INFORMATION: Opening Scenario Judy Marland is an 81-year-old female...

Question Answered step-by-step INFORMATION: Opening Scenario Judy Marland is an 81-year-old female… INFORMATION:Opening ScenarioJudy Marland is an 81-year-old female in your office for memory problems. She is accompanied by her daughter who lives three miles away. He daughter tells you that she wanted somebody to look at her mother because she feels her mother has been getting a lot more forgetful. She forgot to pay the phone bill for two months and the phone company was threatening to shut off her phone. The daughter states that she did not notice any sudden change; it just seems to have come on gradually. You have 30 minutes scheduled to obtain a history, a physical examination, and review laboratory work that was done two months ago when Ms. Marland had cataract surgery. She is doing well postsurgery and says that her vision has improved significantly. History of Present Illness”I have problems remembering sometimes, but who doesn’t?” Based on history from her daughter, this 81-year-old woman has been becoming progressively more confused over the past two months. At times, she is unable to find rooms in her own home and has forgotten to pay bills. Ms. Marland’s history is limited by her memory and her daughter’s lack of knowledge of events in the remote past. Medical HistoryHysterectomy about 20 years ago. G3P2102. Cataract surgery 2 months ago as noted. Had been followed by Dr. Breene, who left the area about one year ago. Your practice assumed care of Dr. Breene’s patients, but no record can be found on Ms. Marland. [Instead, stat something like: Thus you do not have documentation for diagnoses and associated medications.] Family HistoryMother: Died at age 54 (breast cancer; had type 2 DM)Father: Died at age 77 (stroke; also had type 2 DM)Three Children: One son died 30 years ago (automobile accident); daughter, age 58 (A&W); son, age 54 (high cholesterol) Social HistoryDoes not smoke or drink alcohol. She is retired seamstress. Husband diet 10+ years ago from MI at age 74. Neighbor visits her at her home twice per week. She has one son who lives about 1000 miles away. Daughter lives three miles away and takes her to church on Sundays. Daughter is a school teacher, and son-in-law is an attorney. MedicationsTriamterene/hydrochlorothiazide (Dyazide), 1 tablet orally (PO) dailyAspirin, 81 mg PO dailyBenadryl, 25 mg at bedtimeTums, two tablets three times a dayMultivitamin, one tablet PO daily AllergiesNKDA Review of SystemsGeneral: Denies weight loss or gain, fatigue, fever or chills, trouble sleeping, night sweatsHEENT: Denies diplopia, blurring, hearing impairment, sore throatsCardiovascular: Denies chest pain, shortness of breath, dyspnea on exertion, paroxysmal nocturnal dyspnea, peripheral edema; denies excessive bruising;Respiratory: Denies shortness of breath, dyspnea on exertion, coughGastrointestinal: Denies anorexia, nausea, vomiting; occasional constipation, diarrhea, black or clay-colored stoolsGenitourinary: Denies dysuria, hematuriaNeurological: Denies headaches, history of head trauma; no vertigo, balance is normal subjectively; denies weakness, numbness seizures, depression, excessive stress, and anxietyMusculoskeletal: Denies joint or back pain Physical ExaminationVital Signs: Temperature 96.6 F; pulse 88 bpm; respirations 24/min; BP 108/44 mmgHgHeight: 5 ft 3 in; weight: 112 lbs; BMI: 19.8Skin: Slightly pale without open areasHEENT: Head is normocephalic, atraumatic; pupils equal, round, and reactive to light; extraocular movements intact; Snellen 20/40 using both eyes with glasses; tympanic membranes noninjected without excessive cerumen; whisper test ? bilaterally; nares patent without redness or exudate; throat is noninjected; tongue is midline; palate rises symmetrically; edentulous with well-fitting denturesNeck: supple without thyromegaly, adenopathy, or carotid bruitsHeart: Regular rate and rhythm; no rubs, or gallops; grade III/VI murmur heard at the fourth ICS LSB; peripheral pulses are 1+ popliteal, dorsalis pedis, and posterior tibial; pulses 2+ at femoral, radial, and carotidLungs: Clear to auscultation and percussion expect fine bibasilar crackles, which clear with coughingBreasts: Without dimpling, discharge, or massesAbdomen: Soft, nontender; no hepatosplenomegaly; rectal is with brown stool, no masses; stool is guaiac negativeGenitourinary: Normal externally; pelvic examination not doneExtremities: Without cyanosis, clubbing, or edema; reflexes are 2+ at the biceps, triceps, brachioradialis, patellar, and Achilles; no Babinski signs present; strength and sensation in upper and lowe extremities are symmetrical Ms. Marland’s complete blood count (CBC) (Table 46-1), chemistry profile (table 46-2), urinalysis (table 46-3), and chest x-ray (CXR) examination (Box 46-1) from cataract surgery two months ago are provided. Table 46-1Complete Blood Count for Judy Marland from 2 Months Ago CBCResultNormal RangeWBC8.24.5-10.8RBC3.454.20-5.40Hgb10.1 L12.0-16.0Hct33.2 L37.0-47.0MCV78.3 L81.0-99.0MCH28.227.0-32.0MCHC32.432.0-36.0RDW16.2 H11.0-16.0Platelets221150-450Segs66 H50-65Lymphocytes21 L25-45Monocytes80-10Eosinophils5 H0-4 Table 46-2Chemistry Profile for Judy Marland from 2 Months Ago TestResultsNormal RangeFBS130 H60-100BUN27 mg/dL18-28Creatinine1.0 mg/dL0.5-1.5Sodium128 L135-145Potassium5.33.5-5.5Chloride10495-105Albumin3.7 g/dL L4.0-6.0Total Protein6.3 g/dL6.5-8.0Alkaline phosphatase100 U/L30-120ALT (SGPT)220-40AST (SGOT)28 U/L0-40LDH134 U/L50-150Cholesterol252 mg/dL110-200Calcium8.6 mg/dL L8.8-10.2GGT290-30Magnesium2.11.6-2.4Bilirubin0.7 mg/dL0.1-1.0Conjugated bilirubin0.10.0-0.2Iron1760-160Uric Acid6.3 mg/dL2.0-7.0 Table 46-3Urinalysis for Judy Marland from 2 months agoColorYellowCharacterClearSpecific gravity1.025Urine pH5.0GlucoseNegativeNitriteNegativeWBCs0-2RBCs0-1Epithelial cells0-5CrystalsNone Box 46-1 Chest X-Ray Examination for Judy Marland from 2 Months AgoThe lung fields are clear of infiltrates. The pulmonary vasculature and markings are normal. The heart size is within the upper range of normal limits.Impression: Normal chest x-ray.Boyd Bates, DOQUESTIONS:What are the learning issues that are important to explore in this case? What are the problems or issues that will guide the patient’s care? What are the plans for addressing each of the problems or issues in the assessment? Health Science Science Nursing NURS 6613 Share QuestionEmailCopy link Comments (0)