You are working in a community outpatient clinic where you perform the intake assessment on R.M., a 38- year-old woman who is attending graduate school and is very sedentary. She reports overwhelming fatigue that is not relieved by rest. She states that she is so exhausted that she has difficulty walking to class and trouble concentrating when studying. Her face looks puffy, and her skin is dry and pale. She also reports generalized body aches and pains with frequent muscle cramps and constipation. You notice that she is dressed inappropriately warm for the weather. Initial vital signs were 142/84, 52, 12, 96.8®F.
1. Compare her VS with those of a healthy person her same age.
Her temperature is low: 96.8®F Normal range is 97.8®-99®
Her BP is elevated: 142/84 Normal range is 120/80
Heart rate is low (Bradycardia): 52 Normal range is 60-100
Respiratory rate is on the low end of normal: 12 Normal range 12-25
2. List eight general questions you might ask R.M. to get a "ball park" idea of what is going on with her. 1. Does your family have history of thyroid, adrenal, or pituitary disease? 2. Is there a history of diabetes in your family?
3. Have you had weight fluctuation over the past 6 months?
4. How has your appetite been over the past 6 months?
5. Have you been exceptionally anxious or nervous?
6. What have your sleep patterns been like?
7. Have you had any radiation therapy to your head and/or neck? 8. Have your menstrual periods been altered?
3. You know that potential causes of R.M.'s symptoms include depression, hypothyroidism, anemia, cardiac disease fluid and electrolyte imbalance and allergies. As part of your screening procedures, describe how you would begin to investigate which of these conditions probably do not account for R.M.'s symptoms. During the physical assessment, a focus should be on auscultation of the heart and lungs for S/S of cardiac problems. In the case of R.M. there should not be any abnormalities....
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