Instructions: Please respond to two peers’ post regarding their differential dia

Instructions:
Please respond to two peers’ post regarding their differential diagnosis list and/or plan.
What did you find interesting about their response?
How did their differential diagnosis list or plan compare to yours?
Responses need to address all components of the question, demonstrate critical thinking and analysis, and include peer reviewed journal evidence to support the student’s position.
Please be sure to validate your opinions and ideas with citations and references in APA format.
Please review the rubric to ensure that your response meets the criteria.
please use updated references for both peer response
i will provide both below
Peer#1
Dezirae Berry
Mar 5, 2023Mar 5 at 5:53pm
Unit 10 Discussion: Anemia, Infectious Disease
Pertinent Positives: female, fatigue x 3 months, increasing SOB walking up steps, increased need for sleep, memory issues, omeprazole daily use, vegetarian diet
Pertinent Negatives: Denies CP, weight gain/loss, poor appetite or swelling, abdominal pain, n/v/d, vaginal bleeding, bloody or dark tarry stools, weakness; denies NSAID or ETOH use, normal colonoscopy 5 years ago
Missing Information: How long have you been taking omeprazole? Do you take OTC supplements? How long have you been a vegetarian? What does your typical diet consist of? Are you able to afford fresh foods? Do you drink caffeine? What is your activity like day to day? How do you feel your mood has been? Do you go to counseling? Do you have new life stressors? Have you been sick recently?
Differential Diagnosis List:
Fatigue – there are many common causes of fatigue, such as recent life changes, mood disorders, medication side effects, substance overuse, infection, thyroid dysfunction, and chronic medical disease (Domino et al., 2023).
Iron deficiency anemia – Symptoms of iron deficiency anemia can include fatigue, exertional dyspnea, and inability to concentrate, and a risk factor for iron deficiency anemia is a strict vegan diet (Domino et al., 2023).
Depression – Reports hx of depression. Depression can cause symptoms such as fatigue, difficulty with concentration, and changes in sleep (Warshaw et al., 2022).
Plan: Fatigue
Diagnostics: CBC, CMP, iron studies, TSH, ESR/CRP, UA; PHQ-9/GAD-7
Therapeutic: Therapeutics would depend on further evaluation.
Educational: Omeprazole is not meant to be a long-term medication, especially in older adults, due to the increased risk of C. diff infection, bone loss/fractures, and iron deficiency anemia (Lexicomp, 2023). Recommend tapering off omeprazole. For reflux prevention, recommend elevating the head of the bed, avoid eating at least 2 hours before bedtime, and avoid foods that trigger symptoms (Domino et al., 2023). Recommend keeping a diary of symptoms. Encourage increased activity/exercise. Would discuss that vegetarians are at an increased risk for iron and vitamin B12 deficiency (Hargreaves et al., 2021). Therefore, would discuss the importance of having a well-balanced diet to ensure she is getting the vitamins and nutrients she needs. Consider OTC multivitamin with iron.
Consultation/Collaboration: Consider a dietician and gastroenterology referral.
References
Domino, F. J., Baldor, R. A., Barry, K. A., Golding, J., & Stephens, M. B. (2023). The 5-minute clinical consult: Premium 2023 (31st ed.). Wolters Kluwer.
Hargreaves, S. M., Raposo, A., Saraiva, A., & Zandonadi, R. P. (2021). Vegetarian diet: An overview through the perspective of quality of life domains. International Journal of Environmental Research and Public Health, 18(8), 4067. https://doi.org/10.3390/ijerph18084067Links to an external site.
Lexicomp. (2023). Omeprazole: Drug information. UpToDate. https://www.uptodate.com/contents/omeprazole-drug-information?source=auto_suggest&selectedTitle=1~4—1~4—omepra&search=omeprazole#F203615Links to an external site.
Warshaw, G., Potter, J. F., Flaherty, E., Heflin, M., McNabney, M., & Ham, R. J. (2022). Ham’s primary care geriatrics: A case-based approach (Seventh ed.). Elsevier.
peer#2
Haiying (Helen) Zhang
Mar 11, 2023Mar 11 at 6:33pm
NU 627 Week 10 Case Study
Pertinent positives
Subjective
CC: “I am always tired.” JL 71 y.o. F reports feeling tired for the last three months but recently has noticed shortness of breath when walking up the steps and sleeping more. She has noticed some issues with her memory as well. Follow a healthy vegetarian diet. Paternal grandmother was diagnosed with hypertension, while paternal grandfather suffered from heart disease.
PMH: GERD 2016. Depression 2000. Surgical history: R Lumpectomy 1999. Cscope/EGD 5 years ago.
Medications: Omeprazole 20mg PO daily Sertraline 50 mg PO daily
ROS
NS: Does notice some numbness and tingling at times. Has noticed more forgetfulness at times.
Skin: Wife reports pale appearance.
Objective
Constitutional: pale appearance.
HEENT: Conjunctiva pale. Angular cheilitis. Tongue beefy appearance
CVS: slight murmur is noted.
Neuro: Decrease vibratory sensation noted to hands/feet.
Skin: pale
Pertinent negatives
Subjective
She denies CP, weight gain/loss, poor appetite, or swelling. She denies abdominal pain, N/V/D. She denies vaginal bleeding and bloody or dark tarry stools. She denies taking NSAIDs, or ETOH use. She had a normal colonoscopy 5 years ago. She is retired and lives with her wife and they live off their pensions and SSI. Denies alcohol, illicit drug use, and tobacco use. Family History Her brother, and 2 sisters are alive and well; not been diagnosed with any chronic condition. Her parents are deceased, and not been diagnosed with any chronic condition. Health Maintenance UTD on all immunizations and cancer screenings for age. Has had diabetes, HTN, and cholesterol screenings, all within normal limits. Allergies: No known drug allergy.
ROS
General: Denies fever, chills, sleeping difficulties, and weight loss/gain. Denies poor appetite lightheadedness or dizziness. HEENT, Respiratory, CV, GI, GYN, GU, MSS, and psychiatric are all negative.
NS: Patient denies weakness in strength, headache, or headache. Skin: No rashes or lesions.
Objective Data
125/95mmHg. – 88 bpm. -17RR. -98.5 degrees Fahrenheit, Oxygen saturation – 100%. – Height – 5 feet 4 in. – Weight – 130 pounds. BMI=22.3
Constitutional: Alert, oriented, dressed appropriately
HEENT: Normocephalic. Lids/lashes/orbit unremarkable. No discharge. PERRL, EOMI. ENT, neck, Respiratory system, Abdominal examination, MSS, and psychiatric are all negative. CVS: Heart rate is regular, and its rhythm is normal, Pulses are symmetrical and regular. No evidence of a collapsing pulse.
Neuro: PERRLA +6mm. The cerebellar exam is intact. Skin is warm and dry. No rashes nor erythema were noted.
Missing information
I want to ask this patient how long has she been following the vegetarian diet. Does she eat eggs? Does she eat dairy products such as cheese, milk, and yogurt? How severe is her symptom? Does anything seem to improve her symptoms? Is there anything that worsens her symptoms? How many servings of fruits and vegetables does she usually eat in a day? Does she take any supplements?
Then create a differential diagnosis list with at least 3 possible actual diagnoses based on your findings.
Differential diagnosis:
D51.9 -Vitamin B12 deficiency anemia, unspecified (pernicious anemia)– reports feeling tired for the last three months but recently has noticed shortness of breath when walking up the steps and sleeping more. pale appearance. Conjunctiva pale. Tongue beefy appearance. Has been sleeping more and fatigued.
D52.9 – Folate deficiency anemia, unspecified- feeling tired for the last three months but recently has noticed shortness of breath when walking up the steps and sleeping more. Pale appearance.
G60.9 – Unspecified Neuropathy- Does notice some numbness and tingling at times.
G31.84 – Mild cognitive impairment of uncertain/unknown etiology- She has noticed some issues with her memory as well. Has noticed more forgetfulness at times.
The second part is to create a plan utilizing clinical practice guidelines for the priority diagnosis.
Plan for priority diagnosis
D51.9 – Vitamin B 12 deficiency
Plan
Order diagnostic test
Blood tests: CBC, serum vitamin B-12, folate, vitamin C, antibody test for intrinsic factor, CMP, TSH.
Study shows patients with risk factors for vitamin B12 deficiency should be screened with a complete blood count and serum vitamin B12 level (Langan & Goodbred, 2017).
Therapeutic
Recommend to take multivitamin, 1 tablet, daily.
Other pharmacological agent will be prescribed based on the diagnostic test result.
Evidence-based clinical guidelines recommend that parenteral B12 replacement is indicated if urgent treatment is required, if gastrointestinal malabsorption is suspected, and in elderly people (Sukumar & Saravanan, 2019). Oral B12 replacement may be a suitable alternative in asymptomatic individuals with dietary B12 deficiency (Sukumar & Saravanan, 2019).
Education
Teach the patient that Vitamin B-12 deficiency anemia (pernicious anemia) can result from a diet lacking in vitamin B-12, which is found mainly in meat, eggs, and milk. Vitamin B-12 deficiency anemia can also occur if your small intestine can’t absorb vitamin B-12 due to surgery to the stomach or small intestine.
Teach this patient that vegetarians who don’t eat dairy products and vegans who don’t eat any foods from animals are at risk for vitamin B-12 deficiency anemia. Study shows that elderly people, pregnant women, and vegans are more susceptible to B12 deficiency (Sukumar & Saravanan, 2019).
Teach this patient that certain medications such as the antiacid medication may interfere with the absorption of vitamin B-12. Study shows that the long-term usage of PPIs is linked to an increased risk of vitamin B12 insufficiency (Mumtaz et al., 2022).
Teach this patient that foods rich in vitamin B-12 include eggs, fortified foods, such as breakfast cereals, milk, cheese, and yogurt, and red and white meats and shellfish.
Collaboration/Referral
No referral is needed at this time. Consider specialist referral if it is refractory to treatment, or if neurological features or persistent macrocytic anemia is present.
Follow up
Return to clinic in 1 week for lab result review and treatment plan.
References
Langan, R.C. & Goodbred, A.J. (2017). Vitamin B12 deficiency: Recognition and management. Am Fam Physician, 96(6), 384-389. https://pubmed.ncbi.nlm.nih.gov/28925645Links to an external site.
Mumtaz, H., Ghafoor, B., Saghir, H., Tariq, M., Dahar, K., Ali, S. H., Waheed, S. T., & Syed, A. A. (2022). Association of Vitamin B12 deficiency with long-term PPIs use a cohort study. Annals of Medicine & Surgery, 82. https://doi.org/10.1016/j.amsu.2022.104762
Sukumar, N., & Saravanan, P. (2019). Investigating vitamin B12 deficiency. BMJ, l1865. https://doi.org/10.1136/bmj.l1865

Edited by Haiying (Helen) Zhang on Mar 12 at 9:09am
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