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Pertinent Positives

The patient is a 71-year-old female who presents with a history of fatigue for the past three months. She has noticed shortness of breath with activity and sleeps more. Has numbness and tingling and is forgetful at times. She also has a history of depression and appears pale. The patient is also on a strict vegan diet. Vitals are within the normal range. A slight murmur was noted. Pale conjunctiva. Angular cheilitis. Beefy tongue. A decrease in vibratory sensation noted in the hands/feet.

Pertinent Negatives

No headaches. No difficulty in breathing or wheezing. No chest pain or palpitations. No edema, no bloody or tarry stool. No hematuria. No evidence of collapsing pulse. No vaginal bleeding.

Missing Information

There is no information on dizziness, lightheadedness, headache, or the patient’s ability to perform daily living activities.

List of Differential Diagnosis and Actual Diagnosis

  1. Fatigue
  2. Activity intolerance
  • Altered tissue perfusion related to low hematocrit.
  1. Altered nutrition, less than body requirements, related to inadequate consumption of essential nutrients

Plan for the Priority Diagnosis

Diagnosis: Fatigue related to decreased oxygen-carrying capacity

Goals: Attainment and maintenance of adequate tissue perfusion and decreased fatigue. Maintenance of adequate nutrition.

Outcomes: The patient will verbalize and confirm the reduction of fatigue as evidenced by the ability to perform desired activities and increased energy.

Nursing intervention:

1.     Encourage the patient to observe a healthy diet containing essential nutrients

2.     Educate the patient and the family on the importance of a well-balanced diet.

3.     Anticipate the need for a Blood transfusion of packed red cells.


1.     Maintaining a strictly vegan diet deprives the body of essential nutrients like vitamin B12, which is exclusively available from animal products. Lack of vitamin B12 leads to B12 deficiency anemia (Landi, 2007).

2.     The sessions should involve family and caregivers and include food-related cultural aspects (Gulanik, 2016).

3.     Packed RBCs increase the amount of hemoglobin in the blood and, therefore, the oxygen-carrying capacity of blood (Gulanik, 2016).


The patient is assessed for recovery according to the set goals and outcomes. Evaluate for the ability to conduct activities of daily life with ease. Evaluate whether the patient has attained and maintains adequate nutrition (Gulanik, 2016).


Gulanick, M., & Myers, J. L. (2016). Nursing Care Plans: Diagnoses, Interventions, and Outcomes. Elsevier Health Sciences.

Landi, F., Russo, A., Danese, P., Liperoti, R., Barillaro, C., Bernabei, R., & Onder, G. (2007). Anemia status, hemoglobin concentration, and mortality in nursing home older residents. Journal of the American Medical Directors Association, 8(5), 322-327.


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NU 627 DT 10 Instructions

Unit 10 Discussion – Anemia, Infectious Disease


It is anticipated that the initial discussion response should be in the range of 250-300 words. Response posts must demonstrate topic knowledge and scholarly engagement with peers. This is not the only criteria utilized for evaluation; substantive content is imperative. All questions in the topic must be addressed. Please proofread your response carefully for grammar and spelling. Do not upload any attachments. All responses need to be supported by a minimum of one scholarly resource. Journals and websites must be cited appropriately. Citation and reference must adhere to APA format.

Discussion Prompt



This week you will be focusing on anemia and infectious diseases in this vulnerable population. Remember that serum ferritin levels can be affected by acute or chronic inflammation.  Therefore, your chronic kidney disease patient may have a normal ferritin level but actually be iron deficit due to the serum being elevated in response to the CKD.

Initial Post Instructions: 

  • Please critically evaluate the subjective and objective information provided to you in the attached file below.
    The first part of the discussion board is to identify all pertinent positive and, negative information and list missing information.
  • Then create a differential diagnosis list with at least 3 possibly actual diagnosis based on your findings.
    Second part is to create a plan utilizing clinical practice guidelines for the priority diagnosis.
  • Be sure to utilize template, in-text citations and provide full reference citation at the end of the discussion.

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