Candy is a 13 year old who lives with her father and younger sister. Her mother died when Candy was 6 years old and her sister was 4 years old. Her father works a 12 hour shift full time to support himself and his daughters, and Candy makes sure she and her sister get to school each morning, take care of the house after school, and prepare their father’s dinner so he can eat as soon as he gets home from work. All three are very close and on his days off, Candy’s father is very devoted to his children. Candy began her menses when she was 11 years old and experiences regular periods every 28 days. She has excelled in school, being on the honor rolls consistently for the past 3 years. The past semester Candy’s school performance began to decline and she has been complaining of being tired “all of the time.” Her father notes that Candy “looks pale” and makes an appointment for Candy to be seen at the clinic .

At the clinic, the nurse practitioner performs a nursing history during which Candy’s father shares the observations he has made and Candy verifies the information. The nurse practitioner’s assessment reveals Candy is a clean, appropriately dressed, pale adolescent who appears fatigued. Candy’s vital signs are:

Temperature: 35.9 C (96.6 F)

Pulse: 116 beats/minute

Respirations: 30 breaths/minute

Blood pressure: 90/60

Candy’s lab values are:

Hemoglobin: 10 g/dL

Hematocrit: 28%

Total Iron Binding Capacity (TIBC): 450 mg/dL

Serum iron: 35 microgram/L (Broyles, 2006). You will need to answer the following questions and summarize in 1-2 paragraphs.

Be sure to include the diagnosis, differential diagnosis, pathophysiology, epidemiology, physical exam findings, diagnostic testing any needed referrals, management plans, patient education and follow-ups. Please submit to dropbox by the assigned due date.

1. What is diagnosis?
2. List 3 differential diagnosis (rule out by physical exam, diagnostic testing and/or labwork).
3. Discuss the pathophysiology, epidemiology and risk factors for the diagnosis.
4. Is there any other diagnostic testing that you would like to perform?
5. Is there a relationship between Candy’s change in school performance and her diagnosis?
6. Discuss the relationship between the symptoms and the diagnosis.
7. Discuss the significance of the laboratory values.
8. Discuss the cause and effect relationship between Candy’s level of growth and development and her diagnosis.
9. What other data would be helpful for the nurse practitioner to have?
10. What are the priorities of care for Candy?
11. What pharmacological and not pharmacological education would you give to this patient and her father?
12. What other responsibilities should the nurse practitioner delegate to Candy and her father?

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