Assignment 1 Patient With Fatigue Em Is A 74-Year-Old Male With A History Of Rheumatoid
ASSIGNMENT 1 Patient With Fatigue EM is a 74-year-old male with a history of rheumatoid arthritis (RA) who presents in the clinic with a complaint of fatigue
EMis ambulatory with a walker and recently has had intermittent flare-ups of his rheumatoid arthritis (RA) disease activity, with increasing pain and swelling in his affected joints
His energy has been declining over the past few months, so he thought it was a good time to come in for follow-up laboratory testing and reassessment of his medications
Most troublesome, he has fainted twice in the past 2 weeks, which resulted in falls onto his carpeted floor
He is afraid to go out into public and even more afraid to drive his car
He has also had some chest pains with exertion
He is eating and sleeping okay, although he does sleep better if his head is elevated on a few extra pillows
He lives alone and gets meals delivered by a local organization
Past Medical History RAfor 35 years, affecting hands, feet, knees, hips, and cervical spine Systolic hypertension Presbycusis Medications Ibuprofen, 600 mg three to four times per day as needed Methotrexate, 7
5 mg weekly Atenolol, 25 mg daily Hydrocodone/acetaminophen, 5 mg/500 mg every 6 hours as needed for pain Physical Examination Height: 71 inches; weight: 160 lbs
;BMI: 22
3; blood pressure: 162/60; pulse: 84; respiration rate: 16; temperature: 98
6 °F Well-developed, well-nourished elderly male in no distress; pale Lungs: bibasilar rales Heart: regular rate and rhythm, grade 3/6 systolic murmur, audible S3; positive carotid bruit on the left Abdomen: no masses, nontender Rectal: prostate 3+ enlarged, hemoccult negative brown stool Extremities: marked ulnar deviation ofMCPandIPjoints in both hands Labs and Imaging Hemoglobin: 8
9 g/dL Mean corpuscular volume (MCV): 80 fL White blood cell count: 10
7 Ã 109/L Platelets: 250,000/L Reticulocyte count: 0
8% Ferritin: 415 mcg/L Electrocardiogram: no acute findings; some evidence of left ventricular hypertrophy Discussion Questions 1
What isEM’s diagnosis? 2
What is the underlying pathophysiology ofEM’s condition? 3
What is the best therapeutic approach to the treatment ofEM’s condition? 1 PAGE TO ANSWE THE 3 QUESTIONS ABOVE ACCORDING TO THE CASE ABOVE
NO PLAGIO MORE THAN 10 % 3 SCHOLARLY REFERENCES NO OLDER THAN 5 YEARS DUE DATE FEBRUARY 8 , 2023
