Reference no: EM133250977

Case - Dizziness - Mrs. J., a 78-year-old African American, has moved to an assisted living facility. She lived at home alone for the past 4 years since her husband's death. She enters this facility reluctantly but states, "I know my daughter can't take care of me right now-her husband is ill and she has her hands full." Mrs. J. is in good health and takes one medication "for her blood pressure." During the last month she has been having "dizzy spells" and has fallen twice. As you review her medication, she tells you that she started this blood pressure pill 4 weeks ago. She "hates running to the bathroom" so much. When you ask about her dizziness, she says, "I'm fine as long as I stay in bed or in my chair, but when I stand up I feel like I'm going to fall over! I get so light-headed."

Questions -

Question 1 - As you begin to assess her vital signs, what assessment should you include?

Question 2 - When you check Mrs. J.'s vital signs, you find the following:

Supine pulse: 68 beats per minute; supine blood pressure: 156/92 mm Hg

Standing pulse: 90 beats per minute; standing blood pressure: 110/86 mm Hg.

She complains of slight dizziness and asks to sit down. Are these findings significant? If so, what is the cause?

Question 3 - Mrs. J. complains that her "eyes just aren't the same." When you examine her eyes, you observe that the lens on the O.D. is thickened and yellow. She also complains of dry eyes. Are these findings significant?

Question 4 - Mrs. J. also states that she "just can't see like she used to. I can't sew and I have trouble reading." She voices a fear of getting glaucoma. What are some of the components of the health history for the eye, including questions for the aging adult?

Question 5 - Because Mrs. J. has not had her eyes examined for 4 years, you make an appointment for her to see an optometrist. You perform a brief examination and find that her pupils are equal and reactive to light and accommodation, and you observe no problems with extraocular movements. There is no drainage or crusts around her eyes and the conjunctivae are not inflamed. The lids do not droop, and the lashes and brow hair are intact. Her sclerae are a gray-blue color, with a few small brown "freckles" scattered on them. You expected the sclera to be white. Is this finding abnormal?

Question 6 - What can you use in this setting to test near vision?

Question 7 - When you hand Mrs. J. a magazine article to read, she tells you that everything looks "blurry" in the middle. She again voices a worry that she is developing glaucoma. What condition does a loss of central vision suggest?

Question 8 - Mrs. J. also mentions a new "bump on the front of my neck." When you inspect this area, you observe no abnormalities. On palpation, you sense multiple nodules when she swallows. Tenderness is absent and there are no enlarged lymph nodes. Is this finding a concern?

Question 9 - As you finish the interview and walk Mrs. J. to her room, she groans and states "Oh, my hips just hurt so much these days! I guess this pain is just part of getting old." Is pain a normal consequence of aging?