It's me again, the newer NP stationed at the post acute care setting....Please have mercy on me, as I have another question and I need your advice!!!
A resident c/o fatigue so I ran CBC and BMP. Hbg dropeed 2.0 since transfer from hospital about 2 weeks ago. Occult blood was negative. Iron studies results were not significantly abnormal (I can't recall exact results off the top of my head but I reviewed w/ my collaborating doc and no new orders.) Pt continued to c/o fatigue and mentioned new c/o malaise & myalgia w/ bilateral joint pain to shoulders, elbows, and hips. I repeated the CBC and obtained CMP, Vit D, ESR, RA factor. Hbg result was same (I think 9.5), Vit D 16, RA factor WNL, ESR not significantly elevated. Most surprisingly was the Alk Phos level in 300s, AST & ALT elevated (both AST & ALT in 150s). Bili was not elevated. Resident is scheduled for discharge home this week.
I will consult w/ my collaborating doc, and I will provide lab results for f/u to PCP upon discharge from NH. What labs would you order next? Would you check for hepatitis or defer to PCP since she is getting d/c'd later this week? Should I order the HCV antibody test? Resident denied ETOH use, she is not jaundiced, no ascites, no abd pain/discomfort. Pt has a frail appearance and recent ankle fx s/p ORIF. I will start on Vit D & Ca replacement.
Please share your thoughts. Thanks again for your input. Hope you all have a great week :)
