Problem
Objective
Vitals: T: 98.2 P: 86 RR:28 Sa02: 93; BP 140/70 Wt: 191 Ht: 64 inches
Skin: Clear, slightly grayish color.
HEENT: Hair thinning & gray in color. Sclera nonicteric, PERLA< Oral mucosa pink & moist.
Neck: no JVD, no bruits, thyroid nonpalpable, no lymphadenopathy.
Cardiovascular: regular rate & rhythm, + systolic murmur I/VIs, pulses positive in all extremities, bilateral non-pitting edema in lower extremities, chronic lymphedema bilaterally, no ulcerations, skin intact, no hair growth.
Respiratory: lungs clear bilaterally; transverse/AP diameter 2/1 Abdomen: obese contour, soft, nontender, BS in all quadrants, no organomegaly or bruits.
Musculoskeletal: Walks with a cane, full ROM, no deformities, strength appropriate for age.
Skin: without any current suspicious lesions, rashes, or ulcers.
Neurological: Alert, interactive & oriented x3; CN I-XII grossly intact. No evidence of depression on assessment score.
Point of care lab testing done at clinic - significant findings were:
CBC: Hgb: 10.1; HCT: 29.5; FBS: 149; HbAlc: 7.2; K: 4.8; BUN: 42; Creat: 1.44; GFR: 35.
Answer the following questions:
I. What are your top four differential diagnoses?
II. What is the most likely diagnosis and why?
III. What is your treatment plan?
IV. What is your plan of follow-up care?
V. Are there any standardized guidelines that you should use to assess and treat this patient?