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86 year-old female that came to the ER on 6/9/19 with complaints of shortness of breath that had gradually worsened over 3-4 days.

She always experiences some shortness of breath and fatigue, however this episode was worse than what she normally experiences.

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What are potential differential diagnoses?

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What are potential differential diagnoses?

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Please write them in the comments below.

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coronary artery disease

hypertension

Non-ST elevation myocardial infarction (April 2019)

hyperlipidemia

left lower extremity deep vein thrombosis

depression

cerebrovascular accident

right hip arthroplasty (March 2019)

denies a history of smoking

widow and lives at an assisted living facility

2 sons - one lives 45 minutes away and other lives out of state

enjoys participating in activities but fatigue and leg weakness prevent her from participating as often as she would like

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J.W. complains of:

BLE swelling

dizziness and lightheadedness upon standing

fatigue

nocturia

RLE weakness, state she is not able to put any weight on her right leg due to it feeling “like it is going to give out,” but denies it being painful.

Fell within the last year at assisted living facility after using the bathroom

Denies any pain, fever, chills, headaches, or nausea/vomiting

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Have you narrowed down your differential diagnoses?

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Have you narrowed down your differential diagnoses?

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What are additional information would you like to know?

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What concerns do you have?  Any hematology concerns?

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Alert and oriented to person, place, and time
Vital signs: 98.3 F, 90bpm, 116/65, 25, 97% on 3L/NC.

Respirations regular, moderate depth, and slightly labored on 3 liters of humidified supplemental oxygen.  Respirations increase and become more labored during conversation and after transferring to bedside commode.  Lung sounds course and diminished throughout.

Patient denies chest pain, palpitations, and dizziness at this time. No lifts, heaves, or thrills.  Apical rate 92 and irregular.  S1 and S2 audible but faint.  Telemetry rhythm is sinus arrythmia with occasional PVC’s and PAC’s.

Skin is pale with light pink undertones throughout.  Small ecchymosis spots scattered over arms and legs.  Capillary refill brisk in bilateral upper and lower extremities.  2+/4+ pitting edema in bilateral feet and ankles.

Poster erect, bilateral upper extremity grip strength and against resistance 5/5, right lower extremity strength against resistance 4/5 and left lower extremity strength against resistance 5/5.  She is able to stand and transfer with one person assist.

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Hematology Part 1
Avatar of Allyson Dean
Allyson Dean
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5mo