Case studyAdvanced health assessment

Fatigue and sadness Discussion

Eight questions in order, and they will only work if you resist the pull of the obvious answer. Her vital signs say something is physiologically wrong, so the plan cannot end at bereavement.

Editorial process

Last reviewed · August 23, 2026

Written by

Maren Caldwell

MSN, RN, CNE

Medical-surgical nursing, pharmacology and NCLEX preparation

Reviewed by

Dr. Tessa Redmond

DNP, RN, CNE

Evidence-based practice and clinical education

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Interpret the task
Assignment instructions
Deliverables
Proposed outline
Research plan
Reference shortlist
Final review

Why the vital signs stop this being a grief case

The case is engineered to see whether you will stop at the first plausible answer. Everything in the story points toward bereavement, and the chief complaint says so in the patient's own words, so the easy post writes about grief and prescribes support. Then read the numbers. A blood pressure of 95/60 with a heart rate of 98 and a respiratory rate of 22 is not what uncomplicated grief looks like. That combination in a woman described as gaunt suggests volume depletion, and the raised respiratory rate raises the question of infection or a compensatory response to metabolic acidosis. Confusion in a 78-year-old is a red flag in its own right and should be treated as delirium until proven otherwise, which reverses the whole framing: the sadness may be a symptom of the physiological problem rather than its cause. Nothing says the two readings cannot both be true; it says one was assumed and one measured.

So build a differential that is genuinely wide, and give each entry a reason drawn from this patient. Uncomplicated bereavement and major depressive disorder both belong, and the distinction between them is the assessment question the case is really about. Beside them put dehydration, occult infection including urinary and pulmonary sources, hypothyroidism, anaemia, electrolyte disturbance, malnutrition, and undiagnosed malignancy, which three years without care makes entirely possible. Caregiver burden belongs too, not as a diagnosis but as the context that produced her self-neglect. Then answer the questions in the order asked, because the eight parts are a sequence: subjective, then objective, then differentials, then the labs that discriminate between them, then the named screening tools, then a plan, then teaching, then the consult decision with a reason attached rather than a yes or no. Say what the referral would be for, not merely that you would make one, since the threshold is the part being assessed.

Likely learning objectives

Read vital signs as evidence that reframes a psychosocial presentation.
Treat new confusion in an older adult as delirium until excluded.
Construct a differential wide enough to include physiological causes of low mood.
Select named, validated screening instruments rather than generic assessments.

Assignment instructions

Read the full question

Review every instruction before using the planning guidance that follows.

A 78-year-old female comes to your office escorted by a neighbor who is a patient of yours. The neighbor, who has lived next door to the older woman for years, relates that a week ago the elderly woman’s sister died and that she had been her caregiver for many years. The neighbor relates that although she would occasionally see the older woman, she did not visit the home. At the funeral last week, she noticed that the woman appeared fatigued, confused, sad, and gaunt in appearance. Later the neighbor approached the woman, inquired about her health, and determined that the woman had a very difficult time the past couple of months, caring alone for her sister until the end when hospice care was initiated. The neighbor convinced the woman to seek medical care and today is the first appointment with a provider that this 78-year-old female has had in 3 years. The older woman states that she is very fatigued and sad over the loss of her sister. Neither her sister nor the patient has been married. A distant niece came to the funeral but lives about 30 miles away. The woman states that she is not taking any prescription medication and relates no medical problems that she is aware of being diagnosed. Vital signs: T 97.6°F, HR 98, RR 22, BP 95/60, BMI 21 Chief Complaint: Fatigue and sadness over the death of her older sister. Discuss the following: 1) What additional subjective information will you be asking the patient? 2) What additional objective findings would you be examining the patient for? 3) What are the differential diagnoses that you are considering? 4) What laboratory tests will help you rule out some of the differential diagnoses? 5) What screening tools will you select to use on this patient? 6) What is your plan of care? 7) What additional patient teaching may be needed? 8) Will you be looking for a consult?

Course-wide instructions that accompany this question

You must proofread your paper. But do not strictly rely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort on your part and you can expect your grade to suffer accordingly. Papers with numerous misspelled words and grammatical mistakes will be penalized. Read over your paper – in silence and then aloud – before handing it in and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes. Use a standard 10 to 12 point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. It is better to let your essay run over the recommended number of pages than to try to compress it into fewer pages. Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor. The paper must be neatly formatted, double-spaced with a one-inch margin on the top, bottom, and sides of each page. When submitting hard copy, be sure to use white paper and print out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument

The eight questions this case asks

01The additional subjective information you would ask the patient.
02The additional objective findings you would examine for.
03The differential diagnoses under consideration.
04The laboratory tests that would rule out some of those differentials.
05The screening tools you would select for this patient.
06A plan of care, additional patient teaching, and a consult decision.