Dec 20, 2021 Uncategorized

Case study Patient with Respiratory Issue/ info provided

Patient Profile for LRC

Patient K, presented to Conemaugh Memorial Medical Center emergency department at 19:05 PM in the evening with a chief complain of recent syncope.

The patient is an eighty-nine-year-old Caucasian female. She does not have any memory regarding how she moved from her bedroom to the kitchen but was found by ambulance crew sitting on the kitchen floor.  She was diaphoretic with shortness of breath. No chest pain at that time and she states she didn’t fall

Patient presented in the same ER with UTI symptoms 2 days prior and Bactrim antibiotic was prescribed as the treatment regimen which she was taking  on a daily bases. At the ER she denies UTI symptoms, recent nausea or vomiting, chest pain, SOB, palpitation, headache, abdominal pain, and visual disturbances other than a chronic visual impairment. She also denies sinus pain and drainage, earache, sour throat, neck pain, weakness of any extremities, back pain, calf or leg pain.

According to her social history, she lives alone under supervision of her daughter. She needs a cane or walker to walk around and requires assistant to help her with bathing, walking, and climbing up the stairs. She never used illicit drugs however she is a former cigarette smoker. She smoked one pack per day for 40 years, starting in 1945 until1985.She was also exposed to secondhand smoking. She has a medical history of hypertension, arthritis, and GERD and Diabetes and  Lung Disease .

On physical examination, the patient’s vital signs are

Pulse rate 102-104

Respiratory rate 38 bpm.

Patient shows mild hypertension 140/80.

A pulse Oximetric measurement indicates hypoxemia with oxygen saturation (Sp02) at 90% on Room air.

Cardiovascular system, Abdomen examination with no signs of any disorder except, crackles at the bases of the lungs. There is no visible JVD on the neck, no pedal edema. Distal Pulses +2 and Homan’s sign negative which rules out DVT. Slight erythema of left toes 2nd over lapping 3rd; consistent with the patient’s history of arthritis. No visible acute skin changes, other than the rash on the planter surface of left foot.

  Labs

Blood gas on room air ;

pH 7.24,

CO2 24

PO2 88

HCO3   9 mmol/l, anion gap 24,

Sat 88%

urinary ketones 150 mg/dl,

glucose 322 mg/dl

Radiography and Bedside PFT

Chest Xray; increase aeration, flatting of the diaphragm and bullae

FVC 95% of predicted

FEV1  60 % of predicted

Medications

Protonix- BID

Lasix- BID

Bactrim TID x 14 days

DuoNeb – Q6

Pulmicort- BID

Humalog prn/ sliding scale

Microbiology

Sputum culture- normal flora

Urine culture –  Morganella morganii, Proteus mirabilis , Proteus vulgaris

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