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Question
African American female presents to the clinic to see the Family Nurse Practitioner with complaints of bilateral eye redness, chronic fatigue, joint pain, night sweats, nonproductive cough, shortness of breath, and weight loss of 10 pounds over the past six months. On physical exam, she is afebrile, and her blood pressure is 132/88 mm Hg, has a respiratory rate of 22 breaths/minute, pulse is 68, regular, BMI is 18.5. Additional exam findings include bilateral injected conjunctiva with nodules, lacrimal gland enlargement, waxy nodules are noted on face, trunk, and extremities. She is recently divorced, a single parent with one daughter and currently lives with her parents. She recently lost her job and is on Cobra insurance. She states she is under tremendous stress and is having difficulty sleeping.
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