Fluent Essays

Please kindly answer question 10-14 only Case Study #1 Addison CC: I’ve been feeling weaker and more tired over the past 4 months, but it has taken a more severe turn for the worst since last week. I haven’t been able to enjoy any outdoor activities with my family but, for some strange reason, I’ve been getting an unusual tan” HPI: C.K is 48-year-old white woman who presents o her sister’s primary care provider with loss of appetite, progressive fatigue, and mild nausea for the past five days. Ck and her husband are visiting her sister in Wyoming for 2 weeks but she has not felt well enough to bicycle, hike, or climb for the past week. Her sister has insisted that she see a health care professional PMH Appendicitis 10 years ago Seroconverted to PPD (+) 6 years ago: treated for 12 month with INH Pernicious anemia X5 years Hypercholesterolemia X1 year, controlled with diet and exercise FH 2 sister with Hashimato thyroiditis and 1 sister with graves disease SH Drinks wine with dinner Denies tobacco use with IVDU Travels Walks Medication Cyanocobalamin 200 ug IM on the 15th of every month (recently increased dose) ROS Swelling of the face Big red rash that covered her torso and face, repeated fevers Denies chills, SOB, night sweats and cough. + weight loss of 6 LBS, + salt cravings, + dizziness, one fainting spell 6 months ago, +aches and pains, -recent changes in vision, - changes in menstrual cycle, +prominent tanning of the skin although denies sun exposure. Gen: Tired looked Vital signs BP 95/75 P 83sitting rt arm BP 80/60 P 110 standing rt arm RR 14 T 98.0 HT 5’6 WT 124 LBs Skin Intact, warm and very dry Subnormal turgor Pigmented skin cr3eases on palms of hands and knuckles Generalized tanned appearance Sparse axillary hair HEENT Dry mucous membranes Nect Supple with normal thyroid and no masses Shotty lymphadenopathy Lungs Clear, normal vesicular and bronchial lung sounds Breast Hyperpigmentation prominent along brassiere lines Very dark areolae Cardiac Normal ABD Soft + BS GU LMP 2 weeks ago MS Pigmented skin creases on elbows Pedal pulses moderately weak at +1 Lab Na 126 Hct 33.2% Alk Phos 115 IU/L K 5.2 RBC 4.1 Bilirubin 1.2 Cl 97 MCV 85 Protein 8.0 HCO3 30 Plt 41 Albumin 4.7 Bun 20 WBC 6,800 Cholesterol 202 CR 1.2 Neutros 49% Triglycerides 159 Glu 55 Lymph 36% Fe 89 Ca 8.8 Monos 7% TSH 3.2 Phos 2.9 Eos 7% Free T4 16 Mg 2.9 Baso 1% Uric acid 3.6 AST 33 ACTH 947 Hb 11.4 ALT 50 Vitamin B12 UA Clear and yellow, SG 1.016, pH 6.45, -Blood Imaging Abdominal CT scan revealed moderate bilateral atrophy of the adrenal glands Rapid ACTH stimulation test Condition Cortisol Assay Aldosterone Assay Pre-cosyntropin 2.0 3.8 30 Min post cosysntropin 1.9 3..8 Antibody testing + 21-hydroxylase Negative: 17-hydroxylase Negative: C-P450 Question: 1. What is the significance of the varying BP and HR readcing with change in position by the patient 2. What is the single greatest risk factor for addision disease in this patient? 3. What is the most likely cause of Addison disease in this patient 4. Why can tuberculosis be ruled out as a cause of Addison disease in this patient 5. Which 2 test results are most suggestive of the cause of Addison deisease in this patient 6. Would supplementation with fludrocortisone be appropriated in this patient 7. Does this patient have any signs of hypothyroidism, a disorder that is commonly associated with Addison disease 8. There are 19 clinical signs and symptoms in this case study that are consistent with Addison disease. Identify 10 and why 9. Which single test result is diagnostic for Addison disease in this patient 10. Which 3 test results support the assessment that the patient’s anemia is not the result of tiron deficiency/ 11. Which 2 test result support the assessment that the patient anemia is not the result of vitamin B12 deficiency 12. Why is shotty lympadenopath consistent with a diagnosis of Addison disease? 13. What would be the plan of care for this patient 14. What are discharge instruction for this patient?