Question
HPI: Ms. Juggenmeir is a 71-year old Female who comes into your office with concerns of fatigue and dry
skin. She is a retired Banker. She is AAOx4, ambulatory, and lives by herself. She does report increased
fatigue no matter how much sleep she gets. She is also concerned that she may need to come off of one
of her meds because her hair is thinning. She had labs done and also was informed they would review
results at this visit. Other pertinent diagnoses include Hypertension, Hyperlipidemia, and Vitamin D
deficiency. She admits to not taking her vitamin d daily as prescribed.
RESOURCE FOR THIS WEEK: Review Endocrine-related Evidence Based Practice Guidelines.
Ms. Juggenmeir is a 71 y/o female who is AAOX4. She makes no unusual motor movements and
demonstrates no tics. She denies any visual or auditory hallucinations. She denies any suicidal thoughts
or ideations. She denies any falls or pain.
(All other Review of System and Physical Exam findings are negative other than stated.)
Vital Signs: BP 137/82, HR 89, RR 20, Temp 98.1
PMH: Hypertension, Hyperlipidemia, Vitamin D deficiency
Allergies: I.V. Contrast, ACE Inhibitors
Medications:
Women's One A Day-Multivitamin daily
Chlorthalidone 25mg daily
Fish Oil 1 tablet daily
Amlodipine 5mg p.o. daily
Losartan 100mg p.o. daily
Atorvastatin 40mg p.o. at bedtime daily
Aspirin 81mg p.o. daily
Ergocalciferol 50,000 units PO once a month
Social History: as stated in Case Study
ROS: as stated in Case study
Diagnostics/Assessments done:
1. CXR- Last cxr showed no cardiopulmonary findings. WNL
2. TSH/Free T4, T3- as noted below in lab results
3. Basic Metabolic Panel and CBC as shown below
4. Vitamin D Level- as noted below in lab results
, TEST
RESULT
REFERENCE RANGE
GLUCOSE
85
65-99
SODIUM
134
135-146
POTASSIUM
4.2
3.5-5.3
CHLORIDE
104
98-110
CARBON DIOXIDE
29
19-30
CALCIUM
9.0
8.6- 10.3
BUN
20
7-25
CREATININE
1.01
0.70-1.25
GLOMERULAR FILTRATION RATE (eGFR)
76
HPI: Ms. Juggenmeir is a 71-year old Female who comes into your office with concerns of fatigue and dry
skin. She is a retired Banker. She is AAOx4, ambulatory, and lives by herself. She does report increased
fatigue no matter how much sleep she gets. She is also concerned that she may need to come off of one
of her meds because her hair is thinning. She had labs done and also was informed they would review
results at this visit. Other pertinent diagnoses include Hypertension, Hyperlipidemia, and Vitamin D
deficiency. She admits to not taking her vitamin d daily as prescribed.
RESOURCE FOR THIS WEEK: Review Endocrine-related Evidence Based Practice Guidelines.
Ms. Juggenmeir is a 71 y/o female who is AAOX4. She makes no unusual motor movements and
demonstrates no tics. She denies any visual or auditory hallucinations. She denies any suicidal thoughts
or ideations. She denies any falls or pain.
(All other Review of System and Physical Exam findings are negative other than stated.)
Vital Signs: BP 137/82, HR 89, RR 20, Temp 98.1
PMH: Hypertension, Hyperlipidemia, Vitamin D deficiency
Allergies: I.V. Contrast, ACE Inhibitors
Medications:
Women's One A Day-Multivitamin daily
Chlorthalidone 25mg daily
Fish Oil 1 tablet daily
Amlodipine 5mg p.o. daily
Losartan 100mg p.o. daily
Atorvastatin 40mg p.o. at bedtime daily
Aspirin 81mg p.o. daily
Ergocalciferol 50,000 units PO once a month
Social History: as stated in Case Study
ROS: as stated in Case study
Diagnostics/Assessments done:
1. CXR- Last cxr showed no cardiopulmonary findings. WNL
2. TSH/Free T4, T3- as noted below in lab results
3. Basic Metabolic Panel and CBC as shown below
4. Vitamin D Level- as noted below in lab results
, TEST
RESULT
REFERENCE RANGE
GLUCOSE
85
65-99
SODIUM
134
135-146
POTASSIUM
4.2
3.5-5.3
CHLORIDE
104
98-110
CARBON DIOXIDE
29
19-30
CALCIUM
9.0
8.6- 10.3
BUN
20
7-25
CREATININE
1.01
0.70-1.25
GLOMERULAR FILTRATION RATE (eGFR)
76
