Reference no: EM133753868

Case Study: Patient Presentation: A 65-year-old woman with diabetes and chronic kidney disease (CKD) stage 4 presents to the clinic with complaints of excessive fatigue and dyspnea on exertion, which are new for her. She has a history of congestive heart failure with reduced ejection fraction and worsening renal function in the past year. Her CHF and CKD have been adequately managed and no evidence of worsening heart failure, acute illness, or deteriorating renal function is found. She has no history of bleeding or other causes of anemia. She reports taking her medications regularly, which include lisinopril, carvedilol, furosemide, spironolactone, metformin, and iron supplements. She has no known drug allergies. She has been hospitalized twice in the past year for acute decompensated heart failure, requiring intravenous diuretics and inotropic support. Her last hospitalization was six months ago. Her family history is significant for diabetes and hypertension in both parents, who died of myocardial infarction in their 70s. She has two siblings who are alive and well. She is a retired nurse who lives alone in a senior apartment complex. She does not smoke or drink alcohol. She has no history of illicit drug use. She has a regular nephrologist and.