The old lady with complain of weakness after brief hospital stay for endocrine diagnosis

HPI

PT was consulted over phone by the medicine team on a 79 year old caucasian female who is being discharged home after a brief hospital stay, when she complained of overriding weakness…

Curbside description of course of hospitalization:

On medical workup – found with new onset of unexplained hyperparathyroidism. Conservatively managed since patient not willing for extensive workup. Patient ready for discharge – Now c/o overriding fatigue & Weakness (LOS 3 days)

History of present illness is otherwise unremarkable except for advanced age. Patient persists in c/o overriding weakness

Physical Examination

Observation: Elderly female, sitting up in chair, fully dressed for anticipated discharge. Walking stick resting by her side.

Vitals: BP: 123/81, sittting; HR – 81; RR – 14; SaO2 – 98% on RA.

Systems Review:

Cardiac: S1, S2, No murmurs, no bruits

Lungs: CTAB

Motor: UEs – 4/5; LEs’ 4/5 – Symmetrical

Sensory: Intact to Crude touch / JPS – Joint Position Sensation

Reflexes: DTRs – 1+ UEs/LEs’ & symmetrical

Coordination – FTN & HST – normal. Diadochokinesis – normal. No tremors.

Function

Mild difficulty in sit to stand – Supervision from normal heights, but min A from very low surfaces. Slow & wide-based gait, requiring cane support. Gait speed visually assessed – very slow. No overt loss of balance, No falls.

Assessment: At this time, please list every possible reason you can think of of WHY do you find the patient in the current situation?

To do this, you will need to have a verifiable PROBLEM LIST.

So, What are the PROBLEMS? >>> WHY are the problems present (i.e. Causation).

You may or may not need to request specific confirmatory tests – but you have to be clear in your mind on what specific test you would want in this situation.

If you can arrive at plausible WHYs, you have solved the problem. The treatment of the underlying CAUSE (the so called “WHY”), is the resolution of the patient’s symptoms.

Everything else as a part of PT is supportive measures – Education, and Prophylactic.

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