Reference no: EM133721790

Question

John is a 55 yr. old bookkeeper who presented to the family nurse practitioner a chief compliant of malaise, fatigue, and repeated infections for the last year and half. John said that just 3 months ago he was diagnosed with bronchitis for the second time in one year, a urinary tract infection, and a yeast infection that resulted in balanitis. He also stated he feels fatigued throughout the day even after consuming healthy meals and becomes very thirsty. John has not traveled outside the U.S. and there is no family history of repeated infections in the respiratory, urinary, and integumentary system. Habits: Coffee, 2cups a day. Quit smoking 15 years ago. Physical Exam: Overweight male with a BMI of 32, and waistline of 40 inches appears anxious with sunken yes, dry patches on the skin of arms, dry mouth. Appears fatigued and leans against the wall while sitting on chair. Temperature: 38.5 F Pulse: 100 Respirations: 14 Blood Pressure: 150/90 Thorax: Symmetric, no palpable masses. Difficulty breathing on supine position (orthopnea). Vesicular sounds present, absent stertors. Heart rate 110 bpm. Skin: dehydrated, presence of dry patches on arms, and legs. Complaints of leg pain with activity. Nails: Presence of onychomycosis.