NR511 Week 6 Case Study
Greetings Professor and class,
NR511 Week 6 Case Study
CC: “Fatigue”
HPI:
A 56-year-old Caucasian female presents to
... [Show More] the office today with complaints of generalized
fatigue for the last 2-3 months and worsens on exertion, thus causing progressive worsening
since onset. She reports feeling tired all of the time, sleep 8hrs per night, but does not feel wellrested. She stated that she has no energy to do the things she usually does and reported missing
“1 day of work 2 weeks ago” because she could not get out of bed. She denies pain and reported
no treatments or relieving factors.
ROS:
Constitutional: Denies fever, chills, or recent illnesses. She reported a 5lb weight gain since her
last office visit 6 months ago.
HEENT: HEENT: Negative. No visual changes or diplopia. Denies any ear pain, coryza,
rhinorrhea, or ST. She reported having a tonsillectomy as a child. Denies snoring or a history of
sleep apnea. Denies any lymph node tenderness or swelling.
Respiratory: Denies cough, SOB, DOE or wheezing
CV: Denies chest pain
GI: Denies N/V/D. + Constipation
GU: Denies polyuria, polydipsia. + cold intolerance. Menopause status x 5 yrs.
Skin: Negative. No changes in skin, hair, or nails
Psych: Reports worsening of depressive symptoms but thinks it might be contributed to being
“unproductive” and tired all of the time. Negative for SI/HI. No changes in sleep pattern, gets 8-
9hrs of sleep per night but not feeling rested.
Musculoskeletal: Reports generalized weakness and intermittent muscles cramping in calves
Allergies: Iodine dyes
Medications hx: Multivitamin, B-Complex, Prozac 20mg, Bisoprolol-HCTZ 2.5mg/6.25mg,
Calcium 500mg & Vit D3 400IU.
Medical history: HTN, Depression, Postmenopausal status
PSH: Tonsillectomy
Family hx: Maternal GM & GF deceased with CHF, T2DM & HTN; Mother alive (82-y.o)
+HTN, +hyperlipidemia, +T2DM; Father alive (84-y.o.) +HTN, +Hyperlipidemia, +T2DM,
+ASHD (s/p +DVT & +PFO; remains anticoagulated); Oldest child (26 y.o.) has seasonal
allergies, youngest child (24 y.o.) has bipolar depression and ADHD & anxiety
Social hx: Employed F/T, she is married with 2 adult children, denies smoking cigarettes or
illicit drug use. Drinks wine (1-2 glasses p/month) socially.
Physical Examination
Constitutional: Middle-aged, caucasian female AxO and cooperative
Vital Signs: BP 146/95, Temp 98.2, P 74, RR 16, Hgt 5’7”, Wgt 180lbs
HEENT: Head normocephalic, atraumatic. Eyes PERRLA. The tympanic membranes are gray,
intact with light reflex noted. Nares patent; turbinates no bogginess, no swelling, nasal drainage
is clear. Oropharynx moist, no lesions or exudate. Bilateral tonsils surgically removed. No dental
caries noted. Neck supple, thyroid small, firm, & midline no palpable masses; no
lymphadenopathy noted.
Cardiopulmonary: Lungs clear b/l with auscultation respirations unlabored and S1 and S2
noted and no M/G/R. No pedal edema.
GI: Soft, non-tender, BS active x 4 quad
Skin: Skin overall dry, hair coarse and thick, nails without ridging, pitting or discoloration
Psych: Mood pleasant and appropriate.
Msk: Normal strength throughout
Neurological: DTRs 2+ at biceps, 1+ at knees and ankles
DDx:
Hypothyroidism: In hypothyroidism, the thyroid gland (TH) does not produce enough thyroid
hormome. TH is “regulated by TRH through a negative-feedback loop that involves the anterior
pituitary and hypothalamus” (McCance, Huether, Brashers, & Rote, 2019). Disruption of the TH
will affect bodily functions such as how the body regulates temperature, heart rate, and all
aspects of metabolism (McCance, Huether, Brashers, & Rote, 2019). The patient will report cold
intolerance, constipation, weight gain, hoarseness, enlarged thyroid, decrease pulse rate, coarse
dry hair, symptoms of depression, and fatigue (Dains, Baumann, & Scheibel, 2020, p.15).
Pertinent positive findings: constipation, weight gain, dry skin, cold intolerance, impaired
memory, worsening depression, and fatigue
Pertinent negative findings: enlarged thyroid, hoarseness, stiffness, muscle weakness and pain,
tenderness, thinning hair, or bradycardia
Type 2 DM: The pathophysiology of diabetes mellitus is frequently characterized by peripheral
insulin resistance, impaired regulation of hepatic glucose production, and the decline of beta-cell
function, thus leading to a beta-cell failure (McCance, Huether, Brashers, & Rote, 2019, p.
2169). To simply explain, type II DM is related to the levels of insulin in the body, and the
body’s ability to utilize it. Usually, obesity is common in the abdominal region, generally occurs
in those older than 40 years with a strong genetic predisposition, and often associated with
hypertension and dyslipidemia (McCance, Huether, Brashers, & Rote, 2019, p. 2169). Symptoms
associated with type II DM are polydipsia, polyuria, polyphagia, fatigue, neuropathy, weight loss
or weight gain, irritability, skin infections, nausea, acanthosis nigricans, breath that smells fruity
or sweet, and blurred vision (American Diabetes Association, 2020).
Pertinent positive findings: fatigue, weight gain
Pertinent negative findings: polydipsia, polyuria, polyphagia, neuropathy, blurred vision,
nausea, acanthosis nigricans, fruity and sweet-smelling breath, and irritability.
Chronic fatigue syndrome: is a disease marred by pain, fatigue, sleep defects, and other
symptoms that are made worse by exertion and usually last longer than six months. It can also be
characterized as flu-like symptoms that persist or recur with feelings of unrefreshing sleep,
weakness, sore throat, muscle, and joint pain, problems with concentration, and new onset of
headaches (Dains, Baumann, & Scheibel, 2020, p. 221). The patient’s physical exam may be
normal with findings of tender cervical and axillary lymphadenopathy (Dains, Baumann, &
Scheibel, 2020, p. 222). According to the Office of Women’s Health (2019), the symptoms of
chronic fatigue syndrome can also be episodic [Show Less]