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Maria - Hx rheumatoid Arthritis, started on infliximab 6 months ago with…
Maria - Hx rheumatoid Arthritis, started on infliximab 6 months ago with recent increase in dose. Reports significant fatigue over the last month.
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Subjective
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Psychological assessment: Have you been eating more or less? Do you feel like a burden to your family/friends? Screen for depressive symptoms
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When you say it's been worsening over the last month, can you tell me what that means?
What does it feel like when you try to do your ADLs? Do you feel dizzy or winded or does it take more effort to move around?
Objective
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Depending on VS and clinical presentation, I may also consider an EKG and troponin level to assess for cardiac concerns
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Solutions
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If related to medication dosage increase, educate patient about this being a common side effect
Educate patient to stop and take a break when they are feeling lightheaded, or they have significant changes in pulse or respirations
Offer assistive devices like a shower chair, cane, or walker to make ADLs more accessible
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Inform patient about resources in their community to help with barriers such as transportation, nutritious meals, cleaning services, ect.