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The Nurse Practitioner

January 2013, Volume 38 Number 1 , p 6 - 8


  • Cathy R. Kessenich DSN, ARNP
  • Kristi Cronin BSN


Mr. R is a 79-year-old male who is generally healthy. He is a retired boat builder and has osteoarthritis bilaterally in his hands and wrists. He sees his nurse practitioner (NP) every 6 months for a refill of his anti-inflammatory arthritis medication. He admits that he has been feeling tired lately and is short of breath when he goes upstairs to his bedroom every night. Mr. R states that he used to take a daily walk around the block but has stopped doing that because it makes him too tired. He admits to drinking at least four alcoholic beverages per day and has done this most of his adult life. He states that he cannot fall asleep without several drinks before bed, but he does not think that alcohol is a problem for him. On examination, Mr. R appears tired, and his skin color is pale. His BP is 130/60, his pulse rate is 78, and his oxygen saturation (measured via pulse oximetry) is 96%. He is currently taking diclofenac sodium (Voltaren) 75 mg orally twice a day. The remainder of his physical exam was unremarkable.The NP explained to Mr. R that she was going to order lab tests that might help find a reason for his fatigue and exercise intolerance. Mr. R agreed to a complete blood count (CBC), comprehensive metabolic panel (CMP), and thyroid-stimulating hormone (TSH). The next day, the CMP and TSH results were negative. However, the CBC revealed a decreased hemoglobin and hematocrit. The NP telephoned Mr. R and asked him to collect stool samples to see if there was blood in his stool that could account for his decreased hemoglobin and hematocrit. The NP advised Mr. R on collection and return of the specimens and instructed him to go to the lab to obtain the collection devices for the samples.Anemia is commonly encountered in the primary care setting and affects more than 3 million Americans.1 Anemia has greater prevalence in the older adult population and is associated with higher rates of morbidity and mortality than in younger patients.1,2 Symptoms of anemia may

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