Case Study 1
A 65-year-old woman presents to the office with complaints of excessive fatigue and shortness of breath after activity, which is abnormal for her. The woman has a history of congestive heart failure with decreased kidney function within the last year. The woman appears unusually tired and slightly pale. Additional history and examination rules out worsening heart failure, acute illness, and worsening kidney disease. The complete blood count (CBC) results indicate that hemoglobin is 9.5 g/dL, which is a new finding, and the hematocrit is 29%. Previous hemoglobin levels have been 11 to 13g/dL. The patient’s vital signs are temperature 98.7°F, heart rate 92 bpm, respirations 28 breaths per minute, and blood pressure 138/72. The practitioner suspects the low hemoglobin level is related to the decline in kidney function and begins to address treatment related to the condition.
Case Questions
1) Which test(s) should be performed to determine whether the anemia is related to chronic disease or iron deficiency, and what would those results show?
2) Should the practitioner consider a blood transfusion for this patient? Explain your answer.
3) Which medication(s) should be considered for this patient?
4) What considerations should the practitioner include in the care of the patient if an erythropoietic agent is used for treatment?
5) What follow-up should the practitioner recommend for the patient?
Case Study 2
A 60-year-old woman presents with fatigue, anorexia, weight loss, and a low-grade fever with duration of approximately 3 weeks. Her spouse is with her, and they are concerned about the symptoms she is experiencing. In addition, the woman reports that she has pain in her hands and stiffness that is worse in the morning. In her health history, the patient notes that her mother and sister both have rheumatoid arthritis (RA). The practitioner initially suspects RA as the diagnosis.
Case Questions
1) What are the three Healthy People 2020 objectives related to RA?
2) Using terms the non–health-care professional could understand, describe the pathophysiology of RA.
3) What diagnostic tests should the practitioner perform for this patient?
4) What are the differential diagnoses for this patient?
5) What is the initial management of RA?
6) What drug therapies may be included in the management of RA?