NR 511 Weekly Discussions

A 56-year-old Caucasian female presents to the office today with complaints of fatigue. Upon further questioning you discover the following subjective information regarding the chief complaint.
History of Present Illness
Onset ”about 2-3 months”
Location Generalized
Duration Constant
Characteristics Progressively worsening since onset, feels tired all of the time, sleeps 8hrs per night but does not feel well rested. ”No energy to do anything I normally can do”
Aggravating factors Exertion
Relieving factors None identified
Treatments None

ORDER A PLAGIARISM-FREE PAPER NOW

Severity Denies pain; missed 1 day of work 2 weeks ago because ”couldn’t get out of bed”
Review of Systems (ROS)
Constitutional Denies fever, chills, or recent illnesses. +5lb. weight gain since last visit 6 months ago.
Eyes No visual changes or diploplia
ENT Denies ear pain, coryza, rhinorrhea, or ST. Had tonsillectomy as child Denies snoring or history of sleep apnea.
Neck Denies lymph node tenderness or swelling
Chest Denies cough, SOB, DOE or wheezing
Heart Denies chest pain
Abdomen Denies N/V/D. + Constipation
Endocrine Denies polyuria, polydipsia. + cold intolerance. Menopause status x 5 yrs.
Skin No changes in skin, hair or nails
Psych Reports worsening of depressive symptoms but thinks it is because she is so ”unproductive” lately and tired all of the time. -Suicidal or homicidal thoughts. Sleeping 8-9hrs per night (no changes), but not feeling rested.
Musculoskeletal Generalized weakness and intermittent muscles cramping in calves
History – NR 511 Weekly Discussions
Medications Multivitamin, B-Complex, Prozac 20mg, Bisoprolol-HCTZ 2.5mg/6.25mg, Calcium 500mg + Vit D3 400IU.
PMH HTN, Depression, Postmenopausal status
PSH Tonsillectomy
Allergies Iodine dyes
Social Married; Works full time as office manager of an internal medicine office; 2 kids (grown)
Habits Denies cigarettes or drug use. +Occasional glass of wine (1-2 per month).
FH Maternal GM & GF deceased with CHF, T2DM and HTN;
Mother alive (age 82) +HTN, +Hyperlipidemia, +T2DM;
Father alive (age 84) +HTN, +Hyperlipidemia, +T2DM, +ASHD (s/p CABG 2 years ago). Also had +CVA at time of CABG (work-up revealed +DVT and +PFO; remains anticoagulated);
Oldest child (26) with seasonal allergies
Youngest child (24) with Bipolar depression and ADHD, and anxiety
Physical exam reveals the following:
Physical Exam – NR 511 Weekly Discussions
Constitutional Middle aged Caucasian female alert, oriented and cooperative
VS Temp-98.2, P-74, R-16, BP 146/95, Height: 5’7”, Weight: 180 pounds
Head Normocephalic, atraumatic
Eyes PERRLA
Ears Tympanic membranes gray and intact with light reflex noted.
Nose Nares patent. Nasal turbinates without swelling. Nasal drainage is clear.
Throat Oropharynx moist, no lesions or exudate. Surgically removed tonsils bilaterally. Teeth in good repair, no cavities.
Neck Neck supple. No lymphadenopathy. Thyroid midline, small and firm without palpable masses.
Cardiopulmonary Heart S1 and s2 noted, no murmurs, noted. Lungs clear to auscultation bilaterally. Respirations unlabored. No pedal edema
Abdomen Soft, non-tender. BS active
Skin Skin overall dry, hair coarse and thick, nails without ridging, pitting or discoloration
Psych Mood pleasant and appropriate.
Musculoskeletal Strength full throughout
Neuro DTRs 2+ at biceps, 1+ at knees and ankles

1. Briefly and concisely summarize the H&P findings as if you were presenting it to your preceptor using the pertinent facts from the case. Use shorthand where possible and approved medical abbreviations. Avoid redundancy and irrelevant information. NR 511 Weekly Discussions.
2. Provide a differential diagnosis (minimum of 3) which might explain the patient’s chief complaint along with a brief statement of pathophysiology for each.
3. Analyze the differential by using the pertinent findings from the history and physical to argue for or against a diagnosis.
4. Rank the differential in order of most likely to least likely. NR 511 Weekly Discussions
5. Identify any additional tests and/or procedures that you feel is necessary or needed to help you narrow your differential. All testing decisions must be supported with an evidence-based medicine (EBM) argument as to why it is necessary or pertinent in this case. If no testing is indicated or needed, you must also support this decision with EBM.

NR 511 Weekly Discussions

Week 6: Discussion Part Two
.
CBC with differential
WBC 8.6 x10E3/uL
RBC 4.44 x 10E6/uL
Hemoglobin 14.0 g/dL
Hematocrit 41.2%
MCV 93fL
MCH 31.5 pg
MCHC 34.0 g/dL
RDW 13%
Platelet 241 x 10E3/uL
Neutrophils % 67%
Lymphocytes % 22%
Monocytes % 8%
Eosinophils % 3%
Basophils % 0%
Absolute Neutrophils 5.7 x 10E3/uL
Absolute Lymphocytes 1.9 x 10E3/uL
Absolute Monocytes 0.7 x 10E3/uL
Eosinophils Absolute 0.3 x 10E3/uL
Basophile Absolute 0.0 x 10E3/uL
Immature Grans % 0%
Absolute Immature Grans 0.0 x 10E3/uL
TSH with Reflex to FT4
TSH 6.770 uIU/mL
FT4 0.62 ng/dL
PHQ-9 Depression Score=10 (previous was 5 at last visit 6 months ago)
1. What is your primary diagnosis for this patient as the cause for the CC of fatigue? (support your decision for your diagnosis with pertinent positives and negatives from the case)
2. Identify the corresponding ICD-10 code. NR 511 Weekly Discussions.
3. Provide a treatment plan for this patient’s primary diagnosis which includes:
o Medication*
o Any additional testing necessary for this particular diagnosis*
o Patient education*
o Referral
4. Provide an active problem list for this patient based on the information given in the case.
5. Are there any changes that you would make to the patient’s overall plan at this time? Must provide an evidence-based medicine (EBM) argument to support any treatments or testing decisions. NR 511 Weekly Discussions.
6. Provide an appropriate follow-up plan (include any additional testing that you feel is necessary and include an EBM argument). NR 511 Weekly Discussions.

*If part of the plan does not warrant an action, you must explain why. ALL medication and testing decisions (or decisions not to treat with medication or additional testing) MUST be supported with an EBM argument. Over-the-counter (OTC) and RXs must be written in full as if handing a script to the patient in the office.
Search entries or author . NR 511 Weekly Discussions

Order a similar paper and get 15% discount on your first order with us

Dr. Padma Myers
Dr. Padma Myers
98% Success Rate
Read More
“Hello, I deliver nursing papers on time following instructions from the client. My primary goal is customer satisfaction. Welcome for plagiarism free papers”
Stern Frea
Stern Frea
98% Success Rate
Read More
Hi! I am an English Language and Literature graduate; I have written many academic essays, including argumentative essays, research papers, and literary analysis.
Dr. Ishid Elsa
Dr. Ishid Elsa
98% Success Rate
Read More
"Hi, count on me to deliver quality papers that meet your expectations. I write well researched papers in the fields of nursing and medicine".
Dr. Paul P. Klug
Dr. Paul P. Klug
99% Success Rate
Read More
"A top writer with proven reliability and experience. I have a 99% success rate, overall rating of 10. Hire me for quality custom written nursing papers. Thank you"

How Our Essay Writing Service Works

Tell Us Your Requirements

Fill out order details and instructions, then upload any files or additional materials if needed. Then, confirm your order by clicking “Place an Order.”

Make your payment

Your payment is processed by a secure system. We accept Mastercard, Visa, Amex, and Discover. We don’t share any informati.on with third parties

The Writing Process

You can communicate with your writer. Clarify or track order with our customer support team. Upload all the necessary files for the writer to use.

Download your paper

Check your paper on your client profile. If it meets your requirements, approve and download. If any changes are needed, request a revision to be done.

Recent Questions

Stay In Touch!

Leave your email and get discount promo codes and the best essay samples from our writers!