Case 36 Introduction

History of Present Illness (HPI)

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A 71 year-old woman with a history of end stage kidney disease (ESKD) secondary to diabetes, hypertension, cerebrovascular accident (CVA), and chronic left shoulder pain presents to her dialysis unit for her scheduled dialysis session on Monday.

She has been on dialysis for 14 years. She attends all of her dialysis sessions and is adherent with her medications. She reports she has only been taking acetaminophen for her left shoulder pain. Today, she complains of worsening numbness and tingling in her right hand that has developed over the past several weeks. She has not had recent trauma or injury. She says that she otherwise feels well and has not had any recent falls, syncope, gait instability, light-headedness, weakness, or other areas of numbness. She has not had fever, chills, chest pain, shortness of breath, or edema.

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