additional objective for examining a patient
Please respond to discussion
We can infer from the case presented that she appears tired and gaunt, and that some of the questions suggested for subjective history are already known, however the presentation should ask some subjective questions on psychological health including depression and anxiety, mental wellbeing, quality of life measures, social environment, resources, and preferences for care (Kennedy-Malone et al., 2019). Since her recently deceased sister is one of the closest known relatives, we could also ask about her condition during the time that the patient was caring for the sibling and any signs or symptoms that were present.
2: What additional objective findings would you be examining the patient for?
Non-specific fatigue is suspicious for anemia of chronic disease, and our text as well as the name keys towards the presence of an underlying illness even if the origin is currently unknown. Objective findings may include pallor, petechia, “spoon” nails, and tachycardia (Camaschella & Weiss, 2023; Kennedy-Malone et al., 2019).
3) What are the differential diagnoses that you are considering?
Underlying disease or process currently unknown. Consideration for the presenting symptoms are:
Anemia of Chronic Disease
Iron Deficiency Anemia
Depression
4) What laboratory tests will help you rule out some of the differential diagnoses?
CBC, H&H, MCV, MCHC, Ferritin, Reticulocyte count, Total Iron Binding Capacity, urinalysis, chemistry, ESR, A1C (Camaschella & Weiss, 2023; Kennedy-Malone et al., 2019).
5) What screening tools will you select to use on this patient?
This was somewhat discussed last week, and this is another patient with an unknown history. Consider the means available and coverage that the patient has because recommendations below B are not covered by Medicare (2023; Kennedy-Malone et al., 2019)
The level A recommendations for screenings for this patient are hypertension and tobacco cessation, the former seems unlikely given vital signs, the latter is a question for patient history. Level B screening recommendations include BRCA related cancer screenings, STI screenings, depression and suicide risk, falls prevention, osteoporosis, and alcohol use (USPSTF, n.d.).
6) What is your plan of care?
The treatment pathway for ACD relies on treating the underlying condition. In order to treat for this, we need to do some more screening and diagnostic workup to try and identify what that might be. In a woman the age of the patient identified here, that could be something between multi-facetted or just simple aging (Camaschella & Weiss, 2023; Kennedy-Malone et al., 2019; Madu & Ughasoro, 2016). The empiric suggestion from our text authors is to treat with Iron supplements initially, which will not be a successful treatment for ACD, but can differentiate between that and IDA (Kennedy-Malone et al., 2019). My plan would be to investigate what I can of family history to see if there are any genetic components to her sibling’s condition, order lab work as noted above, and follow USPSTF screenings. All of this needs to fit within the context of patient goals. Where a vibrant, active 78 year old with close ties to family and peer groups might want aggressive treatment for any illness, we also have to take her wishes into context for how aggressively to pursue screening and treatment.
7) What additional patient teaching may be needed?
Teaching specific to anemia, as well as activities and diet for maintaining health. Further teaching to follow based on screenings, teaching about need for screenings and reasons behind them (Camaschella & Weiss, 2023; Kennedy-Malone et al., 2019).
8) Will you be looking for a consult?
Psych consult possible, especially in the setting of depression and acute loss of close family. Other consultations depending on the level of screening required and results.
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