Case Studies 3 & 4 (Combined in one)
76 y/o Hispanic female patient, who has been dealing with financial constraints in last years,
has not been able to eat properly due to her economic situation, comes to your practice c/o
that over the past 3 months she has felt increasingly tired. She states sleeping well at night. Her
vital signs are B/P 135/74, R: 16; HR: 80, T 96.8. Pt denies dyspnea or palpitations. You order
some blood work. Your patient’s chemistry panel comes back all WNL, and the fecal occult
blood test negative. All the other results are shown below:
WBC: 7600/mm3
Hematocrit: 27.3%
Hemoglobin: 8.3 mg/dL
Platelets: 151,000 /mm3
RED BLOOD CELL (RBC) indices
MCV 65mm3
MCH 31.6 pg
MCHC 35.1%
RDW 15.6%
Fe 30 mcg/dL
TIBC 422 mcg/dL
Ferritin 8 mg/dL
Vit B12 414 pg/mL
Folate 188 ng/mL
Answer the following questions:
a) Which lab values are normal, and which are abnormal?
b) Explain the significant of each abnormal value.
c) Based on these results and her history. What would be your patient’s diagnosis?
d) Epidemiologically speaking, what individuals are at risk for this condition?
e) What other signs and symptoms of this condition would you assess for in this case?
f) Which question would best help you determine the impact of fatigue on her activities of
daily living?
a. Are you upset about feeling more tired?
b. Do you sleep more now that you used to?
c. How far can you walk until you get SOB?
d. Have you been able to do what you would like to do?
g) Discuss the treatment option for her diagnosis
h) What diet you would recommend her:
a. Whole–wheat pastas and skim milk
76 y/o Hispanic female patient, who has been dealing with financial constraints in last years,
has not been able to eat properly due to her economic situation, comes to your practice c/o
that over the past 3 months she has felt increasingly tired. She states sleeping well at night. Her
vital signs are B/P 135/74, R: 16; HR: 80, T 96.8. Pt denies dyspnea or palpitations. You order
some blood work. Your patient’s chemistry panel comes back all WNL, and the fecal occult
blood test negative. All the other results are shown below:
WBC: 7600/mm3
Hematocrit: 27.3%
Hemoglobin: 8.3 mg/dL
Platelets: 151,000 /mm3
RED BLOOD CELL (RBC) indices
MCV 65mm3
MCH 31.6 pg
MCHC 35.1%
RDW 15.6%
Fe 30 mcg/dL
TIBC 422 mcg/dL
Ferritin 8 mg/dL
Vit B12 414 pg/mL
Folate 188 ng/mL
Answer the following questions:
a) Which lab values are normal, and which are abnormal?
b) Explain the significant of each abnormal value.
c) Based on these results and her history. What would be your patient’s diagnosis?
d) Epidemiologically speaking, what individuals are at risk for this condition?
e) What other signs and symptoms of this condition would you assess for in this case?
f) Which question would best help you determine the impact of fatigue on her activities of
daily living?
a. Are you upset about feeling more tired?
b. Do you sleep more now that you used to?
c. How far can you walk until you get SOB?
d. Have you been able to do what you would like to do?
g) Discuss the treatment option for her diagnosis
h) What diet you would recommend her:
a. Whole–wheat pastas and skim milk
b. Lean cuts of poultry, pork and fish
c. Beans and dark green, leafy vegetables
d. Cooked cereals, such as oats and bananas.
i) What would be your initial supplement for this patient? (be specific about the name,
dose, frequency, etc.)
j) What teaching you would you provide your patient about the supplement you just
prescribed above
