Question

Part 2

M.A. 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 fatigue?
2. What other assessments are necessary for this patient?
3. What are some causes of fatigue?
4. Develop a problem list from 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

First of all i like to define you all the terms used in this case study to get you easily familiar with the case of the patient :-

HYPERTENSION :- Blood pressure is the force exerted by circulating blood against the walls of the body’s arteries, the major blood vessels in the body. Hypertension is when blood pressure is too high.

Blood pressure is written as two numbers. The first (systolic) number represents the pressure in blood vessels when the heart contracts or beats. The second (diastolic) number represents the pressure in the vessels when the heart rests between beats.

Hypertension is diagnosed if, when it is measured on two different days, the systolic blood pressure readings on both days is ≥140 mmHg and/or the diastolic blood pressure readings on both days is ≥90 mmHg.

HYPERLIPIDEMIA :-Hyperlipidemia means there is too much cholesterol in the blood.

Cholesterol is a waxy fat molecule that the liver produces. It is essential for healthy cell membranes, brain functioning, hormone production, and vitamin storage.

There are two types of proteins, or lipoproteins, that transport cholesterol to the cells: Low-density lipoproteins (LDL), or bad cholesterol, and high-density lipoproteins (HDL), or good cholesterol. LDL has damaging effects on health. HDL, however, counteracts the effects of LDL.

Triglycerides are another type of fat in the blood. They are not a type of cholesterol but have a strong association with heart disease. As such, doctors also measure triglyceride levels in people with hyperlipidemia.

A person can develop hyperlipidemia if they have one or a combination of the following:

• high LDL levels
• high HDL levels
• elevated levels of triglycerides.

FATIGUE :- Fatigue can be described as the lack of energy and motivation (both physical and mental). This is different than drowsiness, a term that describes the need to sleep.

Individuals with fatigue may have three primary complaints; however, it can vary in each person.

1. There may be lack of motivation or the ability to begin an activity;
2. the person tires easily once the activity has begun; and
3. the person has mental fatigue or difficulty with concentration and memory to start or complete an activity.

ECG :- An electrocardiogram (ECG or EKG) records the electrical signal from your heart to check for different heart conditions. Electrodes are placed on your chest to record your heart's electrical signals, which cause your heart to beat. The signals are shown as waves on an attached computer monitor or printer.

CV:- CV Health is a cardiovascular risk assessment that analyzes blood for lipid markers and independent risk factors leading to cardiovascular disease (CVD). Traditional lipid markers (such as LDL/HDL cholesterol and triglycerides) while informative, do not fully account for individual cardiovascular risk.

CV Health assesses a combination of standard lipid markers and advanced biomarkers that provide information on cholesterol metabolism, inflammation, and insulin resistance. With this information, clinicians can develop targeted treatments addressing specific metabolic areas to help minimize risk and support improved cardiovascular health.

Now at last coming to the case is as:-

Ans1. The questions the nurse should ask related to be fatigue:-

Since how long you are facing the edema and fatigue ?

Do you face edema during walking or even in rest?

What is the pattern of urine you excrete its colour, odour and frequency?

Do you feel chest pain or dyspnea?

What is your lifestyle habits like alcohol tobbacco kr other drugs related?

Do you exercise ?

Waht is you dietic pattern and sleep pattern?

Do you feel weakness or bodyache or fever due to daily activities or just being resting?

Ans2. Urinanalysis, CBC, Creatinine level test, glucose level test , sodium test, liver function test, kidney function test are the various tests may need to be done to the patient.

Ans3. Causes of fatigue :-

Fatigue is associated with many health conditions and lifestyle factors.

Mental health issues

Fatigue is a common symptom of clinical depression, either due to the depression itself or associated problems, such as insomnia

• stress
• bereavement and grief
• eating disorders
• anxiety
• boredom
• emotional exhaustion or burnout
• life events, such as moving home or getting a divorce

Endocrine and metabolic reasons

Health conditions and other factors that affect hormones can cause fatigue. These include:

• Cushing’s syndrome
• kidney disease
• electrolyte problems
• diabetes
• thyroid conditions
• pregnancy
• hormonal contraception, including birth control pills and the implant

Drugs and medications

Certain drugs and medications can cause fatigue. These include:

• some antidepressants
• anxiety medications
• antihypertensives
• statins
• steroids
• antihistamines
• sedatives

Medication withdrawal can also cause fatigue until the body adjusts. Changes in dosage can also be a cause.

Heart and lung conditions

Heart and lung conditions can affect blood flow in the body or cause inflammation and may lead to fatigue. These include:

• pneumonia
• arrhythmias
• asthma
• chronic obstructive pulmonary disease
• valvular heart disease
• coronary heart disease
• congestive heart failure

Sleep problems

The following sleep factors can also lead to fatigue:

• working late
• working shifts
• jet lag
• sleep apnea
• narcolepsy
• insomnia
• reflux esophagitis

Chemicals and substances

Vitamin deficiencies, mineral deficiencies, and poisoning can all affect sleep and cause fatigue.

Consuming caffeinated or alcoholic beverages can also disrupt normal sleep, especially close to bedtime. Using products containing nicotine can also disrupt sleep.

Medical conditions

Several medical conditions can cause fatigue, including:

• anemia
• diabetes
• high blood pressure
• obesity
• heart disease
• chronic fatigue syndrome
• weakened immune system function
• fibromyalgia
• systemic lupus
• rheumatoid arthritis
• gastroesophageal reflux disease
• inflammatory bowel disease
• cancer and cancer treatments, including chemotherapy and radiation therapy
• massive blood loss

Fatigue can also be a symptom of infection. Some infections that cause extreme tiredness include:

• malaria
• tuberculosis
• infectious mononucleosis
• cytomegalovirus
• HIV
• flu
• hepatitis

Chronic pain

People with chronic pain may wake up frequently throughout the night. They may also wake up feeling tired and poorly rested, having been unable to get good quality sleep.

The combination of chronic pain and a lack of sleep can cause persistent tiredness and fatigue.

Being overweight or underweight

Overweight increases the risk of fatigue by increasing the risk of conditions that have fatigue as a common symptom, such as diabetes or sleep apnea.

Carrying more weight and experiencing joint or muscle pain can lead to or exacerbate fatigue.

Similarly, people with underweight may tire easily, depending on the cause of their condition. Eating disorders, cancer, chronic diseases, and an overactive thyroid can all cause weight loss, as well as excessive tiredness and fatigue.

Too much or too little activity

A person with fatigue may not feel able to exercise, and a lack of exercise can cause further fatigue. A lack of exercise may eventually cause deconditioning, making it harder and more tiring to perform a physical task.

Ans 4. Metoprolol is used with or without other medications to treat high blood pressure (hypertension). Lowering high blood pressure helps prevent strokes, heart attacks, and kidney problems. This medication is also used to treat chest pain (angina) and to improve survival after a heart attack.

Aspirin is used to reduce fever and relieve mild to moderate pain from conditions such as muscle aches, toothaches, common cold, and headaches. It may also be used to reduce pain and swelling in conditions such as arthritis. Aspirin is known as a salicylate and a nonsteroidal anti-inflammatory drug (NSAID). It works by blocking a certain natural substance in your body to reduce pain and swelling.

As per the case the patient is on these medications to take and other diagnosis and complains shows that the patient was on high risk for heart problem due to being hypertensive and hyperlipidemic .

Ans5. :- Plan of care to be mantained is:-

Put your legs on pillows to raise them above your heart while lying down.

Exerciseyour legs.

Follow a low-salt diet, which may reduce fluid buildup and swelling.

Eat heart-healthy foods

A few changes in your diet can reduce cholesterol and improve your heart health:Reduce saturated fats.

• Eliminate trans fats.
• Eat foods rich in omega-3 fatty acids.
• Increase soluble fiber.
• Add whey protein.

Exercise on most days of the week and increase your physical activity

Exercise can improve cholesterol. Moderate physical activity can help raise high-density lipoprotein (HDL) cholesterol, the "good" cholesterol. With your doctor's OK, work up to at least 30 minutes of exercise five times a week or vigorous aerobic activity for 20 minutes three times a week.Adding physical activity, even in short intervals several times a day, can help you begin to lose weight.

Quit smoking

Quitting smoking improves your HDL cholesterol level.

Drink alcohol only in moderation

If you drink alcohol, do so in moderation. For healthy adults, that means up to one drink a day for women of all ages and men older than age 65, and up to two drinks a day for men age 65 and younger.

Too much alcohol can lead to serious health problems, including high blood pressure, heart failure and strokes.

Ans6.Main cause of fatigue may be ;-

High cholestrol

Hypertensive

Restlesness due to change in health status may lead to improper sleep pattern.

Due to medications.