Case Study Shock, Respiratory and Urinary
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Case Study : Shock, Sepsis, and Multiple Organ Dysfunction Syndrome
1.
Adam Smith, 77 years of age, is a male patient admitted from a nursing home to the intensive care unit with septic shock secondary to urosepsis. The patient has a Foley catheter in place from the nursing home with cloudy greenish, yellow-colored urine with sediments. The nurse removes the catheter after obtaining a urine culture and replaces it with a condom catheter attached to a drainage bag. The patient has a history of urinary and bowel incontinence. The patient is confused, afebrile, and hypotensive with a blood pressure of 82/44 mm
Hg. His respiratory rate is 28 breaths/min. The pulse oximeter reading is at 88% room air, so the primary provider ordered 2 to 4 L of oxygen per nasal cannula titrated to keep SaO
2
greater than 92%. The patient responded to 2 L of oxygen per nasal cannula with an SaO
2
of 93%. The patient has diarrhea. His blood glucose level is elevated at 160 mg/dL. The white blood count is 15,000, and the C-reactive protein, a marker for inflammation, is elevated. The patient is treated with broad-
spectrum antibiotics and norepinephrine beginning at 2 mcg/min and titrated to keep systolic blood pressure greater than 100 mm Hg. A subclavian triple lumen catheter was inserted and verified by chest x-
ray for correct placement. An arterial line was placed in the right radial
artery to closely monitor the patient’s blood pressure during the vasopressor therapy. a.
What predisposed the patient to develop septic shock?
The passage stated that Adam was admitted to the ICU with septic shock secondary to urosepsis. Urosepsis predisposed the patient to develop septic shock. He also has a history of urinary and bowel incontinence with having a foley cathether which increases his risk for infection.
b.
What potential findings would suggest that the patient’s septic shock is
worsening from the point of admission?
The passage states Adam is confused, afebrile, and hypotensive with a blood pressure of 82/44 mm Hg. His white blood cell count is 15,000 along with having a C-reactive protein elevated. He also has low oxygen saturation levels.
c.
Explain the importance of nutritional support for this patient and which
type of nutritional support should be provided.
The importance of nutritional support for Adam is because of the septic shock
which can lead to increased metabolic demands. Due to the signs of infection, strengthening his immune system can be done through good nutrition. The type of nutritional support needed is a feeding tube to administer enteral nutrition through and lowers the risk of infection by associating with parental nutrition.
2. Carlos Adams was involved in a motor vehicle crash and suffered blunt trauma to his abdomen. Upon presentation to the emergency department, his
vital signs are temperature, 100.9°F; heart rate, 120 bpm; respiratory rate, 20 breaths/min; and blood pressure, 90/54 mm Hg. His abdomen is firm, with bruising around the umbilicus. He is alert and oriented but complains of dizziness when changing positions. The patient is admitted for management of suspected hypovolemic shock. The following prescriptions are written for the patient:
Infuse 0.9% NS at 125 mL/hr
Obtain complete blood count, serum electrolytes
Oxygen at 2 L/min via nasal cannula
Transfuse 4 units of blood
X-ray of the abdomen STAT a.
Describe the pathophysiologic sequence of events seen with hypovolemic shock.
Hypovolemic shock results from fluid loss or blood loss. Due to a critical loss in circulating volume there isn’t enough blood to enter the heart. This leads to a decrease stroke volume and low cardiac output. In retaliation the body will vasoconstrict to compensate. The organs will continue to decline and shut down along with the blood pressure declining. b.
What are the primary goals of medical management for this patient?
The primary goals of medical management to counteract the hypovolemic shock and increased the level of fluid. Case Study: Patients with Lower Respiratory Tract Disorders
1. Harry Smith, 70 years of age, is a male patient admitted to the medical-
surgical unit with acute community-acquired pneumonia. He was diagnosed with paraseptal emphysema 3 years ago. The patient smoked one pack of cigarettes per day for 55 years; he quit 3 years ago. The patient has a history
of hypertension and diabetes controlled with oral diabetic agents. The patient
presents with confusion as to time and place. The family stated that this is a new change for the patient. The admission vital signs are blood pressure, 90/50 mm Hg; heart rate, 101 bpm; respiratory rate, 28 breaths/min; and temperature, 101.5°F. The pulse oximeter on room air is 85%. The CBC is as follows: WBC, 12,500; platelets, 350,000; HCT, 30%; and Hgb, 10 g/dL. ABGs on room air are pH, 7.30; PaO
2
, 55; PaCO
2,
50; and HCO
3
, 25. Chest x-ray results reveal right lower lobe consolidation, presence of apical bullae, a flattened diaphragm, and a small pleural effusion in the right lower lobe. Lung
auscultation reveals severely diminished breath sounds in the right lower
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Related Questions
CASE HISTORY 2
The patient was a 19-year-old male who was brought to the emergency room by his sister. He gave a 24-hour history of dysuria and noted some “pus-like” drainage in his underwear and on the tip of his penis. Urine appeared clear, and urine culture was negative although urinalysis was positive for leukocyte esterase and multiple white cells were seen on microscopic examination of urine. He gave a history of being sexually active with five or six partners in the past 6 months. He claimed that he and his partners had not had any sexually transmitted diseases. His physical exam was significant for a yellow urethral discharge and tenderness at the tip of the penis. (A Gram stain done in the emergency room is shown in Fig. 1). He was given antimicrobial agents and scheduled for a follow-up visit 1 week later. He did not return.
QUESTIONS:
What pathogen caused the disease? Briefly describe the epidemiology and pathogenesis of this disease.
What is the morphology and staining…
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Patient D: 38 y/o male vegetarian. Complains of mild irritation during urination. Urine volume 1.1 liters/24 hours. Microscopic examination of urine revealed many small pyramid shaped crystals.
1) List the abnormal findings.
2) What is your diagnosis?
3) What might have caused this disease?
4) How does diet affect urine?
5) Have you ever tried drinking 12 large glasses of water in a day? Why would drinking water be helpful to this individual?
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Web Assignment
1. Conduct online research on benign and malignant kidney tumors.
Prepare a PowerPoint presentation on the following:
Learning Ob
Kidney cancer stages
Risk factors for kidney cancer
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A. Terminology
Write the term defined below in the answer column.
1. Inflammation of the kidney (general).
2. Albumin in the urine.
3. A measure of the concentration of solutes in urine.
4. Erythrocytes in the urine.
5. Inflammation of the urinary bladder.
6. Most abundant inorganic compound in urine.
7. Leukocytes or pus components in the urine.
8. pH range of normal urine.
9. Hemoglobin in the urine.
10. More than a trace of glucose in the urine.
11. Ketones in the urine.
12. Inflammation of the kidney involving glomeruli.
13. Accumulations of materials hardened in tubules.
14. Most abundant nitrogenous waste.
15. Excessive urine production.
16. Bile pigment in the urine.
17. Inflammation of the urethra.
18. Kidney stones.
19. Little or no urine production.
20. Most abundant inorganic solute in urine.
B. Clinical Significance
Select the name of the possible clinical condition from the
list below that is indicated by the urinalysis results. Write
your answer in the answer column.…
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Clinical Case Study: Blood
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Patient C: An 18 y/o healthy female presents for a routine physical examination. Patient has great difficulty producing a very small volume of urine despite not having urinated since early morning.
During discussion with physician it is revealed that she has had only 2 cups of coffee and a donut to eat all day
1) What are the abnormal findings?
2) What is your diagnosis?
3)What suggestions might you have for this patient?
4) Why does the body form concentrated urine? and where in the kidney does urine concentration occur?
5) Why is an extended water fast a bad idea?
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Do explain shortly.
Name of drug :
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32-Six hours after removing a postoperative client's indwelling urinary catheter, the client has not voided. What action should the practical nurse take?
A- Ask the client if they are uncomfortable.
B- Reinsert the indwelling urinary catheter.
C- Obtain order to increase intravenous infusion rate.
D- Complete a bladder scan.
asap please
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Question: Can you make a list of Nursing Diagnosis related to the given Case Scenario below?
INFANT WITH TETRALOGY OF FALLOT
Case Scenario: Baby Pearl, a 9-month-old girl presents to the emergency department with his mother,who reports episodes of tachypnea, cyanosis, and irritability during feeding. The mother explainsthat these episodes have become more frequent, with baby Pearl becoming more cyanotic aroundthe mouth and fingers especially when crying (tet spells) when she was around 7 months old.These episodes resolve spontaneously but are occurring every few days.
The mother breastfeeds every 3 hours, but sometimes takes a long time to feed. She alsoobserved that baby Pearl becomes diaphoretic with feeding, and stops frequently to catch herbreath while feeding. She reported to the nurse that vomiting the milk (sometimes goes out fromthe nose) and becomes more frequent after feeding. The patient currently appears comfortable,with no signs of respiratory distress, fever, or…
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◄ Mail
AA
12:05
s-pdx-prod.inscloudgate.net
Case Study Shock and Multiple Organ Dysfunction
Syndrome
1. A S, is a 77-year-old male patient admitted from a nursing
home to the intensive care unit with septic shock
secondary to urosepsis.
2. Patient has Foley catheter in place with cloudy greenish,
yellow-colored urine with sediments. The nurse removes
the catheter after obtaining a urine culture and replaces it
with a condom catheter attached to a drainage bag since the
patient has a history of urinary and bowel incontinence.
3. The patient is confused, afebrile, and hypotensive. BP
82/44 mm Hg. RR 28 breaths/min and the pulse oximeter
reading is at 88% room air. Physician ordered 2 to 4 L of
oxygen per nasal cannula titrated to keep SaO2 greater than
90%. The patient responded to 2 L of oxygen per nasal
cannula with a SaO2 of 92%.
4. The patient developed diarrhea. His blood glucose level is
elevated at 160 mg/dL. The white blood count is 15,000
and the C-reactive protein, a marker for…
arrow_forward
Question: Can you make an Overall and Summary of the given Case Scenario?
INFANT WITH TETRALOGY OF FALLOT
Case Scenario: Baby Pearl, a 9-month-old girl presents to the emergency department with his mother,who reports episodes of tachypnea, cyanosis, and irritability during feeding. The mother explainsthat these episodes have become more frequent, with baby Pearl becoming more cyanotic aroundthe mouth and fingers especially when crying (tet spells) when she was around 7 months old.These episodes resolve spontaneously but are occurring every few days.
The mother breastfeeds every 3 hours, but sometimes takes a long time to feed. She alsoobserved that baby Pearl becomes diaphoretic with feeding, and stops frequently to catch herbreath while feeding. She reported to the nurse that vomiting the milk (sometimes goes out fromthe nose) and becomes more frequent after feeding. The patient currently appears comfortable,with no signs of respiratory distress, fever, or neurological impairment.…
arrow_forward
CASE STUDY:
Patient X, 3-year-old female came in because of difficulty of breathing.
Condition started 4 days prior to admission when periorbital edema was noted
which progressed and became generalized. Condition was associated with
nonproductive cough & low-grade fever, relieved by Paracetamol. Three days.
prior to admission, tea colored urine was noted. There was neither dysuria nor
urinary frequency. Two days prior to admission, consult was sought with a
private physician and was given Amoxicillin 53 mg/kg/day. Few hours PTA,
patient was noted to be dyspneic hence consultation was sought at emergency
room and subsequently admitted.
Past Medical History: No previous admission. No allergic reaction.
Family History: Denies of any heredofamilial diseases.
Personal/Social History: Patient was delivered at home assisted by a hilot by
NSVD with no complication. Breastfeeding was given until 11 months old and
solids were started at 6 months.
Immunization: Complete primary immunization…
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CASE: URINARY TRACT INFECTION
A 27-year-old woman comes in with a prescription for nitrofurantoin tablets 50 mg q.d.s. for three days and requests to speak with the pharmacist. She explains that her doctor tested her urine with a "colored strip" and diagnosed her with a urinary tract infection (UTI). She is experiencing significant discomfort when urinating due to a burning/stinging sensation, and her doctor has advised her to purchase Effercitrate over the counter. A friend suggested she also buy cranberry juice.
6. Aside from nitrofurantoin, list and describe other antibiotics used to treat urinary tract infections.
7. What lifestyle advice can be offered to patients with cystitis?
8. The following are some UTI myths; discuss whether they are true or not. a. UTIs are spread through sexual partners.b. A UTI can be avoided by drinking cranberry juice.c. UTIs can be avoided by wiping from front to back, avoiding tight clothing, and urinating after intercourse.d. A high salt diet…
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UTI Case scenario
J.D, a 26 year old female, presents to the urology clinic for the first time. She was referred bythe primary health care provider for recurrent urinary tract infection with gross haematuria.Her presenting complaint includes a four week (4/52) history of urinary frequency andurgency, lower abdominal pain, intense vaginal pain (worse during intercourse). She reportsthat she has a history of inflammatory bowel disease, seasonal allergies and is on anxiolyticsdue to her stressful personal life. She reports occasional lightheadedness and fatiguability.Her diet consists of very little vegetables, a lot of spicy, fried foods and has coffee five timesdaily. She has three sexual partners.
J.D brought a letter from her referring doctor stating that her urinalysis with MCS(microscopy, culture and sensitivity) have always been negative; she has been treated withfluconazole 150mg po (OD) STAT and a 14 day course of fluconazole, without resolution ofsymptoms. A KUB ultrasound and…
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Urine Color Changes with Commonly Used Drugs
I. Matching Type: Match column A with Column B. Write the answer before the number.
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Case Study:
A 52 year-year old man with a history of AIDS, hypertension, diabetes mellitus, and alcohol abuse was found unconscious in his home by his roommate. In the emergency department, he was hypotensive (103/60 mm Hg), febrile (temperature 101F), and unresponsive. Computed tomoggraphy scan of the abdomen showed choleccystitis and gallstones. Laboratory data are listed.
The patient was diagnosed with acute renal failure. He was administered intravenous fluids; BUN fell to 68 mg/dL and creatinine fell to 2.2 mg/dL. The patients blood culture report was positive for e. coli. He was treated with tobramycin and cefepime. The patient continued to deteriorate and died 5 days after admission. Cause of death was multiorgan failure secondary to AIDS, sepsis, and alcoholic cirrhosis.
DATA TABLE
Drugs of Abuse Negative Urinalysis
Serum ethanol 84mg/dL Hemoglobin Positive…
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case discussion:
72 yr old, male with history oif diabetes, PAD, HTN and CKD. Recently admitted for C-diff diarrhea and was started on vancomycin and discharged home. He now present to ER (7 days later) with left lower leg sweeling nd erythema and as such was diagnosed with cellulitis. He is not septic or ill-appearing so as an APN/APRN( Advance Practitioner Registered Nurse), you decide to discharge him with oral antibiotics.
In regards to the principles of PHARMACOKINETICS(absorption, distribution, metabolism and excretion), what are the key considerations when treating this patient and why are they so important?
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Urinary Incontinence Case Study: Mrs. Kingsley Mrs. Kingsley moved into Gardens on the Green Care Center this afternoon. Her husband of 54 years suffered a heart attack and died a month ago. Mr. Kingsley was Mrs. Kingsley’s primary caregiver for the last 3 years after Mrs. Kingsley had a stroke which resulted in limited mobility of her right arm and a slow gait. Mrs. Kingsley enjoys using her mind and enjoys being around other people, but she has been generally physically slower after her stroke. The Kingsleys have 3 children. The 3 adult children live out of town. They tried to coordinate home care for their mother over the last month after their father, Mr. Kingsley, died. But the care was fragmented at best. The children offered to have Mrs. Kingsley move in with them, but Mrs. Kingsley did not want to leave Evansville, the city where she grew up and where she raised her family. Mrs. Kingsley needs assistance with her activities of daily living. She needs assistance with dressing…
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Case 2
A 45-year-old male patient visits the hospital with a 3-month history of upper abdominal pain associated with nausea. Pain is worsened whenever he drinks alcohol, soda or even coffee. He is a smoker and a moderate alcohol drinker. He denies use of NSAIDs. Physical assessment and vital signs are normal. However, there is notable epigastric tenderness from the abdominal examination. His stool is also heme positive. CBC shows a mild hypochromic, microcytic anemia. Endoscopic examination reveals diffuse gastritis and ulcer. A gastric biopsy is then ordered by the physician.
1. What organism is most likely to be seen from the gastric biopsy? Identify the specific type of ulcer to complete the diagnosis. 2. Provide other clinical test to facilitate rapid detection of this organism. Describe briefly the procedure.3. Enumerate factors which contribute to the organism’s ability to colonize the stomach. 4. If left untreated, what other long term complications could this organism cause?
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CASE ANALYSIS:
Mr. Willis, a 46-year-old mechanic, is referred to hospital by his primary care doctor. He gave a history of diarrhea and vomiting a week ago and now was complaining of headaches and feeling ‘lousy’. His doctor had given him metoclopramide and ferrous sulphate. Mr Willis did not appear jaundiced although he said he had noticed his urine was unusually dark a few weeks ago. On examination, he was obese with a blood pressure of 120/80mmHg and had a pulse of 80. Rectal examination revealed black stools. He had a normal gastroscopy with three negative FOBs. His serum biochemistry showed a normal level of alanine transaminase and a slightly raised total bilirubin level. Mr Willis’ reticulocyte count was 13.5% (normal range: 0.5–1.5%). He was diagnosed with having G6PD deficiency, probably triggered by an infection.
How do you explain Mr Willis’ dark urine and dark stools?
Would Mr Willis benefit from any medication following admission? Explain your answer.
Why is it…
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QUESTIONS. (please see attached pictures)
1. On the given case scenario, present the relevance of each diagnostic and laboratory tests to the patient.
2. In relation to the patient’s case, trace the pathophysiology of the disease.
Thank you!
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The nurse is caring for an older adult who is receiv-
ing oxybutynin (Ditropan) to reduce the occurrence
of bladder spasms related to a UTI. For which side
effect should the nurse assess the patient?
1. Diaphoresis
2. Palpitations
3. Gastric irritation
4. Orange-colored urine
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Health Care Problems
Therapeutic Goal
Therapeutic Recommendation
Rationale
Hypertension
Pokycystic Kidney Disease
Grave's Disease
C
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SEE MORE QUESTIONS
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Related Questions
- CASE HISTORY 2 The patient was a 19-year-old male who was brought to the emergency room by his sister. He gave a 24-hour history of dysuria and noted some “pus-like” drainage in his underwear and on the tip of his penis. Urine appeared clear, and urine culture was negative although urinalysis was positive for leukocyte esterase and multiple white cells were seen on microscopic examination of urine. He gave a history of being sexually active with five or six partners in the past 6 months. He claimed that he and his partners had not had any sexually transmitted diseases. His physical exam was significant for a yellow urethral discharge and tenderness at the tip of the penis. (A Gram stain done in the emergency room is shown in Fig. 1). He was given antimicrobial agents and scheduled for a follow-up visit 1 week later. He did not return. QUESTIONS: What pathogen caused the disease? Briefly describe the epidemiology and pathogenesis of this disease. What is the morphology and staining…arrow_forwardPatient D: 38 y/o male vegetarian. Complains of mild irritation during urination. Urine volume 1.1 liters/24 hours. Microscopic examination of urine revealed many small pyramid shaped crystals. 1) List the abnormal findings. 2) What is your diagnosis? 3) What might have caused this disease? 4) How does diet affect urine? 5) Have you ever tried drinking 12 large glasses of water in a day? Why would drinking water be helpful to this individual?arrow_forwardWeb Assignment 1. Conduct online research on benign and malignant kidney tumors. Prepare a PowerPoint presentation on the following: Learning Ob Kidney cancer stages Risk factors for kidney cancerarrow_forward
- A. Terminology Write the term defined below in the answer column. 1. Inflammation of the kidney (general). 2. Albumin in the urine. 3. A measure of the concentration of solutes in urine. 4. Erythrocytes in the urine. 5. Inflammation of the urinary bladder. 6. Most abundant inorganic compound in urine. 7. Leukocytes or pus components in the urine. 8. pH range of normal urine. 9. Hemoglobin in the urine. 10. More than a trace of glucose in the urine. 11. Ketones in the urine. 12. Inflammation of the kidney involving glomeruli. 13. Accumulations of materials hardened in tubules. 14. Most abundant nitrogenous waste. 15. Excessive urine production. 16. Bile pigment in the urine. 17. Inflammation of the urethra. 18. Kidney stones. 19. Little or no urine production. 20. Most abundant inorganic solute in urine. B. Clinical Significance Select the name of the possible clinical condition from the list below that is indicated by the urinalysis results. Write your answer in the answer column.…arrow_forwardClinical Case Study: Bloodarrow_forwardPatient C: An 18 y/o healthy female presents for a routine physical examination. Patient has great difficulty producing a very small volume of urine despite not having urinated since early morning. During discussion with physician it is revealed that she has had only 2 cups of coffee and a donut to eat all day 1) What are the abnormal findings? 2) What is your diagnosis? 3)What suggestions might you have for this patient? 4) Why does the body form concentrated urine? and where in the kidney does urine concentration occur? 5) Why is an extended water fast a bad idea?arrow_forward
- Do explain shortly. Name of drug :arrow_forward32-Six hours after removing a postoperative client's indwelling urinary catheter, the client has not voided. What action should the practical nurse take? A- Ask the client if they are uncomfortable. B- Reinsert the indwelling urinary catheter. C- Obtain order to increase intravenous infusion rate. D- Complete a bladder scan. asap pleasearrow_forwardQuestion: Can you make a list of Nursing Diagnosis related to the given Case Scenario below? INFANT WITH TETRALOGY OF FALLOT Case Scenario: Baby Pearl, a 9-month-old girl presents to the emergency department with his mother,who reports episodes of tachypnea, cyanosis, and irritability during feeding. The mother explainsthat these episodes have become more frequent, with baby Pearl becoming more cyanotic aroundthe mouth and fingers especially when crying (tet spells) when she was around 7 months old.These episodes resolve spontaneously but are occurring every few days. The mother breastfeeds every 3 hours, but sometimes takes a long time to feed. She alsoobserved that baby Pearl becomes diaphoretic with feeding, and stops frequently to catch herbreath while feeding. She reported to the nurse that vomiting the milk (sometimes goes out fromthe nose) and becomes more frequent after feeding. The patient currently appears comfortable,with no signs of respiratory distress, fever, or…arrow_forward
- ◄ Mail AA 12:05 s-pdx-prod.inscloudgate.net Case Study Shock and Multiple Organ Dysfunction Syndrome 1. A S, is a 77-year-old male patient admitted from a nursing home to the intensive care unit with septic shock secondary to urosepsis. 2. Patient has Foley catheter in place with cloudy greenish, yellow-colored urine with sediments. The nurse removes the catheter after obtaining a urine culture and replaces it with a condom catheter attached to a drainage bag since the patient has a history of urinary and bowel incontinence. 3. The patient is confused, afebrile, and hypotensive. BP 82/44 mm Hg. RR 28 breaths/min and the pulse oximeter reading is at 88% room air. Physician ordered 2 to 4 L of oxygen per nasal cannula titrated to keep SaO2 greater than 90%. The patient responded to 2 L of oxygen per nasal cannula with a SaO2 of 92%. 4. The patient developed diarrhea. His blood glucose level is elevated at 160 mg/dL. The white blood count is 15,000 and the C-reactive protein, a marker for…arrow_forwardQuestion: Can you make an Overall and Summary of the given Case Scenario? INFANT WITH TETRALOGY OF FALLOT Case Scenario: Baby Pearl, a 9-month-old girl presents to the emergency department with his mother,who reports episodes of tachypnea, cyanosis, and irritability during feeding. The mother explainsthat these episodes have become more frequent, with baby Pearl becoming more cyanotic aroundthe mouth and fingers especially when crying (tet spells) when she was around 7 months old.These episodes resolve spontaneously but are occurring every few days. The mother breastfeeds every 3 hours, but sometimes takes a long time to feed. She alsoobserved that baby Pearl becomes diaphoretic with feeding, and stops frequently to catch herbreath while feeding. She reported to the nurse that vomiting the milk (sometimes goes out fromthe nose) and becomes more frequent after feeding. The patient currently appears comfortable,with no signs of respiratory distress, fever, or neurological impairment.…arrow_forwardCASE STUDY: Patient X, 3-year-old female came in because of difficulty of breathing. Condition started 4 days prior to admission when periorbital edema was noted which progressed and became generalized. Condition was associated with nonproductive cough & low-grade fever, relieved by Paracetamol. Three days. prior to admission, tea colored urine was noted. There was neither dysuria nor urinary frequency. Two days prior to admission, consult was sought with a private physician and was given Amoxicillin 53 mg/kg/day. Few hours PTA, patient was noted to be dyspneic hence consultation was sought at emergency room and subsequently admitted. Past Medical History: No previous admission. No allergic reaction. Family History: Denies of any heredofamilial diseases. Personal/Social History: Patient was delivered at home assisted by a hilot by NSVD with no complication. Breastfeeding was given until 11 months old and solids were started at 6 months. Immunization: Complete primary immunization…arrow_forward
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Recommended textbooks for you
- Surgical Tech For Surgical Tech Pos CareHealth & NutritionISBN:9781337648868Author:AssociationPublisher:Cengage
Surgical Tech For Surgical Tech Pos Care
Health & Nutrition
ISBN:9781337648868
Author:Association
Publisher:Cengage