Georgina Graves is a 42-year-old female who presents to the provider’s office with fatigue.
- PMH: none, (except gynecological issues)
- Significant family history of heart disease
- Fatigue started about 2 months ago, getting worse
- Relieved with rest, exacerbated with activity
- Denies chest pain
- C/O shortness of breath on exertion
- Smoker 1 PPD
- Vital signs: T 37 P 100 R 18 BP 110/54
- Lungs: clear
- O2 Sat = 94%
- Skin = cool to touch
- CV = heart rate regular, positive peripheral pulses, ECG = intermittent complete left bundle branch block (New Finding)
Medications: Premarin 0.3 mg po/day
- What other questions should the nurse ask about the fatigue?
- What other assessments would be necessary for this patient?
- What are some causes of fatigue?
- What should be included in the plan of care?
- Based on the readings, what is the most likely cause of fatigue for this patient?
- Apa format required
- Reference:Jarvis, C. (2016). Physical examination & health assessment (7th ed.). Philadelphia, PA: Saunders.
- Chapter 18: Thorax and Lungs
- pp. 413–441 (Structure, Function, The Thoracic Cavity, Developmental Competence, Subjective Data, Objective Data)
- Chapter 19: Heart and Neck Vessels
- pp. 459–492 (Structure and Function, Heart Wall, Chambers, and Valves, Heart Sounds, Developmental Competence, Subjective Data, Objective Data )
- Chapter 20: Peripheral Vascular System and Lymphatic System
- pp. 509–529 (Structure and Function, Lymphatics, Developmental Competence, Subjective Data, Objective Data)