Overview
To prepare:
- Review the Week 4 Case Assignment and questions provided by your instructor.
- Reflect on the patient’s symptoms and aspects of disorders that may be present.
- Consider how you might assess, perform diagnostic tests, and recommend medications to treat patients presenting with the symptoms in the case study.
The Assignment:
After reviewing the case and the accompanying case analysis questions, included in the document, answer the questions directly in a word document. You do not have to complete a Focus note, only answer the questions following the guidelines. When providing evidence to support your answers, be sure they evidenced-based, current (no more than 5 years old), and follow current standards of care. Follow APA 7th edition formatting, including a cover page and references.
Mrs. Mary Davis is an 84-year-old retired pharmacist. She lives in a 2-story townhome in the city. She and her husband bought it 10 years ago and it was a fixer upper they were going to work on in their retirement. Mary’s husband died suddenly 9 years ago. Most of the planned renovations are still not completed and Mary has no plans to move, she often tells others, “they will have to take me out of her in a box.” She has a half bath on the first floor and a full bath on the second floor. The full bath does have accessible shower and grab bars installed. The stairs to the second floor are straight, no landing in the middle. After getting up from a nap on her couch today she was hurrying to the bathroom and became lightheaded, she fell forward and hit her face on the coffee table. There was no loss of consciousness and once she got back to her feet she realized her nose was bleeding profusely. Quickly the front of her shirt was covered in blood. She text her daughter, who lives nearby, that she fell and had a nose bleed. After applying ice and pressure for 10 minutes the bleeding has slowed. Once Mary’s daughter arrived they decide to go to her primary care providers office, they have an urgent care clinic as well.
VS: BP 122/82 Pulse 86 Resp 20 Temp 98.3 02 Sat 95% Height 5 feet 2 inches Weight 180 lbs
PMH/PSH: Hypertension, hypercholesterolemia, osteoarthritis (shoulders and hands), generalized anxiety disorder (GAD).
Allergies: NKDA Medications: • Baby aspirin ½ tab 3 x week, Monday, Wednesday and Saturday • Citalopram 10mg po daily • Lisinopril 10mg po daily • Atenolol 25 mg po daily • Atorvastatin 20mg po q HS • Xanax 0.5mg po q 4 hrs PRN anxiety • Acetaminophen 500mg tabs, 1-2 po TID PRN arthritis pain
Social History: As described in case presentation.
ROS: As described in case presentation.
Diagnostics/Assessments done: BMP, CBC, UA
TEST RESULT REFERENCE RANGE GLUCOSE 128 H 65–99 SODIUM 143 135–146 POTASSIUM 4.1 3.5–5.3 CHLORIDE 100 98–110 CARBON DIOXIDE 25 19–30 CALCIUM 9.7 8.6–10.3 BUN 19 7–25 CREATININE 1.3 H 0.70–1.25 GLOMERULAR FILTRATION RATE (eGFR) 55 >or=60mL/min/1.73m2
TEST RESULT REFERENCE RANGE WBC 7.3 4.0 – 11.0 K/mm2 Hemoglobin 10.0 L 11 – 16 g/dL Hematocrit 33.7 L 35% - 48% Platelets 412 130 - 400 Neutrophils % 59.9 37 – 80 (%) Lymphocytes % 30.3 23.0 – 45.0 (%) Monocytes % 7.6 % 2.5 – 14 (%) Eosinophils % 1.5 % 0.5 – 4.0 (%) Basophils % 0.4 % 0.0 – 2.0 (%)
Urinalysis Color Yellow (Yellow) Appearance (Urine) Cloudy (clear) Ketones, UA Negative (Negative) Specific gravity <1.005 (1.005-1.025) Blood, UA Small (Negative) PH, Urine 6.0 (5.0-8.0) Leukocytes Small (Negative) Nitrites Negative (Negative)
ANSWER THESE QUESTIONS: 1. What are the immediate priorities and concerns for Mary at this visit? 2. What further assessments are needed beyond the labs already done? 3. If Mary’s epistaxis doesn’t stop with time and pressure list some options for treatment in the office setting.
4. List 3 differential diagnosis for possible cause of her fall. 5. What health promotion topics are appropriate for this individual, consider options if this was not an urgent visit? 6. Describe any follow up care, including referrals for Mary