NR601 week 6 discussion part 1 and 2

Discussion Part One

Ms. S. is a 62-year-old black female who has returned to the clinic to discuss her concerns that her lifestyle modifications to lose weight have not worked. At the last visit 3 months ago, she was advised to change her eating habits and increase activity to promote weight loss. She reports walking at least 30 minutes a day but has lost very little weight. She indicates that the walking only made her extremely thirsty and hungry and attributes her increased thirst and hunger to increased exercise and her increased urination due to drinking more water since “it’s been hot lately” and exercise makes me thirsty”. She has returned to the clinic to discuss if there is anything else that can be done to lose weight and to determine why she is so tired, thirsty and hungry all the time. She also thinks she may have an overactive bladder since she has to urinate frequently during the day, which has influenced her not to go on outings with her friends.

Discussion Questions Part One

• Conduct a ROS on this patient.
• Indicate which symptoms most are concerning to you.
• List your differential diagnoses.
• What types of screenings would be appropriate to use based on the chief complaint?
• What primary diagnosis are you choosing at this point?

Discussion Part Two (graded)

Physical Exam:

Discussion Part Two (graded)

Vital signs: blood pressure 145/90, heart rate 100, respirations 20

height 5’1”; weight 210 pounds

Labwork:

CBC: normal

UA: 2+ glucose; 1+ protein; negative for ketones

CMP: BUN/Creat. elevated; Glucose is 300 mg/dL

Hemoglobin A1c: 12%

Thyroid panel: normal

LFTs: normal

Cholesterol: total cholesterol (206), LDL elevated; HDL is low

EKG: normal

General: obese female in not acute distress

HEENT: unremarkable

CV: S1 and S2 RRR without murmurs or rubs

Lungs: Clear to auscultation

Abdomen- soft, round, nontender with positive bowel sounds present; no organomegaly; no abdominal bruits

Discussion Questions Part Two

• For the primary diagnosis, what non-pharmacological and pharmacological strategies would be appropriate?
• Include the following: lab work and screenings to be completed.
• Describe patient education strategies.
• Describe follow-up and any referrals that may be necessary.