NR 601 Week 3 Case Study Assignment

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Discussion Part One

Katie Smith, a 65 year-old female of Irish descent, is being seen in your office for an annual physical exam. You are concerned since she has rescheduled her appointment three times after forgetting about it. She and her husband John are currently living with their daughter Mary, son-in-law Patrick, and their four children. She confesses that while she loves her family and appreciates her daughter’s hospitality, she misses having her own home. As she is telling you this, you notice that she develops tears in her eyes and does not make eye contact with you.

Background:
- Although Mrs. Smith is scheduled for an annual physical exam and reports no particular chief complaint, you will need to complete a detailed geriatric assessment. Katie reports a lack of appetite. She tells you that she nibbles most of the time rather than eating full meals. She also reports having insomnia on a regular basis.
PMH:
- Katie reports a recent bout of pneumonia approximately 3 months ago, but did not require hospitalization. She also has a history of HTN and high cholesterol.
Current medications:
- HCTZ 25mg daily
- Evista 60mg daily
- Multivitamin daily
Surgeries:
- Appendectomy as a child in Ireland (date unknown)
- 1968- Cesarean section
- Allergies: Denies food, drug, or environmental allergies
Vaccination History:
- Cannot remember when she had her last influenza vaccine
- Does not recall having received a Pneumovax
- Her last TD was greater than 10 years ago
- Has not had the herpes zoster vaccine
- Screening History:
- Last Colonoscopy was 12 years ago
- Last mammogram was 4 years ago
- Has never had a DEXA/Bone Density Test
Social history:
- Emigrated with her husband from Ireland in her 20s and has always lived in the same house until recently. She retired a year and a half ago from 30 years of teaching elementary school; has never smoked but drinks alcohol socially. She states that she does not have an advanced directive, but her daughter Mary keeps asking her about setting one up.
Family history:
- Both parents are deceased but lived disease-free up into their late 90s. She has one daughter who is 44 years old with no chronic illness and two sons, ages 42 and 40, both in good health.

Discussion Day 1:

Differential Diagnoses with rationale
Further ROS questions needed to develop DD
Based on the patient data provided, choose geriatric assessment tools that would be appropriate to use in conducting a thorough geriatric assessment. Provide a rationale on why you are choosing these particular tools.

Discussion Part Two (graded)

Physical examination:
Vital Signs:
Height: 5’0” Weight: 150 pounds BMI: 29.3 BP: 120/64 T: 98.0 oral P: 68 regular R: 16, non-labored
HEENT: Normocephalic, symmetric. Evidence of prior cataract surgery in both eyes. PERRLA, EOMI, cerumen impaction bilateral ears.
NECK: Neck supple; non-palpable lymph nodes; no carotid bruits.
LUNGS: Clear to auscultation
HEART: RRR with regular without S3, S4, murmurs or rubs.
ABDOMEN: Normal contour; active bowel sounds, LLQ tenderness.
PV: Pulses are 2+ BL in upper and lower extremities; no edema. No evidence of peripheral neuropathy.
NEUROLOGIC: Negative
GENITOURINARY: No CVA tenderness
MUSCULOSKELETAL: Gait fluid and steady. No muscle atrophy or asymmetry. Full ROM all joints. Strength 5/5 and equal bilaterally. Joint swelling in fingers both hands.
PSYCH: Flat affect; patient declined to answer PHQ-9 and GDS
SKIN: Grossly intact without rashes or ecchymosis.

Discussion Part Two:

Summarize the history and results of the physical exam. Discuss the differential diagnosis and rationale for choosing the primary diagnosis. Include one evidence-based journal article that supports your rationale and include a complete treatment plan that includes medications, possible referrals, patient education, ICD 10 Codes, and plan for follow up.