Progressive fatigue with shortness of breath Col Casey Kilroy is a 50-year-old female with progressive fatigue and shortness of breath. She reports that
... [Show More] she was sent to the office after attempting to donate blood and was turned away due to being anemic. She states the fatigue started a few months ago. She noticed she would not finish a round of gold without using a cart. She states it comes on quickly and goes away with rest. She reports the fatigue limits her from accomplishing her daily tasks. Her associated symptoms are shortness of breath while doing housework that is relieved with rest, lightheaded when she exercises, headaches, ice chewing, and heavy menstrual periods with heavy bleeding for 4 days with periods that last 7-8 days. She also reports some tingling in her legs that she contributes to poor circulation. She has a past medical history of GERD, arthritis, a tubal ligation and appendectomy. She denies any history of smoking or drug use. He endorses a glass of wine a day. She follows a vegan diet. Her family history includes Crohn’s disease, diabetes and colon cancer. Her immunizations are up to date and she has had a recent pap test and mammogram. Admission Orders (do not write an explanation of the order(s), ONLY the order) 1. DX: (1) : Iron deficiency Anemia 2. Admit to: Medical Surgical Unit –Dr. Amber, call upon arrival with rm # 3. Isolation/Precautions: standard 4. Allergies: No known allergies 5. Diet: NPO 6. Activity: up as tolerated 7. IV: large bore IVs 8. IVF: NS at 100ml /hr 1 unit PRBC if hgb >8 9. Labs: Every 4-hour H&H, Type and cross match. Stool for Ova and parasites. PT/INR. 10. AM LABS: CBC, BMP, 11. RADS (US, CT, XRAYs)/Diagnostic tests: Endoscopy - Colonoscopy 12. PT/OT/Nutrition/SW/Pysch/etc. Consults: Dietary, Respiratory Therapy 13. Consult: GI – Trace Guaiac positive Hematology – New diagnosis of Anemia 14. Screening (s): HIV, TB, PNA vaccine, flu shots, etc: None 15. Medications: Venofer 10mg in 50 ml NS over 15 minutes every 3 days for 5 total doses Protonix 40 mg IV BID Zofran 4 mg IV q6h PRN for Nausea or Vomiting Acetaminophen 1000 mg IV Q6H PRN fever greater than 101.5, pain less than 5. maximum 4000 mg/day 16. Non-pharmacological Management: Education on Pathophysiology of Iron deficiency Anemia, Risk factors of the disease, Symptoms of Iron Deficiency Anemia, Prevention of progression of Iron Deficiency Anemia. Dietary education on foods high in iron. Obtain Blood Consent Nursing Orders [Show Less]