Week 6 Case study part 1.

Week 6 Case study part 1: 1. Summary: A 56-year-old woman with a CC of fatigue. She is 5 years into menopause and states her depressive symptoms are getting worse possibly due to lack of productivity. Her symptoms started 2-3 months ago, it is constant and progressively getting worse, aggravating factor is exertion, she states no relieving factors, and denies pain. She has a history of hypertension and depression for which she currently takes Prozac 20mg, bisoprolol-HCTZ 2.5mg/6.25mg, and vitamins such as multivitamin, b-complex, calcium 500mg with vit D3 400IU. Her physical exam was significant for elevated BP of 146/95, dry skin and coarse hair, cold intolerant, and DTRs +1 at knees and ankles. 2. Differential diagnosis + pathophysiology a. Hypothyroidism i. This is a condition when the thyroid gland is underactive which results in insufficient amounts of thyroxine (T4) and triiodothyronine (T3) which then leads to an increased amount of TSH from the pituitary gland. This stimulates hypertrophy and hyperplasia of the thyroid gland and in turn tries to compensate by producing more T3 (Dunphy et al., 2019). b. Depression i. Deficiency in the monoaminergic transmitters in the brain involving norepinephrine, serotonin receptors (5-HT) and dopamine in the brain causes symptoms of depression (Dunphy et al., 2019).. c. Anemia i. Excessive loss of iron from the body or diminished absorbable dietary iron causes less binding of oxygen molecules in the red blood cells. This causes less oxygen to travel from the lungs to the rest of the tissues in the body (Dunphy et al., 2019). 3. Ranking differential diagnosis a. Hypothyroidism i. Positive findings: weight 180lbs which calculates to an overweight BMI, cold intolerance, coarse hair, dryness, fatigue, constipation, +1 DTR knees and ankles, depression ii. Negative findings: Heartrate within normal limits, Thyroid midline, small and firm without palpable masses. b. Depression i. Positive findings: fatigue, states depression getting worse, unproductive, generalized weakness ii. Negative findings: Sleeps 8-9 hours per night, denies suicidal or homicidal thoughts c. Anemia i. Positive findings: menopause x 5 yrs, fatigue, intermittent muscle cramping in calves This study source was downloaded by from CourseH on :03:48 GMT -06:00 ii. Negative findings: heart rate within normal limits, no changes in sleep, no chest pain, no shortness of breath 4. Testing a. The two most important blood tests to evaluate hypothyroidism are to test for TSH levels free thyroxine levels. Abnormally high TSH levels correlates to hypothyroidism which means the thyroid gland is being asked to produce more thyroxine levels because there is a detection of low T4. The second lab to test for is free thyroxine levels which would be low due to underproduction and availability in the bloodstream (Chaker, et al., 2017). b. CBC with differential will be ordered in order to assess for anemia. On this panel, anemia is noted by low RBC, hemoglobin, and hematocrit levels. With differential, the WBC can be evaluated to narrow down the type and shape of the anemia in order to make a more specific diagnosis (Nielson, et al., 2018). c. According to American Family Physician (2018), in order to evaluate the patient’s Depressive symptoms, the PHQ-9 is a more comprehensive tool for adults to screen for the severity of Depression. Chaker, L., Bianco, A. C., Jonklaas, J., & Peeters, R. P. (2017, September 23). Hypothyroidism. Retrieved from Dunphy, L., Winland-Brown, J., Porter, B., & Thomas, D. (2019). Primary Care-The art and science of Advanced Practice Nursing-An interprofessional approach 5 th ed. Philadelphia: F.A. Davis. Maurer, D. M., Raymond, T. J., & Davis, B. N. (2018, October 15). Depression: Screening and Diagnosis. Retrieved from Nielsen, O. H., Soendergaard, C., Vikner, M. E., & Weiss, G. (2018, January 13). Rational Management of Iron-Deficiency Anaemia in Inflammatory Bowel Disease. Retrieved from