Question: HPI: Ms. Lewis is a 63-year old female who comes into your office with concerns of low blood sugar... Flag HPI: Ms. Lewis is a 63-year old female who comes into your office with concerns of low blood sugar in the morning, fasting. She reports seeing blood sugar as low as 50 fasting in the mornings for the last few weeks. She has a known history of Diabetes, Hypertension, Hyperlipidemia, and Chronic Osteoarthritis. She also reports elevated blood pressure. Her blood pressure at presentation is 165/90. Ms. Lewis is a 63 y/o female who is AAOX4. She makes no unusual motor movements and demonstrates no tics. She denies any visual or auditory hallucinations. She denies any suicidal thoughts or ideations. She denies any falls, denies any pain. (All other Review of System and Physical findings are negative other than stated.) Vital Signs: BP 165/90, HR 89, RR 20, Temp 98.1 PMH: Hypertension, Hyperlipidemia, Diabetes, Chronic Osteoarthritis Allergies: Penicillin, lisinopril Medications: Women’s One A Day-Multivitamin daily Chlorthalidone 25mg daily Fish Oil 1 tablet daily Amlodipine 5mg p.o. daily Atorvastatin 40mg p.o. at bedtime daily Novolog 10 units with meals TID Aspirin 81mg p.o. daily Lantus 25 units Subcutaneous nightly Ergocalciferol 50,000 units PO once a month Social History: as stated in Case Study ROS: as stated in Case study Diagnostics/Assessments done: CXR- Last cxr showed no cardiopulmonary findings. Within normal limits. Basic Metabolic Panel and CBC as shown below Vitamin D Level- as noted below in lab results TEST RESULT REFERENCE RANGE GLUCOSE 85 65-99 SODIUM 134 135-146 POTASSIUM 4.2 3.5-5.3 CHLORIDE 104 98-110 CARBON DIOXIDE 29 19-30 CALCIUM 9.0 8.6- 10.3 BUN 20 7-25 CREATININE 1.01 0.70-1.25 GLOMERULAR FILTRATION RATE (eGFR) 76 >or=60 mL/min/1.73m2 TEST RESULT REFERENCE RANGE Vitamin D 1,25 OH 58 36-144 TEST RESULT REFERENCE RANGE WBC 7.3 3.4- 10.8 RBC 4.31 135-146 HEMOGLOBIN 14 13-17.2 HEMATOCRIT 42% 36-50 MCV 90 80-100 MCHC 34 32-36 PLATELET 272 150-400 1. Provide a minimum of three differential diagnoses. List them from top priority to least priority. Compare the diagnostic criteria for each, and explain what rules each differential in or out. Explain you critical thinking process that led you to the primary diagnosis you selected. Include pertinent positives and pertinent negatives for the specific patient case.
Question: HPI: Ms. Lewis is a 63-year old female who comes into your office with concerns of low blood sugar... Flag HPI: Ms. Lewis is a 63-year old female who comes into your office with concerns of low blood sugar in the morning, fasting. She reports seeing blood sugar as low as 50 fasting in the mornings for the last few weeks. She has a known history of Diabetes, Hypertension, Hyperlipidemia, and Chronic Osteoarthritis. She also reports elevated blood pressure. Her blood pressure at presentation is 165/90. Ms. Lewis is a 63 y/o female who is AAOX4. She makes no unusual motor movements and demonstrates no tics. She denies any visual or auditory hallucinations. She denies any suicidal thoughts or ideations. She denies any falls, denies any pain. (All other Review of System and Physical findings are negative other than stated.) Vital Signs: BP 165/90, HR 89, RR 20, Temp 98.1 PMH: Hypertension, Hyperlipidemia, Diabetes, Chronic Osteoarthritis Allergies: Penicillin, lisinopril Medications: Women’s One A Day-Multivitamin daily Chlorthalidone 25mg daily Fish Oil 1 tablet daily Amlodipine 5mg p.o. daily Atorvastatin 40mg p.o. at bedtime daily Novolog 10 units with meals TID Aspirin 81mg p.o. daily Lantus 25 units Subcutaneous nightly Ergocalciferol 50,000 units PO once a month Social History: as stated in Case Study ROS: as stated in Case study Diagnostics/Assessments done: CXR- Last cxr showed no cardiopulmonary findings. Within normal limits. Basic Metabolic Panel and CBC as shown below Vitamin D Level- as noted below in lab results TEST RESULT REFERENCE RANGE GLUCOSE 85 65-99 SODIUM 134 135-146 POTASSIUM 4.2 3.5-5.3 CHLORIDE 104 98-110 CARBON DIOXIDE 29 19-30 CALCIUM 9.0 8.6- 10.3 BUN 20 7-25 CREATININE 1.01 0.70-1.25 GLOMERULAR FILTRATION RATE (eGFR) 76 >or=60 mL/min/1.73m2 TEST RESULT REFERENCE RANGE Vitamin D 1,25 OH 58 36-144 TEST RESULT REFERENCE RANGE WBC 7.3 3.4- 10.8 RBC 4.31 135-146 HEMOGLOBIN 14 13-17.2 HEMATOCRIT 42% 36-50 MCV 90 80-100 MCHC 34 32-36 PLATELET 272 150-400 1. Provide a minimum of three differential diagnoses. List them from top priority to least priority. Compare the diagnostic criteria for each, and explain what rules each differential in or out. Explain you critical thinking process that led you to the primary diagnosis you selected. Include pertinent positives and pertinent negatives for the specific patient case.
Phlebotomy Essentials
6th Edition
ISBN:9781451194524
Author:Ruth McCall, Cathee M. Tankersley MT(ASCP)
Publisher:Ruth McCall, Cathee M. Tankersley MT(ASCP)
Chapter1: Phlebotomy: Past And Present And The Healthcare Setting
Section: Chapter Questions
Problem 1SRQ
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Question: HPI: Ms. Lewis is a 63-year old female who comes into your office with concerns of low blood sugar... Flag HPI: Ms. Lewis is a 63-year old female who comes into your office with concerns of low blood sugar in the morning, fasting. She reports seeing blood sugar as low as 50 fasting in the mornings for the last few weeks. She has a known history of Diabetes, Hypertension, Hyperlipidemia, and Chronic Osteoarthritis. She also reports elevated blood pressure. Her blood pressure at presentation is 165/90. Ms. Lewis is a 63 y/o female who is AAOX4. She makes no unusual motor movements and demonstrates no tics. She denies any visual or auditory hallucinations. She denies any suicidal thoughts or ideations. She denies any falls, denies any pain. (All other Review of System and Physical findings are negative other than stated.) Vital Signs: BP 165/90, HR 89, RR 20, Temp 98.1 PMH: Hypertension, Hyperlipidemia, Diabetes, Chronic Osteoarthritis Allergies: Penicillin, lisinopril Medications: Women’s One A Day-Multivitamin daily Chlorthalidone 25mg daily Fish Oil 1 tablet daily Amlodipine 5mg p.o. daily Atorvastatin 40mg p.o. at bedtime daily Novolog 10 units with meals TID Aspirin 81mg p.o. daily Lantus 25 units Subcutaneous nightly Ergocalciferol 50,000 units PO once a month Social History: as stated in Case Study ROS: as stated in Case study Diagnostics/Assessments done: CXR- Last cxr showed no cardiopulmonary findings. Within normal limits. Basic Metabolic Panel and CBC as shown below Vitamin D Level- as noted below in lab results TEST RESULT REFERENCE RANGE GLUCOSE 85 65-99 SODIUM 134 135-146 POTASSIUM 4.2 3.5-5.3 CHLORIDE 104 98-110 CARBON DIOXIDE 29 19-30 CALCIUM 9.0 8.6- 10.3 BUN 20 7-25 CREATININE 1.01 0.70-1.25 GLOMERULAR FILTRATION RATE (eGFR) 76 >or=60 mL/min/1.73m2 TEST RESULT REFERENCE RANGE Vitamin D 1,25 OH 58 36-144 TEST RESULT REFERENCE RANGE WBC 7.3 3.4- 10.8 RBC 4.31 135-146 HEMOGLOBIN 14 13-17.2 HEMATOCRIT 42% 36-50 MCV 90 80-100 MCHC 34 32-36 PLATELET 272 150-400 1. Provide a minimum of three differential diagnoses. List them from top priority to least priority. Compare the diagnostic criteria for each, and explain what rules each differential in or out. Explain you critical thinking process that led you to the primary diagnosis you selected. Include pertinent positives and pertinent negatives for the specific patient case.
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