SOLVED462

You are working in a family practice when a 65-year-old developmentally-delayed woman, Ms. Jennifer Robinson, presents to the office with complaints of excessive fatigue and shortness of breath after activity, which is abnormal for her. Ms. Robinson has a history of trisomy 21 and congestive heart failure with decreased kidney function within the last year. The woman appears unusually tired and slightly pale. Additional history and examination rules out worsening heart failure, acute illness, and worsening kidney disease. You were able to get the following results and vitals in the clinic today: The complete blood count (CBC) results indicate that hemoglobin is 9.5 g/dL, which is a new finding, and the hematocrit is 29%. Previous hemoglobin levels have been 11 to 13g/dL. The patient’s vital signs are temperature 98.7°F, heart rate 92 bpm, respirations 28 breaths per minute, and blood pressure 138/72. Initial Post by Wednesday (Day 3) at 11:59 p.m. List 10 to 20 additional pieces of subjective information you need to elicit from the mother and patient to help formulate your differential diagnoses and plan. You may not ask questions that were already addressed in the HPI/ROS. You will need two scholarly references for the questions you ask.
SCIENCE
HEALTH SCIENCE
NURSING

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