NR 603 Week 1 Case Study Discussions Part 2: Diagnostic Testing and Final Diagnosis

Introduction: Diagnostic testing is a critical step in confirming or ruling out the conditions listed in a differential diagnosis. It helps to narrow down the possible causes of a patient’s symptoms and enables the healthcare provider to make an informed final diagnosis. In this case, the patient’s presentation of fatigue, pallor, weight loss, and other symptoms necessitates a targeted approach to testing. Recommended Diagnostic Tests:
  1. Complete Blood Count (CBC):
    • Rationale: A CBC is a fundamental test to evaluate for anemia, which could explain the patient’s fatigue, pallor, and tachycardia. This test will measure hemoglobin levels, hematocrit, red blood cell count, and indices that can differentiate between types of anemia (e.g., microcytic anemia in iron deficiency).
    • Expected Outcome: If the patient has iron deficiency anemia, the CBC would likely show low hemoglobin and hematocrit, along with microcytic, hypochromic red blood cells.
  2. Serum Ferritin and Iron Studies:
    • Rationale: If anemia is suspected from the CBC results, serum ferritin, and iron studies (including serum iron, total iron-binding capacity, and transferrin saturation) are necessary to confirm iron deficiency as the cause.
    • Expected Outcome: In iron deficiency anemia, serum ferritin would be low, indicating depleted iron stores, and transferrin saturation would be reduced.
  3. Thyroid Function Tests (TFTs):
    • Rationale: Given the possibility of hypothyroidism, which can present with fatigue and weight changes, it is important to check thyroid-stimulating hormone (TSH) and free thyroxine (T4) levels.
    • Expected Outcome: If hypothyroidism is present, TSH levels would be elevated, and free T4 levels would be low.
  4. Basic Metabolic Panel (BMP):
    • Rationale: A BMP can provide valuable information about the patient’s kidney function, electrolyte balance, and glucose levels, which may help rule out other metabolic causes of fatigue.
    • Expected Outcome: The BMP would likely be within normal limits unless there is an underlying metabolic condition contributing to the patient’s symptoms.
  5. Depression Screening (e.g., PHQ-9):
    • Rationale: Since depression is part of the differential diagnosis, a validated screening tool like the PHQ-9 can help assess the severity of depressive symptoms and guide further mental health evaluation.
    • Expected Outcome: If depression is a contributing factor, the patient may score in the moderate to severe range on the PHQ-9.
Interpretation of Results:
  1. CBC Results: The patient’s CBC results show a hemoglobin level of 10.5 g/dL (normal range: 12.0-15.5 g/dL) and a hematocrit of 32% (normal range: 37-47%), indicating mild anemia. Red blood cell indices reveal microcytosis and hypochromia, consistent with iron deficiency anemia.
  2. Iron Studies: The iron studies reveal a serum ferritin level of 10 ng/mL (normal range: 12-150 ng/mL), confirming low iron stores. The transferrin saturation is also reduced, further supporting the diagnosis of iron deficiency anemia.
  3. Thyroid Function Tests: The TSH level is within the normal range, ruling out hypothyroidism as a cause of the patient’s symptoms.
  4. BMP: The BMP results are unremarkable, with all values within the normal range, suggesting no metabolic abnormalities contributing to the patient’s fatigue.
  5. PHQ-9 Screening: The patient scores a 4 on the PHQ-9, indicating minimal depressive symptoms, which are unlikely to be the primary cause of her fatigue.
Final Diagnosis: Based on the diagnostic test results, the final diagnosis for this patient is iron deficiency anemia. This condition is characterized by insufficient iron, leading to reduced hemoglobin production and the resulting anemia. The patient’s symptoms of fatigue, pallor, and weight loss are consistent with this diagnosis. The etiology of the iron deficiency could be related to dietary insufficiency, chronic blood loss (e.g., menstrual or gastrointestinal), or increased iron demand, and these factors will need to be explored further. Conclusion: The diagnostic process successfully narrowed down the differential diagnosis to iron deficiency anemia. This diagnosis is supported by the patient’s clinical presentation and confirmed by laboratory findings. The next steps will involve identifying the underlying cause of the iron deficiency and developing a comprehensive treatment plan. References: