Rita S. is a 72-year-old Hispanic widow in no apparent distress. She lives independently in the

Rita S. is a 72-year-old Hispanic widow in no apparent distress. She lives independently in the community. She has no significant past medical history and tells you that she takes no prescription or over-the-counter medications. She presents as a new patient to your office with a complaint of fatigue and anorexia. She tells you she has lost 10 pounds in the past three to five months. The patient reports that the fatigue began about a month or two ago and has been getting worse. She is worried because she also notes having shortness of breath with minimal activity. She tells you she can’t complete her usual activities. She has started to rely on her daughter to do her grocery shopping and housework because she becomes exhausted doing these activities.

1. Fatigue can be related to any of the following: illness; physiologic and medications; lifestyle; or emotional/psychological. For each of these domains, list three factors that could influence a complaint of fatigue.PE 5’4” 95 lbs., BP 122/64, HR 102, PO temp 98.2
2. What aspects of the physical exam would you focus on given Rita’s presentation? Why? What would you be looking for? Be sure to describe the patient and her condition in your own words. Do not just cut and paste descriptions from your references.
3. The differential for an elder with fatigue/anorexia/sob is long but distinguished. Assume that your physical exam is normal. Provide a list of the top five prioritizeddifferentials for Rita.Her lab results are as follows:
   WBC 12, HgB 9.5, HCT 30 RBC 3, MCV 110 Fe, 75 TIBC 300, Ferritin 100, BUN 34, Creat 1.3, Na 149, K 3.9
4. Based on the lab test results, what additional tests are necessary in formulating your diagnosis?
5. Based on the laboratory results, what are the possible diagnoses?
6. Provide a focused plan of care for the diagnoses of Fe deficiency anemia and pernicious anemia. Your plan should include pharmacologic, non-pharmacologic, consults, referrals, diagnostics, patient education, and follow-up.
7. When would you expect to see a significant response in the H/H? When would you expect to see a full correction?