Gloria Smart is a 55-year-old female who presents to your office today for regular gyn care. You read her medical history and note she received a cardiac stent at age 50, has mild hypertension, and is on Zocor, Plavix, and lisinopril. Surgical history is remarkable for tonsils as a child and bunion surgery. She works full time, by choice, because it “makes me feel young.” She is up to date with colonoscopies. Gyn history normal pap history, last DXA within normal limits, normal mammogram. BMI is 26. First menses age 14 and menopause age 52. She works out at her local gym 5 days a week. Social history is negative for tobacco and recreational drugs. She has an occasional glass of wine. She has never married and has been with her current partner for 2 years and will be getting married in 2 months. She has never been pregnant, and her partner has never had a child.
Gloria relates as you start to talk to her that she and her fiancé have been talking about it, and they would like to have a child. She wants a referral and some guidance.
Gloria then sees an infertility specialist and discusses IVF and donor eggs. She and her fiancé proceed and she gets pregnant on her second cycle. She is referred back to you at 12 weeks to be co-managed with the maternal-fetal medicine specialist.
Gloria and her fiancé present to your office with a complaint that her blood pressure has been up at home when they check it with their BP cuff. Her fiancé thinks it might be related to a pain she has in her ribs on the right side that started after they went out Chinese food. They also ask if you can give her something to help with her “swelling” as her face won’t look good at the planned marriage in 2 weeks. Her BP is 160/ 92, with a repeat 160/ 88. You note that she has 2+ pitting edema in her legs and that her face appears slightly swollen.
- Review the given case study and address the following:
- Summary of case study
- What is your differential diagnosis?
- Why did you make this diagnosis decision?
- What is your treatment plan?
- What evidence-based research can you provide to support your decision (choice for differential diagnosis and plan/intervention)?
- What resources did you use to meet your best practice guidelines?
- Address the ethical dilemmas and/or other issues for your case study:
- Ethical issues
- Psychological issues
- Physical issues
- Financial issues