Question

J.R a 24-year-old goes to her primary care provider (PCP) and reports feeling fatigued and dizzy at times when getting up and has LLE pain with swelling and redness that has not been relieved with ibuprofen 600mg. The client reports taking ibuprofen every 8 hours for the last few days. The client also reports that she has been having very heavy menses (bleeding) soaking up at least 10 pads daily for 3 days. She has been weak with disinterest in doing activities for the last week. The client has had a medical history of sickle cell anemia since birth. and is currently on folic acid 1mg daily to manage the condition. The client works in a plant where she is standing in one position all day. Upon assessment, the nurse notes the following: Temp-98.6, Pulse-101, Respiration-22, B/P-92/60, SPO2-95% Room Air and pain 8/10 in LLE, +2 edema in LLE with erythema and warmth to touch. The client denies any SOB or dyspnea. 1. What referrals may the client need for the complaint she has made at the PCP?

Answer 1

The 24-year-old patient with symptoms of fatigue, dizziness, LLE pain with swelling and redness, and heavy menses may need referrals to a hematologist, vascular specialist, gynecologist, and possibly an occupational therapist.

Step-by-step explanation:

The case you've described indicates a complex clinical picture that might require a multidisciplinary approach. The symptoms of fatigue, dizziness upon standing, and leg pain with swelling and redness are concerning. The heavy menses with a history of sickle cell anemia and the described leg symptoms could suggest a hematological issue such as anemia or a possible thrombotic event like deep vein thrombosis (DVT). These scenarios are especially concerning in the context of sickle cell anemia which can predispose to thrombosis and may also cause anemia due to increased red cell breakdown (hemolysis).

Given this situation, the client may need a referral to a hematologist to evaluate for complications of sickle cell anemia and management of potential anemia. Additionally, with the presence of leg swelling, redness, and pain, a referral to a vascular specialist may be appropriate to rule out DVT. Considering the severe and heavy menses, a consultation with a gynecologist might also be warranted to manage menstrual bleeding and determine if this is contributing to her symptoms. Finally, since her work involves standing in one position all day, which may exacerbate certain health issues, an occupational therapist or a workplace ergonomic assessment might be useful to suggest modifications that could alleviate some of these health burdens.