A 78-year-old female comes to your office escorted by a neighbor who is a patient of yours. The neighbor, who has lived next door to the older woman for years, relates that a week ago the elderly womans sister died and that she had been her caregiver for many years. The neighbor relates that although she would occasionally see the older woman, she did not visit the home. At the funeral last week, she noticed that the woman appeared fatigued, confused, sad, and gaunt in appearance. Later the neighbor approached the woman, inquired about her health, and determined that the woman had a very difficult time the past couple of months, caring alone for her sister until the end when hospice care was initiated. The neighbor convinced the woman to seek medical care and today is the first appointment with a provider that this 78-year-old female has had in 3 years. The older woman states that she is very fatigued and sad over the loss of her sister. Neither her sister nor the patient has been married. A distant niece came to the funeral but lives about 30 miles away. The woman states that she is not taking any prescription medication and relates no medical problems that she is aware of being diagnosed.

Vital signs: T 97.6F, HR 98, RR 22, BP 95/60, BMI 21

Chief Complaint: Fatigue and sadness over the death of her older sister.

Discuss the following:

1) What additional subjective information will you be asking the patient?
2) What additional objective findings would you be examining the patient for?
3) What are the differential diagnoses that you are considering?
4) What laboratory tests will help you rule out some of the differential diagnoses?
5) What screening tools will you select to use on this patient?
6) What is your plan of care?
7) What additional patient teaching may be needed?
8) Will you be looking for a consult?

Submission Instructions:

Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources. Your initial post is worth 8 points.
You should respond to at least two of your peers by extending, refuting/correcting, or adding additional nuance to their posts. Your reply posts are worth 2 points (1 point per response.)
All replies must be constructive and use literature where possible.
Please post your initial response by 11:59 PM ET Thursday, and comment on the posts of two classmates by 11:59 PM ET Sunday.
You can expect feedback from the instructor within 48 to 72 hours from the Sunday due date.
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Grading Rubric

Your assignment will be graded according to the grading rubric.

Discussion Rubric
Criteria    Ratings    Points
Identification of Main Issues, Problems, and Concepts

5 points
Distinguished

Identify and demonstrate a sophisticated understanding of the issues, problems, and concepts.

4 points
Excellent

Identifies and demonstrate an accomplished understanding of most of issues, problems, and concepts.

2 points
Fair

Identifies and demonstrate an acceptable understanding of most of issues, problems, and concepts.

1 points
Poor

Identifies and demonstrate an unacceptable understanding of most of issues, problems, and concepts.

5 points
Use of Citations, Writing Mechanics and APA Formatting Guidelines

3 points
Distinguished

Effectively uses the literature and other resources to inform their work. Exceptional use of citations and extended referencing. High level of APA precision and free of grammar and spelling errors.

2 points
Excellent

Effectively uses the literature and other resources to inform their work. Moderate use of citations and extended referencing. Moderate level of APA precision and free of grammar and spelling errors.

1 point
Fair

Ineffectively uses the literature and other resources to inform their work. Moderate use of citations and extended referencing. APA style and writing mechanics need more precision and attention to detail.

0 point
Poor

Ineffectively uses the literature and other resources to inform their work. An unacceptable use of citations and extended referencing. APA style and writing mechanics need serious attention.

3 points
Response to Posts of Peers   
2 points
Distinguished

Student constructively responded to two other posts and either extended, expanded or provided a rebuttal to each.

1 points
Fair

Student constructively responded to one other post and either extended, expanded or provided a rebuttal.

0 point
Poor

Student provided no response to a peer’s post.