3-30
Interpretations- Depressed patient will be less likely to engage
the clinician and may have decreased personal
hygiene.
Vital signs - Hypoxemia may cause isolated fatigue rather
than dyspnea. Hypoxemia may also be a
marker of underlying sleep apnea - Associated with congestive heart failure (CHF).
- May suggest anemia.
- Mononucleosis can cause severe pharyngitis
and persistent fatigue. - Hypothyroidism is a classic etiology of fatigue.
- Anemia will often have a soft ejection murmur.
- These abnormal heart sounds will be heard in
CHF. - Possible underlying pulmonary disease
(Emphysema / COPD) - Possible bronchitis / pneumonia
- Possible mononucleosis
- Common finding in hypothyroidism
- Possible neuromuscular disorder
- Possible lymphoma, mononucleosis or chronic
infection - Possible lupus, rheumatoid arthritis, or Lyme
disease
Basic ToolsGeneralVital signsHEENT
CardiovascularPulmonaryAbdomenNeurologicLymphaticRheumaticClinical Findings- Assess interaction and general
appearance - Check pulse ox - if available
- Jugular venous distention
- Pallor of the mucous membranes
- Pharynx erythematous +/-
exudate - Thyroid goiter
- Systolic ejection murmur
- S3 / S4 Gallop
- Increased AP diameter of chest
- Rhonchi / rales / pleural rub
- Splenomegaly
- Sluggish relaxation phase of DTRs
- Abnormal muscle tone / muscle
girth - Lymphadenopathy.
- Inflamed joints
Table 3-3: Fatigue: Objective Signs
Advanced Tools: Labs: CBC, rule out anemia hematologic malignancy, or chronic infection
With a negative history and a normal physical exam, labs are not likely to help with diagnosis. However,
a routine set of basic labs should be drawn prior to initiation of treatment of depression or other psychiatric
illness.
Plan:
Treatment
Stopped Medication
Resume medication or consider alternate if side effects are a problem.
Altered sleep patterns
Primary: Ambien (zolpidem) or Sonata (zaleplon) 5-10 mg po at bedtime
Alternate: Antihistamines (more side effects) such as Benadryl or Atarax