Question

S.P. is a 75-year-old female who presents to the provider’s office with fatigue.

Subjective Data

PMH: HTN, hyperlipidemia, MI 3 years ago

Fatigue started about a month ago, getting worse

Relieved with rest, exacerbated with activity

Denies chest pain

Ankles swollen

Objective Data

Vital signs: T 37 P 112 R 18 BP 110/54

Lungs: bilateral lower lobe crackles

O2 Sat = 94%

Skin = cool to touch

CV = heart rate regular, positive peripheral pulses, ECG = no changes

+2 edema bilateral ankles

Medications: Metoprolol 20 mg per day, 325 mg of aspirin per day

Questions

1. What other questions should the nurse ask about the fatigue?

2. What other assessments are necessary for this patient?

3. What are some causes of fatigue?

4. Develop a problems list from the objective and subjective data.

5. What should be included in the plan of care?

6. Based on the readings, what is the most likely cause of fatigue for this patient?

Answer 1

#1. WHAT OTHER QUESTIONS SHOULD THE NURSE ASK ABOUT THE FATIGUE? The nurse can ask about 1. what time do you go to sleep in the night? ( because changes in bed times can cause fatigue) 2. Do you have pain at night? ( because patient have the symptom of chest pain and to know how often) 3. What medicines do you take at night? #2.OTHER ASSESSMENTS:a) Routine laboratory test ( Hemoglobin, serum creatinine and lipid profile) b) Chest x-ray ( to find out lung congestion) c) Electrocardiogram ( to find out the rhythm and cardiac changes) and d) Echocardiogram ( to find out the cardiac functions). #3. SOME CAUSES OF FATIGUE: Fatigue means feeling of extreme tiredness. The causes of fatigue includes a) endocrine/ metabolic disorders such as anaemia, hypothyroidism, kidney and liver diseases, diabetes and electrolyte imbalance. b) Infections causing such as hepatitis, influenza, malaria, tuberculosis and HIV infections. c) cardiac and pulmonary diseases( congestive heart failure, coronary artery disease, valvular heart disease, asthma, chronic obstuctive pulmonary disease and pneumonia. d) medications such as antidepressants, sedative, and hypertension medications causes fatigue. e) sleep problems and f) vitamin deficiencies such as vitamin B12 deficiency, vitamin D deficiency, iron deficiency causes fatigue. #4. LIST OF DISEASES: From the list of signs and symptoms from objective and subjective data, the patient may have problems like cardiac, pulmonary and kidney failures. #5. PLAN OF CARE: a) continuous monitoring of vital signs (temperature, blood pressure , heart rate and respiration) b) restrict the fluid intake to 1liter/day c) monitor the intake and output chart. d) weight daily to monitor the fluid status in the body e) evaluate daily the degree of scale of edema and ascultate lung and heart sounds. f) assist the patient to maintain a position of comfort to reduce fatigue and to reduce the distress. g) turn the patients position frequently to prevent from bedsore because of fluid overload. h) chest physiotherapy to reduce the lung secretions and to prevent from any other complications and i) oxygen therapy. #6. These symptoms that patient experience is because of low cardiac output.