Saint Thomas University Fifty

The 50-Year-Old Patient Evaluation & Management Plan


A 50-year-old woman presents to the office with complaints of excessive fatigue and shortness of breath after activity, which is abnormal for her. The woman has a history of congestive heart failure with decreased kidney function within the last year. The woman appears unusually tired and slightly pale. Additional history and examination rules out worsening heart failure, acute illness, and worsening kidney disease. The CBC results indicate hemoglobin is 9.5 g/dL, which is a new finding, and the hematocrit is 29%. Previous hemoglobin levels have been 11 to 13g/dL. The patient’s vital signs are temperature 98.7°F, heart rate 92 bpm, respirations 28 breaths per minute, and blood pressure 138/72. The practitioner suspects the low hemoglobin level is related to the decline in kidney function and begins to address treatment related to the condition. Discuss the following:

  1. Which test(s) should be performed to determine whether the anemia is related to chronic disease or iron deficiency, and what would those results show?
  2. Should the practitioner consider a blood transfusion for this patient? Explain your answer.
  3. Which medication(s) should be considered for this patient?
  4. What considerations should the practitioner include in the care of the patient if erythropoietic agents are used for treatment?
  5. What follow-up should the practitioner recommend for the patient?

Submission Instructions:

  • Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources
  • Grading Rubric

    Your assignment will be graded according to the grading rubric.

    Discussion Rubric
    Criteria Ratings Points
    Identification of Main Issues, Problems, and Concepts Distinguished – 5 points
    Identify and demonstrate a sophisticated understanding of the issues, problems, and concepts.
    Excellent – 4 points
    Identifies and demonstrate an accomplished understanding of most of issues, problems, and concepts.
    Fair – 2 points
    Identifies and demonstrate an acceptable understanding of most of issues, problems, and concepts.
    Poor – 1 point
    Identifies and demonstrate an unacceptable understanding of most of issues, problems, and concepts.
    5 points
    Use of Citations, Writing Mechanics and APA Formatting Guidelines Distinguished – 3 points
    Effectively uses the literature and other resources to inform their work. Exceptional use of citations and extended referencing. High level of APA precision and free of grammar and spelling errors.
    Excellent – 2 points
    Effectively uses the literature and other resources to inform their work. Moderate use of citations and extended referencing. Moderate level of APA precision and free of grammar and spelling errors.
    Fair – 1 point
    Ineffectively uses the literature and other resources to inform their work. Moderate use of citations and extended referencing. APA style and writing mechanics need more precision and attention to detail.
    Poor – 0 points
    Ineffectively uses the literature and other resources to inform their work. An unacceptable use of citations and extended referencing. APA style and writing mechanics need serious attention.
    3 points
    Response to Posts of Peers Distinguished – 2 points
    Student constructively responded to two other posts and either extended, expanded or provided a rebuttal to each.
    Fair – 1 point
    Student constructively responded to one other post and either extended, expanded or provided a rebuttal.
    Poor – 0 points
    Student provided no response to a peer’s post.

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