Get Answer: Module Lesson Elderly Question Guide
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Original Question
Module 2 Lesson 2: Elderly Discussion Case Scenario and Rubric 85-year-old-female with type 2 diabetes mellitus with neuropathy, hypertension, rheumatoid arthritis, iron deficiency anemia, hypokalemia, and obesity. Patient is well known to you and in for scheduled visit. Upon entering the examination room, you observed patient sitting in chair with her head down avoiding eye contact, with sad facial expression and depressed mood. When you ask patient what she is in for today? Patient shows you her arms which have various sized abrasions and bruises on hands, wrists, and lower arms. You asked patient if she would give you more information about what’s going on. Patient reports that there has been a change in her living condition since last visit to the clinic 3 months ago. Patient reports that 10 weeks ago her daughter lost her job and her daughter and her daughter’s four children moved in with her 2 months ago. Patient reports that she has not been sleeping well at night and not getting much rest during the day due to excessive amount of noise and moving around in the house. Patient’s glucose log shows an average of 78mg/dl (fasting) to an average of 180 mg/dl (2 hours after eating), which is in target range for patient. She denies signs or symptoms of hypo/hyperglycemia. Patient admits to not taking medications as prescribed and sometimes not eating but once a day. Patients reports since her daughter moved in sometimes there are no food in the house and on separate occasions, she has given her daughter a $50.00 bill to pay $1.00 co-pay for Metformin; $20.00 bill to purchase to a dozen of eggs; $50.00 bill to purchase thirty Tylenol Arthritis tablets; and patient reports her daughter does not give her any change back. Three weeks ago, patient reports she had not had any visitors and $540.00 was taken from her purse. Patient reports that sometimes her daughter is rough with her. Patient shows you her arms which have various sized abrasions and bruises on hands, wrists, and lower arms. Medications: Metformin 1000 mg 1 tab twice a day for high blood sugar. Take with food. Gabapentin 600 mg 1 tab every morning, 300mg every 12 noon, and 600 mg at bedtime for neuropathy. Olmesartan/HCTZ 20/25 1 tab every morning for high blood pressure. Hydroxychloroquine 100 mg 1 tab twice a day for rheumatoid arthritis Methotrexate 2.5 mg 5 tabs once a week for rheumatoid arthritis Vitron-C 1 tab daily for iron deficiency anemia KCL 20 MEq 1 tab twice a day for low potassium. Tylenol Arthritis 650 mg 1 tablet three times a day prn pain. O: Vital signs: BP 130/88; P 90; R 18; T 98.4 F(orally); HT 66 inches; Weight 229 lbs., (wt. down by 8 lbs. since last visit 3 months ago); BMI 37. Lab: HgA1c 7.8% (was 7.6% three months ago; in target range for patient). Glucose: 160 mg/dl (random, no metformin today; in target range for patient). CBC, BMP, lipid profile, liver profile, TSH , Folic acid, Urine albumin, and U/A. All lab results in normal range. Other than: patient avoiding eye contact; sad facial expression and depressed mood; abrasions and bruises on bilateral arms, wrists, and hands; the provider’s physical assessment is normal for this woman age and health status. Questions: List 2 questions would you ask the patient and why? List 1 to 2 new dxs related to today’s visit? What actions would you implement at this visit and why?
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