NR 511 WEEK 6 CASE STUDY DISCUSSION PART 1
WITH ANSWERS|| VERIFIED SOLUTION
Date of visit: November 7, 2017
A 56-year-old Caucasian female presents to the office today with complaints of fatigue. Upon
further questioning you discover the following subjective information regarding the chief
complaint.
1. Briefly and concisely summarize the H&P findings as if you were presenting it to
your preceptor using the pertinent facts from the case. Use shorthand where possible and
approved medical abbreviations. Avoid redundancy and irrelevant information.
56yo Caucasian female with a hx of HTN and depression that presents with CC of
constant generalized fatigue. Reports fatigue started 2-3 months ago and has progressively gotten
worse. Reports feeling tired all the time and "no energy to do anything I normally can do".
Despite getting 8hrs of sleep per night she does not feel well rested. Fatigue is worse with
exertion. Symptoms have been severe enough to cause her to miss 1 day of work because she
“couldn’t get out of bed”. Family hx significant for T2DM and heart disease. – Tobacco, +
ETOH (wine) occasionally. Takes Multivitamin, B-Complex, Prozac 20mg, Bisoprolol-HCTZ
2.5mg/6.25mg, Calcium 500mg + Vit D3 400IU. Allergic to iodine dyes. Reports 5 lb. weight
gain in the past 6 months, + constipation, + cold intolerance, - polyuria, - polydipsia, +
depression, - SI/HI, + intermittent BLE cramping, - hair/skin/nail changes, - snoring, - hx of
OSA.
Physical exam: A/Ox3, NAD. Vitals WNL. Thyroid small, firm, no palpable masses. HEENT
unremarkable. CV and Resp WNL. Abdomen unremarkable. Skin dry, hair coarse and thick,
nails without abnormality. Strength of extremities 5/5 throughout and DTRs that were 2+ at
bilateral biceps, but 1+ at both knees and ankles.
2. Provide a differential diagnosis (minimum of 3) which might explain the patient's
chief complaint along with a brief statement of pathophysiology for each.
▪ Hypothyroidism
o Primary hypothyroidism involves dysfunction of the thyroid gland itself,
decreasing its ability to synthesize the thyroid hormone (McCance & Huether,
2014). Secondary hypothyroidism is less common and occurs as a result of
pituitary/hypothalamus gland dysfunction (McCance & Huether, 2014). Whether
its primary or secondary hypothyroidism, inadequate production of thyroid
hormone has the potential to affect all of the major organ systems in the body.
▪ Major depressive disorder (MDD)
o MDD is a chronic condition that stems from a deficiency of neurotransmitters,
such as serotonin, norepinephrine, and acetylcholine, in the brain (Dunphy,
Winland-Brown, Porter, & Thomas, 2014). Alterations in these neurotransmitters
can result in a wide array of symptoms including general sadness and anhedonia
to decreased energy levels/fatigue.
WITH ANSWERS|| VERIFIED SOLUTION
Date of visit: November 7, 2017
A 56-year-old Caucasian female presents to the office today with complaints of fatigue. Upon
further questioning you discover the following subjective information regarding the chief
complaint.
1. Briefly and concisely summarize the H&P findings as if you were presenting it to
your preceptor using the pertinent facts from the case. Use shorthand where possible and
approved medical abbreviations. Avoid redundancy and irrelevant information.
56yo Caucasian female with a hx of HTN and depression that presents with CC of
constant generalized fatigue. Reports fatigue started 2-3 months ago and has progressively gotten
worse. Reports feeling tired all the time and "no energy to do anything I normally can do".
Despite getting 8hrs of sleep per night she does not feel well rested. Fatigue is worse with
exertion. Symptoms have been severe enough to cause her to miss 1 day of work because she
“couldn’t get out of bed”. Family hx significant for T2DM and heart disease. – Tobacco, +
ETOH (wine) occasionally. Takes Multivitamin, B-Complex, Prozac 20mg, Bisoprolol-HCTZ
2.5mg/6.25mg, Calcium 500mg + Vit D3 400IU. Allergic to iodine dyes. Reports 5 lb. weight
gain in the past 6 months, + constipation, + cold intolerance, - polyuria, - polydipsia, +
depression, - SI/HI, + intermittent BLE cramping, - hair/skin/nail changes, - snoring, - hx of
OSA.
Physical exam: A/Ox3, NAD. Vitals WNL. Thyroid small, firm, no palpable masses. HEENT
unremarkable. CV and Resp WNL. Abdomen unremarkable. Skin dry, hair coarse and thick,
nails without abnormality. Strength of extremities 5/5 throughout and DTRs that were 2+ at
bilateral biceps, but 1+ at both knees and ankles.
2. Provide a differential diagnosis (minimum of 3) which might explain the patient's
chief complaint along with a brief statement of pathophysiology for each.
▪ Hypothyroidism
o Primary hypothyroidism involves dysfunction of the thyroid gland itself,
decreasing its ability to synthesize the thyroid hormone (McCance & Huether,
2014). Secondary hypothyroidism is less common and occurs as a result of
pituitary/hypothalamus gland dysfunction (McCance & Huether, 2014). Whether
its primary or secondary hypothyroidism, inadequate production of thyroid
hormone has the potential to affect all of the major organ systems in the body.
▪ Major depressive disorder (MDD)
o MDD is a chronic condition that stems from a deficiency of neurotransmitters,
such as serotonin, norepinephrine, and acetylcholine, in the brain (Dunphy,
Winland-Brown, Porter, & Thomas, 2014). Alterations in these neurotransmitters
can result in a wide array of symptoms including general sadness and anhedonia
to decreased energy levels/fatigue.
