NR 509 Wk2 Discussion

NR 509 Wk2 Discussion

NR 509 Wk2 Discussion

Week 2: Discussion Part One

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Cynthia is a 65-year-old African American female who presents to the clinic for a check-up. Her last examination was ~5 years ago. She has no specific, significant, or urgent complaint. She explains that her only issues are thirst, fatigue, and leg numbness and tingling, which is beginning to occur more often. You decide to do a physical exam, as well as draw labs and receive the following results:

 

Social history: no smoking or alcohol consumption.

Physical examination:

GEN: well nourished, slightly obese female

VS: BP 180/103 HR 73 RR 13 T 98.4 Weight 90 kg, Height 5’6”

HEENT: PERRLA

COR: RRR, NMRG

CHEST: CTA

NEURO: monofilament test shows decreased peripheral sensation

EXT: normal

Laboratory (fasting):

Na 139 mEq/L

K 3.8 mEq/L

ALT 34 U/L

Ca 9.1 mg/dL

CL 102 mmol/L

HCO3 22 mEq/L

AST 39 U/L

TP 6 g/dL

BUN 33 mg/dL

SCr 2.0 mg/dL

Alb 4.1 g/dL

Cholesterol 254 mg/dL

BG 300 mg/dL

TSH 0.12 mU/mL

UA: SG 1.013 mg/24h, pH 6.5, +++ protein

 

What are the major problems in this patient, and what diagnoses do these values indicate?

Additionally, what is your assessment and pharmacological plan for each of these problems including the medication, dose, and mechanism of action?

Sample Partial solution

What are the major problems in this patient, and what diagnoses do these values indicate?

Cynthia’s symptoms of thirst, fatigue, leg numbness and tingling are of most concern. The symptoms along with her lab work up shows decreased peripheral feeling has me thinking peripheral neuropathy and damage to the kidneys. The patient’s blood pressure would indicate hypertension. She also has hypercholesterolemia as her cholesterol is very high at 254 mg/dL. When kidney damage worsens, blood pressure and cholesterol levels rise become elevated as well. Labs show an elevated BUN and a creatinine level of 2.0 mg/dL, indicating a kidney concern. Her blood glucose of 300 mg/dL is high and may indicate she has diabetes. Protein in the urine may indicate nephropathy.

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