Question

Mary T. is a 29 year old referred to you because of a routine screening test, which revealed markedly elevated cholesterol. ROS identified dry skin, 10 lb. Weight gain, regular but heavy menses, easy and frequent bruising, milky breast discharge and fatigue. Meds include multivitamin and oral contraceptives.

1. What laboratory tests would you order for her?Mary further explains that she has had a stressful year. Her mother, whom she had cared for during the terminal phases of breast cancer died. She took several months off from work due to depression following her mother’s death. She now works full-time as a travel agent and discusses having difficulty concentrating. She works out of her home and cares for her 4-year-old daughter.
2. Discuss the normal grieving process in view of her symptoms?PE: BP 120/72, Weight 145, pounds Height 61 inchesSkin: dry, scaly, slight loss of scalp hair, several bruises on arms and legs, diminished DTRs, thyroid slightly enlarged.Labs: glucose and electrolytes WNL, Total Cholesterol 267/LDL 178/HDL 40/Triglycerides 167, HGB 11, HCT 33.4, TSH 20.
3. List 5 differential diagnoses based on the available data.
4. How would you explain your findings to her? What will you tell her about her labs?
5. What follow-up labs will you order and when?
6. How do you plan to treat her cholesterol? Her fatigue?

Answer 1

5 DIFFERENTIAL DIAGNOSIS

*Hyperlipideamia.

*Anaemia.

*Goiter

*Depression

*Menorrhagia

>I explain my findings to her their own language using common words and phrases instead of complex medical terms.

Have patience instructions back to me.

Use analogies, that are more easily and understood and identified by the patient.

Draw a picture, if patients needs to visualize what we are explaining.

>Tell about her labs, it indicates you have hyperlipidemia, Anaemia, goiter,

>Instruct the patient, must done routine laboratory check up monthly. TSH and cholesterol to be done early morning monthly

MANAGEMENT OF HYPERLIPIDEAMIA

*Eat heart healthy foods - A few changes in your diet can reduce cholesterol

:Reduce saturated fats.

:Eliminate trans fats.

:Eat foods rich in omega 3 fatty acids.

:Increases soluble fibre

:Add whey protien.

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

:Taking a brisk daily walking during your lunch hour.

:Riding your bike to work.

: Playing a favourite sport.

*Lose weight - Carrying even a few extra pounds contributes to high cholesterol. Look for ways to incorporate more activity into your daily routine, such as using the stairs instead of taking the elevator or parking farther from your office. Try to increase standing activities such as cooking and yard work.

*Provide cholesterol lowering drugs as per doctor's order.

MANAGEMENT OF FATIGUE

*Instruct the patient to take active and passive exercise.

*Take time to relax.

*Eat nutritional diet well.

*Practice good sleeping patterns.

*Get a message therapy is improve your sleep and decrease fatigue.

*Engage in mind body strategies.