about occupational factors that may impact health (stress, shift work, physical demands) 1

Cultural and Behavioral Factors

• Ask about cultural dietary preferences and practices that may impact disease management 1
• Inquire about use of traditional or alternative treatments 4
• Ask about religious or spiritual practices that may influence health behaviors 4
• Determine the patient's understanding of their conditions and perceived severity 1

Risk Factor Assessment

• Ask about smoking status, alcohol consumption, and recreational drug use 1
• Inquire about family history of cardiovascular disease, diabetes, and obesity 1
• Ask about stress levels and coping mechanisms 1
• Determine sleep patterns and quality 1

Special Considerations for African American Patients

• Ask about previous experiences with healthcare system and any perceived discrimination 1
• Inquire about trust in healthcare providers and the medical system 4
• Ask about medication concerns specific to African Americans (e.g., concerns about different medication responses) 1
• Determine if the patient has experienced barriers to care related to race or ethnicity 1

Assessing Readiness for Change

• Ask about the patient's perception of their health conditions and readiness to make lifestyle changes 1
• Inquire about previous successful health behavior changes 1
• Ask about personal health goals and priorities 1
• Determine what motivates the patient to improve their health 4

Common Pitfalls to Avoid

• Avoid focusing solely on medication adherence without addressing underlying social determinants of health 1
• Don't overlook the importance of cultural factors in dietary recommendations 1
• Avoid medical jargon that may reduce patient understanding and engagement 4
• Don't assume all African American patients have the same risk factors or experiences 1
• Avoid stigmatizing language when discussing obesity and lifestyle factors 1