Some of the additional information required is







Some of the additional information required is:

Causes of abdominal pains

History of other ailments, like HIV/AIDS

The weather and climatic change

What causes extreme fatigue

Any liver diagnosis

Any problems with the appendix

If there any bile duct complications

Presence of irritable bowel syndrome

Any physical examinations performed

Mothers full medical history in details concerning the bad stomach

Irritable Bowel syndrome (IBS)

This syndrome is associated with abdominal pains either due to abnormal contractions of intestinal muscles or visceral hyper sensitivity caused by sensitive nerves within the intestine. No causes of functional pain have been found. Diagnostic test needed are for ulcers, celiac disease, and collagenous colitis, examination of biopsies of the small intestine and colon.


Many women with anemia experience cases of acute fatigue, especially caused by menstrual blood loss. Anemia is mainly caused by iron deficiency though Maria eats regular diet. Being overweight can also be a source of fatigue, and may cause sleep disorders. The remedy would be to lose weight, quit certain lifestyles like smoking, drinking, and sleeping with CPAP device that keeps the air passages open. Taking the right diet is another remedy to help level blood sugar in optimal ranges. The diet should include foods such as eggs, and taking snacks throughout the day (Leon &, Marc, 2005),

Anemia causes iron deficiency during menstrual blood loss in women, since more red blood cells are needed to carry enough oxygen to the tissues and organs. Hypothyroidism is a thyroid, which is a small gland in the lower neck that controls metabolism. One will feel sluggish and may add weight if the gland is under active, and the metabolism functions is too slow. This occurs when the speed of converting fuels into energy is too slow.

Certain foods such as too much caffeine may add more fatigue in consumed in large quantities, even though it improves alertness and concentration if taken in moderate quantities. Chronic fatigue that lasts up to six months may present symptoms like multi joint pains, headache, and muscle pain, and can be defined as chronic fatigue syndrome. The diagnosis may need a lot of time in clearly identifying the problem if the symptom is really fatigue, and other causes of fatigue should be investigated. Cushing’s disease, other infections like malaria, HIV infection, and influenza are numerous sources of fatigue. Heart diseases such as congestive heart failure, coronary heart disease, chronic obstructive pulmonary disease, asthma, pneumonia, and arrhythmias are also associated with fatigue. Their existence also needs to be explored.

History of drug abuse, alcohol abuse, grief, bereavement, and bulimia are psychiatric conditions that may present fatigue. Even the medication history should not be left behind when investigating the causes of fatigue. Especially anti depressants, sedatives, medication and strong drug withdrawal, steroids, and blood pressure medications. Associated symptoms include vomiting, nausea, diarrhea, blood in urine and stool, constipation, fever, muscle cramps and aches.


Depression can also be a cause of severe fatigue, as well as other physical symptoms. Other causes of depression should be examined such as headaches, loss of appetite, and other causes of emotional disorder. Depression is a very complex condition to diagnose since it is attributed to many causes. The factors that might increase depression are abuse, either physical, sexual, or emotional abuse that might make depression manifest itself in later stages of life.

Certain medications are known to enhance depression, especially drugs for treating high blood pressure, beta blockers, and reserpine. Personal conflicts are a sure source of depression, or disputes among family members. Grief or loss of a loved one, like Maria’s son was involved in an accident raises the level of sadness, thus increasing the levels of depression. Depression is also a hereditary disease that occurs in the family history. It may be passed genetically from parent to the offspring. Hippocampus is associated with cortisal, which is toxic, and those people with smaller amounts of hippocampus are likely to suffer from depression.

Brain chemistry can show the effects of anti depressants, and a deep understanding of biochemical processes related to depressions may make diagnosis easier. Women experience depression more than men due to hormonal and physical changes, coupled with long periods of sadness in new mothers. New added responsibilities in life also enhance the chances of suffering from depression. These responsibilities may be at work or home, single motherhood, caring for children and aging parents.

Hidden UT

This is common in women who have had urinary tract infection that is associated with fatigue. The symptoms are burning pain and a urging sense of emergency. Urine test known as UTI may be taken to confirm the existence of this condition. The disease does not always come with definite symptoms.


Presence of diabetes should be investigated, as it is also associated with extreme fatigue for unexplained reasons. Abnormal high levels of sugar remaining in the blood stream instead of entering into the body cells. Even in cases of having enough to eat leads to unexplained fatigue. Testing of diabetes would be necessary.

Food allergies

There are certain hidden food allergies that intensifies fatigue after meals. .Any type of food allergy should be confirmed. Some symptoms of food allergy are coughing, fainting or collapsing, wheezing and short breathing, nausea and bloated feeling, itchy skin and rash, diarrhea, and vomiting. All these diagnoses need not to occur at the same time to suggest food allergy. The IgE blood test can be performed to measure the anti bodies present in blood. Another test could be allergy skin prick to offer supportive evidence.

Anaphylaxis is a severe form of allergy with symptoms present in different parts of the body at the same time. These may include rashes, swelling of lips and throat, loss of consciousness, and difficulty in breathing. In serious cases, death may occur from this form of allergy.

Diagnosis for allergy can sometimes be very confusing as other conditions may mimic these symptoms. For example histamine poisoning is a kind of false allergy caused by prompt decay of certain foods. This condition is sometimes referred to as scombridae poisoning. Sometimes RAST blood test and skin prick test may not show evidence of food allergy; this condition may be confused by food additive intolerance. Aspirin is related to a number of chemical compounds found in a range of foods, a condition known as salicycates. Since Maria was on aspirin medication, she might be aspirin sensitive, since she suffers from chronic allergic conditions.

Increased Blood in the Stool

This symptom maybe caused by a number of different ailments. Inflammatory Bowel Disease that makes intestinal walls to swell, inflamed, and develops ulcers, Crohn’s disease that occurs anywhere in the digestive tract. The small intestines, colon may develop shallow, crater like areas with deep sore with cobblestone pattern.

Diagnosis of blood in stool can be an indication of hemorrhoids. In most cases, hemorrhoids are not visible, but hidden. It occurs when pressure is increased that causes sensitive veins to swell showing lumps around the anal canal and anus. Blood in the stool is not always caused by hemorrhoids; it may b a medical condition occurring in the upper gastrointestinal tract. Other causes are acute gastritis, colon cancer, irritable bowel syndrome, ulcerative colitis, Meckel’s diverticulum, colon polyps, constipation, and typhoid fever.

Ulcerative Coritis

Ulcerative Coritis is another type of Chrohn’s disease that affects the colon and rectum. It occurs with inflammation and ulcers in the innermost of these regions. This disease is associated with abdominal pain, diarrhea many times a day, bloody stool, and weight loss. Those with a family history are likely to develop it than those without. Patients with this disease experience joint pains, skin sores, fatigue, anemia, and frequent fevers. A colonoscopy test should be performed to ascertain the existence of this disease.


This is a condition where abnormal blood vessels that are fragile lead to bleeding. It may be caused by peptic ulcers associated with open sores within the stomach linings or duodenum. It is a bacterial infection called Helicobacter Pylon. There is a need to evaluate the bleeding in stool using fecal occult test that may detect hidden blood (, n.d.).

Arthritic Pain

Rheumatoid arthritis is autoimmune illness that comes with chronic inflammation of the joints. This occurs when somebody’s body is attacked by its own immune system. This inflammation can also affect the tissues around the joints. The disease is more common in women, and may recur in families with the genetic disorder. It is caused by viral or fungi infections. Other symptoms include extreme fatigue, loss of appetite, fever, joint aches, and stiffness. Morning and evening periods of inactivity associated with rash, anemia, weight loss, and anorexia. Diagnosis involves examination of joints, and various parts of the body for inflammation. This is done together with a blood test known as sediment rate and X-ray tests, and may take several visits before a certain diagnosis is certain. Blood test to measure the degree of flammation may be necessary to detect presence of C-reactive protein. X-ray is to detect swollen tissues, bony erosions, and monitoring the progression of the disease. Eroded joints can also be detected by MRI scanning, radioactive test procedure, and bone scanning.

Weight Loss and Rash to Anal Area

Weight loss is mainly associated with eating habits; Irregular meals should be avoided to prevent drops in blood sugar level. Sexually transmitted diseases can also exhibit rashes to the anal area. Boils is an infection that fights white blood cells that the body sends through through the blood stream. The signs of boils may exhibit painful experiences and swelling in the buttocks. They are mainly bacterial in nature, follicutis inflammation can be found in hair follicles, acne, skin wounds and injuries (Golden, 2004).

Final Diagnoses/problems with ICD 9 Code

Final diagnosis is rheumatoid arthritis and Inflammatory Bowel Disease, especially Ulcerative Coritis.

ICD 9 codes are a requirement when reporting diagnose for health insurance claims. They reduce claim delays, denials, and improve reimbursement. It is most universally accepted classifying system, external causes of injury, for coding diagnoses, health status, and health care encounters. It has the following challenges:

The tabular list is running out of numbers because of limited space for assigning codes in some case.

It does not provide codes for sufficient clinical specificity in describing severity, or complexity of many ailment conditions., thus need for additional documentations when filing claims

Limited exchange of healthcare data among healthcare organizations and professionals, since some countries are using ICD 10

It is limited in monitoring utilization of recourses

Shortcomings in measuring performance, analyzing healthcare costs, and outcomes

It was developed specifically for inpatient settings

Limited scope in including the ambulatory care services

Inclusion of emergent diseases

Group diagnoses for epidemiological purposes

Nursing Diagnoses

A nursing diagnosis is a component of the nursing process or a clinical judgment of individuals, family, or community experience. These standardized nursing diagnoses are obtained through nursing assessment. NANDA international is responsible for defining, disseminating, and integrating standardized nursing diagnose. The categories include;

Actual diagnosis

Risk diagnosis

Health promotion diagnosis

Syndrome diagnosis

Management Plan

Nursing management plan is concerned with performance leadership in governance and decision making within organizations that have nurses. This involves planning, organizing, staffing, directing, and controlling nurse. Some of key areas are:

Medical management

Medical management is concerned with selection, training, motivation, and retaining of nursing staff in health care facilities. Work force planning involves the strategies for acquiring, utilizing, improving, and preserving human capital. This effort should be commensurate with individual and aggregate patient needs.

Staffing norms determines the quality, quantity, and utilization of nurses that match with the aims of healthcare organizations. Medical management of nurses looks at problems and opportunities within the healthcare system, and providing technical expertise.

Teaching and counseling

Teaching and counseling is designed to help patients cope with illness and disease. Therefore, this aspect emanates from the needs of patients, their relatives, and nurses to meet most relevance in healthcare management. These are nursing activities aimed at providing interventions by giving information, anticipating patient problems, encouraging patient action and responsibility, assisting patients with decision making, and problem solving.

Teaching healthcare effectively to patients should provide hospitable learning environments, helping patients decide on who are to be involved in their learning process, and establishing a base line of knowledge.

Health promotion and maintenances

Health education and communications are aimed at enhancing the well being and prevention of ill health. This is done by influencing knowledge, beliefs, attitudes, and behavior of the community.

Cultural, Ethical and Socioeconomic Issues

Maria Santiago a twenty eight year old woman Latino from Mexico. She is probably from lower average economic and social standing group. The issues that might affect her care may include gender, ethnic, racial, discrimination, lack of knowledge of specific disease regiment, cultural beliefs, socioeconomic status, and individual factors like psychological functioning, difficulty navigating health care systems, lack of social support, neighborhood stresses, and age (Dan, et al, (2011).

There is diversity in Hispanics in having access to services, utilization of services, getting appropriate outcomes of services, availability of services, and having the need for services. Her treatment will be greatly affected by her level of education, country of origin, and generation. The ethical issues could emanate from relatively few clinical applications of pharmacogenetics, where discovery of genetic factors influence response to medicines may not match with changes in clinical practice. Other ethical issues that might influence her treatment respect of persons in terms of autonomy to make decisions, and protection of vulnerable people. Treatment will solely be based on the result of the diagnostic tests rather than clinical assessment.

Nursing Theory

The nursing theory to guide Maria’s treatment to assess her condition by all methods explained in the nursing theory. Identifying the specific needs of the patient, demonstrating effective communication and interaction with her. Selection of a theory to solve her problem, and evaluating how the nursing process was successful.


Nursing practice theories are limited in scope, and level of abstraction in providing frameworks for nursing intervention, predicting outcomes of the nursing practice. The theories should help to generate more knowledge in the delivery of nursing care.

In Maria’s case, nursing theories should direct specific conceptual frameworks that define Maria’s and her environment, health, and nursing in general.


Rheumatoid Arthritis (RA) Pictures Slideshow on (n.d.). Retrieved from HYPERLINK “”

Dan L, et al, (2011), Harrison’s Principles of Internal Medicine: Mc Grawhill. Volumes 1 and 2, 18th Edition

Golden, R. (2004). A history of William Osler’s The principles and practice of medicine. Osler Library studies in the history of medicine No. 8. Montreal, McGill University,

Leon S &, Marc A. (2005), Clinical gynecologic endocrinology and infertility Clinical gynecologic endocrinology and infertility. NY Sage

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