Question

Mrs. M is a 68-year-old African-American female who came to the clinic due to progressive lethargy, dizziness and fatigue that began approximately three months ago. She also complains of shortness of breath, fatigue, cool lower extremities, and a beefy red tongue. She has a past medical history of type Il diabetes mellitus (DM), hypertension (HTN), coronary artery disease (CAD), and osteoporosis. She is allergic to sulfa drugs with the reaction of hives when she took the medication four years ago. Her current medications include lisinopril/hydrochlorothiazide (Prinzide) 20/12.5mg daily. aspirin 81 mg daily, atorvastatin 20 mg daily, metformin 500 mg twice daily, ergocalciferol 800 units daily and ibandronate (Boniva) 150 mg once monthly. She denies ever smoking, denies alcohol and illicit drug use. She retired four years ago and was a social worker. She has a family history of CAD, DM and HTN; her mother died at 55 years of age of heart disease and her father died of prostate cancer seven years ago. Both her sisters are living and diagnosed with HTN. This patient is 5'6" tall and weighs 200 pounds, her current heart rate is 100 bpm, BP 130/80, respirations 20 breaths per minute with an oxygen saturation of 94% on room air. Her recently drawn lab results include hemoglobin 7 g/dL, hematocrit 23%, mean corpuscular volume (MCV) 73 FL, mean corpuscular hemoglobin (MCH) 25 pictograms/cell, mean corpuscular hemoglobin concentration (MCHC) 30 g/dL, total iron binding capacity (TIBC) 550 ug/dl, serum iron 50 ug/dl, and serum ferritin 15 ng/ml. 1. What questions would be important to ask Mrs. M when evaluating these abnormal labs? Your diagnosis is not only based on your lab values but also on the patient's clinical history and presentation therefore your questions are very important. 2. When the patient is discharged home on an iron supplement what important teaching would you include regarding this medication? i.e., its administration and side effects.

Answer 1

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DEC Hnd:R Taron is best absorbel o an empty Stomach. po0oo..d.utR Thols naused and diumhaer to avoid > MiK md Not Calcium dd antucid should be tuken at the Scme time as by eating food dontuining iteinutn C, श्मी िपरगर flere als, goun) Calcium(nalk and deurg) and polyphends Ctea and Coffee) can hinder iron absorption meals. Avoid foods contoning phytates SI6.of iran supplement -constifation Nausea Vomitting