Good Evening Dr. Johnson and Class, This is a 56 y.o. Caucasian female with CC of fatigue which started about 2-3 months ago. Pt describes it as “no energy to do anything I normally can do”. Fatigue is generalized, constant, and worsening, aggravated with exertion and not relieved by rest. She reports sleeping 8-9 hours per night without feeling rested. There are no associated symptoms like pain. Denies any treatment. Fatigue is severe enough that she missed a day of work 2 weeks ago because she couldn’t get out of bed. ROS is significant for 5 lb weight gain over 6 months, (+) cold intolerance, (+)constipation, generalized muscle weakness and intermittent muscle cramping in the calves, reports worsening depressive symptoms but relates it …show more content…
Depression Pertinent (+) - fatigue upon awakening, not relieved by rest, personal and family h/o depression, worsening depressive symptoms, Prozac 20mg Pertinent (-)- no pain, no changes in sleep pattern, sleeps 8-9 hours/day, denies any suicidal or homicidal thoughts, pleasant mood and is appropriate Differential in order of priority: Hypothyroidism Fatigue related to medication adverse effects (Prozac and Bisoprolol/HCTZ Depression Tests to confirm diagnosis. Thyroid panel that includes TSH, and FT4 to diagnose hypothyroidism (Gregory, 2014). To determine if fatigue is caused by medication side effects a CBC will be done to rule out aplastic anemia. Anemia causes fatigue in adults and can be easily diagnosed by a complete blood count (Hennek et al., 2016). A CMP will also be ordered to rule out hypercalcemia, kidney and liver disease (NIH-U.S. National Library of Medicine,
She had a two week history of feeling generally unwell, complaining of tiredness and lethargy. She had no other significant symptoms. Her past history includes well controlled asthma and anxiety. She was a smoker of 20 cigarettes per day. She was taking amitriptyline, Symbicort (budesonide and formoterol inhaler). She had no significant family history of medical illness and had no clinical findings on examination. Blood tests showed corrected calcium of 4.22mmol/L (NR 2.20 -2.60) with suppressed paired PTH of 1.45pmol/L (NR1.60- 6.9). Her renal function was initially impaired, but normalized with rehydration. Her liver function tests, full blood count, vitamin D, myeloma screen and serum ACE levels were all within normal limits. Ultra sound scan (USS) of kidneys, USS of parathyroid and computerized tomography (CT) of thorax, abdomen and pelvis were all reported as normal with no cause found for her
This is another property which relates the fatigue to tensile property of any material. It can be defined as the ratio of the endurance limit (Se) to the ultimate strength (Su) of the material of any structure. The value of fatigue ratio ranges from 0.25 to 0.60. It’s value solely depends upon the type of the material.
A considerable amount of literature has been published on the impact of working hours (8 vs. 12 hour shifts) on fatigue among the nurses. These studies revealed that twelve-hour shifts increase the risk of fatigue, reduce the level of alertness and performance, and therefore reduce the safety aspect compared to eight-hour shifts (Mitchell and Williamson, 1997; Dorrian et al., 2006; Dembe et al., 2009; Tasto et al., 1978). Mills et al. (1982) found that the risk of fatigues and performance errors are associated with the 12-hour shifts. Beside this, Jostone et al. (2002) revealed that nurses who are working for long hours are providing hasty performance with increased possibility of errors.
Alarm fatigue is a growing problem that causes nurses to feel overwhelmed and not perform to the best of their abilities. Many people don’t understand the concept of alarm fatigue until they are in a hospital and hear the different noises going on first hand. Alarm fatigue occurs when nurses or other health care members have sensory overload due to the alarms, which then lead to ignoring the alarms raising concerns with patient safety (Horkan, 2014).
MEDICAL UPDATE: Client continues to report shoulder, neck, and left arm pain, numbness. She also reported dizziness and sore finger. Client report she goes for pain management and Spine Specialist. Client also sees Neurology. She also reported last week she picks her a copy of the blood work and Vitamin D deficiency and everything is ok. Client reported Vitamin D deficiency is on the border line. SHE also reported follow up appointment with her PCP today and with the Spine doctor 8/5/2016 and Neurology 7/27/2016. Client reported no changes in medications.
Aviation Maintenance Technicians (AMTs) regularly work extended hours and throughout the night (Rankin, n.d.). The pressure of working during those late hours and under severe time constraints, the safety consequences of maintaining an aging aircrafts, and other factors had affected the performance of AMTs in the aviation industry. According to the FAA, such type of occupation with long extend hours of work can lead to a sleep deprivation, which can lead to fatigue. The FAA also said fatigue is considered as a major human factor that lead to many maintenance errors that resulted in many aircraft accidents. The fatigue can be physiological or psychological in nature (FAA). An AMT provide an important service to the aviation industry, and then it is important to realize the role of fatigue in AMT operations, because when an AMT is not performing according to standards, it could compromise the safety of the aircraft.
The problem list for JM includes: ineffective management of therapeutic regimen; nutrition imbalance, and sedentary lifestyle. If assessment of her medication regimen indicates
During the assessment, the patient would answer questions appropriately then often had a blank stare during questioning. At times he would answer all questions appropriate and accurately then the blank stare would return. In review of the patient’s history his spouse told me he had a history of depression, DM, and HTN. His history was negative for CHF and CVA. The patient was on Metformin, Lisinopril, and Effexor. He had no recent medication changed. In the review of systems, the patient denied all other symptoms including headache, fever, signs of UTI, signs of stroke, and all other pertinent complaints. He denies any new stressors.
Alarm fatigue is a growing concern in our healthcare system and nursing care today. Studies have shown that as many as 86% to 99.4% of alarms that sound by physiological monitors are false-positives that do not result in a change in patient care (Graham, 2010). The primary objective of physiological alarms on the nursing units is to notify the clinicians to a patient’s deteriorating status in order for timely and proper action to be taken before an adverse outcome occurs. Due to the high volume of false-positive alarms, over time, these alarms start to be taken less seriously, slowing reaction time to a possible patient’s problem, or being ignored all together. Alarm fatigue can be challenging due to the fact that it involves both technical
The patient, TM, for this case example, is a 26-year-old male with a history of schizoaffective disorder, depressed type.
To diagnose RMS, patients must go through lab studies, genetic studies, imaging studies, and biopsy. Lab studies include complete blood count (CBC) to detect anemia or pancytopenia, liver function tests (LFTs) including LDH, AST, ALT, alkaline phosphatase, and bilirubin levels which all detect proper function of the liver, renal function tests (RFTs) including BUN and creatinine levels, urinalysis to detect hematuria, and blood electrolyte and chemistry. Genetic studies include fluorescent in situ hybridization (FISH) and reverse transcriptase when FISH is unavailable or ineffective. Imaging studies include plain radiology, CT scanning, MRI, bone scanning, ultrasonography, and
The patient described above presented with typical symptoms, complaints, and measureable data. The recommended treatment goals are supported by the current literature and combine proven behavioral, psychological, and pharmacological strategies and well as strength training regimens.
One of the fundamental restrictions on human achievement both in sport and in society is fatigue. Despite this, many people do not fully understand how or even why they experience fatigue. Comprehension of such ideas can allow individuals to perform at their maximum ability in their community and, in the case of athletes, when training and competing in sport. There are countless factors that play a role in the production and management of fatigue. Recovery and nutrition are two of these factors that are both essential to the process of fatigue and can be relatively easily controlled and manipulated by an individual. Recovery concerns the dissolution of fatigue through the management of workload in both long-term and short-term settings.
Fatigue in aviation has always been a significant issue when it comes to the safety of the crew and passengers. Fatigue in flight is not the only issue. There is also a serious safety issue in other areas of aviation such as maintenance, air traffic control (ATC), and even in areas such as baggage claim and gate security. One can find evidence of fatigue in just about every aspect of daily life. A majority of vehicle accidents can be contributed to fatigue in one way or another. One can even see it in the late night college student trying to finish a paper before its deadline. Although the last example doesn’t have any serious safety concerns it is still a very real instance of fatigue. The area of transportation has seen thousands of incidents where fatigue has
Patient A: 45 Y/O AAF present with fatigue x2 months with some SOB with activities; no previous health