Scenario
You are working in a community outpatient clinic where you perform the intake assessment on R.M., a 38-year-old woman who is attending graduate
... [Show More] school and is very sedentary. Her chief complaint is overwhelming fatigue that is not relieved by rest. She is so exhausted that she has difficulty walking to classes and trouble concentrating when studying. She reports a recent weight gain of 15 pounds over 2 months without clear changes in her dietary habits. Her face looks puffy, she has experienced excessive hair loss, and her skin is dry and pale. She complains of generalized body aches and pains with frequent muscle cramps and constipation. You notice she is dressed inappropriately warm for the weather.
1. Compare her VS with those of a healthy person at her same age.
R.M vitals
BP 142/84 (Normal 120/80) HR 52 (Normal 60-100)
RR12 (Normal 10-20)
Temp 96.8 (Normal 97-99)
2. List eight general questions you might ask R.M. to assist in determining what is going on with her.
-Do you take any other medications or over the counter meds, or herbal supplements?
-Do you have any medical history I should be aware of, like any hypertension?
-Are you feeling okay, any symptoms of depression, have you noticed any changes?
-Do you do any physical activity and how often?
-What does your physical activity normally look like?
-What does your diet normally look like?
-What does a typical day look like for you?
-When did you notice your symptoms started?
Does anyone in your family have a history thyroid issues?
3. You know that potential causes for some of R.M.'s symptoms include depression, hypothyroidism, anemia, cardiac disease, fluid and electrolyte imbalance, and allergies. As part of your screening procedures, describe how you would begin to investigate which of these conditions probably do not account for R.M.'s symptoms.
I would ask the doctor to order labs for RM including a TSH, CBC, and comprehensive metabolic panel EKG
4. Unnecessary diagnostic tests are expensive. What tests do you think would be the most appropriate for R.M., and why?
I believe the TSH and CBC will be the priority to avoid unnecessary diagnostic testing that could be expensive for the pt. I think these tests would help us develop a diagnosis in the most effective way.
5. Interpret R.M.'s laboratory results.
TSH 20.9 (high) normal range (2-10)
TRH 18.8 (High) (2-10 ng/dL)
T 3 24 mU/L(Low) (70-205 ng/dL)
Free T 4 0.2 ng/dL(Low) (0.8-2.4 ng/dL) [Show Less]