(Solution) NR 511 Week 6 Case Study Discussion Part 1 & 2 with Answers

NR 511 Week 6 Case Study Discussion Part 1 with Answers

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 ………………continue
• Review of Systems (ROS) ………………continue
• History ………………continue
• Physical Exam ………………continue

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.
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. NR 511 Week 6 Case Study Discussion
4. Rank the differential in order of most likely to least likely.
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 supported with an evidence-based medicine (EBM) argument as to why it is necessary or pertinent in this case. If no testing is also support this decision with EBM.

NR 511 Week 6 Case Study Discussion Part 2 with Answers

Now, assume that you sent your patient for labs and she returns the following day, as instructed, to review the results.

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
… 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) NR 511 Week 6 Case Study Discussion
2. Identify the corresponding ICD-10 code.
3. Provide a treatment plan for this patient’s primary diagnosis which includes:

• o Medication*
• Any additional testing necessary for this particular diagnosis*
• Patient education*
• 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 Week 6 Case Study Discussion
6. Provide an appropriate follow-up plan (include any additional testing that you feel is necessary and include an EBM argument).

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*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. NR 511 Week 6 Case Study Discussion