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Case Scenario:
John Doe, 53y.o., has a history of Type I diabetes mellitus, cigarette smoking 40 pack years, CAD, and PVD. Six weeks ago, he developed a wound in his left heel which measured 4cm by 2cm when he discovered it. Despite IV antibiotics and chemical debridement, the wound developed a gangrene infection. He is scheduled for a BKA of the left lower extremity tomorrow at 10:00am. His meds include daily insulin, aspirin 325mg/day, Pletaal 100mg BID.
Please make 1 intraoperative NCP with 1 diagnosis
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- Case Study #7: A 58-year old lawyer presents in the emergency room with headache, irritability, generalized muscle pain and uncontrollable back spasms. He has become very restless and worried because he has had the back spasms all through his court case that afternoon and they became extremely painful. In his history, the lawyer states that he has a very busy practice. He is on medication for high blood pressure (beta blocker) and has mild asthma. He injured himself about 10 days earlier, puncturing his left arm with a nail from an old barn he is tearing down. The wound has produced moderate quantities of pus, but he has been keeping it clean. When asked, he did not remember having a tetanus shot since he was a kid. The wound was sampled for microscopic examination and culture. The back appears to have very tight contractions and spasms. The patient is in obvious agonizing pain. 1. What is your presumptive diagnosis? 2. What bacterium is most likely causing the problem? 3. Which…10:28 NCM 112 RLE Case Report A 32-year-old man was referred to the emergencies of our hospital because of a right lower limb critical limb ischemia. Past medical history included chronic alcoholism and a three- month history of bilateral intermittent claudication. He did not report any episode of superficial thrombophlebitis. He smoked about 10 cigarettes since the age of ten and 10 cannabis joints daily since the age of twelve. He had no other cardiovascular risk factors. At clinical examination, his right leg was extremely painful and pale. He had absent pedal pulses on both sides, and a mild sensory loss on the right side. Allen's test of upper extremities was negative. Echo Doppler was suggestive of a bilateral common iliac occlusion and of a three-vessel occlusion on the right leg. A computerized tomography (CT) angiography detected the presence of an intraluminal aortic and iliac clot and a bilateral stal ibial essels occlusion. The patient was fully anticoagulated with…Case Study #8: A 35-year -old Native-American male presents in the clinic with a complaint of recurrent low-grade fevers, sweating, weakness, muscle pains and a loss of about 10% of his body weight over a 4 month period. The worsening weakness and muscle pain prompted the visit. The patient reports that he has been working on a bison slaughter line owned by his tribe, and blood and tissue juices often splash in his face or contaminate minor hand and arm injuries. He likes to hunt and fish. He is married and has two children. He eats fairly well, but he has not been as hungry lately. He had rheumatic fever as a child and was in a fairly serious car accident three years earlier, resulting in a leg broken in three places. He feels he was physically fit prior to the past 4 months. He likes to play basketball and softball. He has had all the usual childhood immunizations, but does not see the doctor often. On physical examination, the patient has a temperature of 101F. He has mildly swollen…
- Please AspaCase study: Amelia is a 68-year-old woman who was brought into ED by herneighbour. She woke this morning at 0600 hours with a 5/10 headache.At 0700 she called her neighbour and asked her to bring her to hospitalwhen she began to feel weak, and her headache increased to 7/10. Atthis time, one side of her face began to “feel strange”.She has past medical history of Atrial fibrillation (AF), hypertension (HT)and dyslipidaemia which she manages with Apixaban 2.5mg BD, Sotolol80mg daily, Amlodipine 5mg daily, Irbesartan/hydrochlorothiazide300/25mg daily, Rosuvastatin 10mg daily.Amelia used to smoke 20 cigarettes/day but states she quit 5 years ago.When she was brought into ED, she told staff that she did not take hermedications this morning as she was too distracted by her increasingheadache.You are assigned to care for Amelia. As you are about to enter her room,you overhear Amelia crying to her neighbour, explaining that she isworried as her mother had died of a stroke. Vital signs:•…All please
- Case Study: Jason is a 52-year-old Asian American male visiting his doctor for a routine exam. He works as a warehouse manager and mentions that his job is very stressful. He also states that he wishes he could be more physically active during the day. Questions: 1. In addition to weight, name 4 other risk factors that increase the likelihood of a person developing cardiovascular disease. Explain.Provide a possible diagnosis for the following Cardiovascular Case. A 64 year old male was brought to the emergency room due to severe chest heaviness and dyspnea 30 minutes ago upon waking up this morning. He is has diabetes mellitus and hypertension for the past 20 years, but neither takes his medications regularly nor follows up with his internist. He is a banker for the past 40 years and loves to spend his weekend in a drinking spree with his close friends. He also smokes 10 sticks of cigarettes since he was in high school. He usually feels some mild chest heaviness when walking long distances but feels improvement after he rests. For the past week, he is stressed because of the demands of his work and slept in the late hours of night due to his work-from-home set-up. He has a family history of coronary artery disease and myocardial infarction, as well as hypertension and diabetes. At the emergency room, he is restless due to persistent angina and dyspnea. His Blood Pressure is…Please help
- b. What is her CrCl? 4. J.C., a 70 year old male (5'8", 100 kg) is to begin Vancomycin (along with Zosyn and Levaquin) for broad-spectrum coverage for pneumonia (moderate infection with goal AUC 500-600). WBC=13.8, SCr=0.9 mg/dL. Using AUC dosing, please come up with a dosing regimen that is appropriate for JC. a. What is the dosing weight? CrCl ? b. What LD & MD & interval would you recommend? c. When should you order a vancomycin trough for J.C? Now, lets adjust his dose Assume his initial dose was 1750mg g 12h scheduled at 0900 & 2100. Assume his doses were given on time. The hospital policy required an infusion time of 2hr. The peak was 45ug/ml drawn after the 4th dose at 1230, 3.5hr after the start of the infusion. The trough level was 21ug/ml drawn at 2030, 11.5hr after the 4th dose. How would you adjust the dose? a. Calculate the patient specific k b. Calculate Cmax & Cmin c. Calculate the AUC d. Calculate patient specific Vd e. Calculate new dosing interval f. Calculate new…CASE STUDY SCENARIO Mr. Zane is a 65 –year-old African Canadian male from Brampton, Ontario, Canada. He came to the Emergency Department with his wife of 30 years. Mr. Zane was sent to the Emergency Department by his primary healthcare provider because “he has not been feeling well” for the past few days. He describes a fullness in his head and chest without any associated symptoms. His medical history is pertinent only for primary hypertension, and he states that he ran out of his medication two weeks before he started experiencing symptoms. Physical examination reveals an anxious man with a BP of 230/130 mm Hg and a heart rate of 108 beats per minute. Respirations are elevated at 22 breaths per minute. No papilledema is seen on funduscopic examination. Lungs have bilateral crackles, one quarter up from the bases. Cardiac examination reveals a regular tachycardic rhythm with normal S1 and S2. Jugular venous pressure is normal but demonstrates sustained fullness with abdominal…Case Study, Cardiovascular Disorders Gloria Gonzales is a 56-year-old Hispanic female with a history of type 2 diabetes mellitus, obesity, and hypertension. She was admitted to the medical unit 2 days ago with chest pain that was unrelieved with three nitroglycerin sublingual. She has had the following lab work: CK, LDH, AST, troponin, lipid levels, and an ECG stress test. She is scheduled to have a cardiac catheterization in the morning 1.Explain the rationales for the laboratory tests and ECG stress test. 2. What should the nurse do to prepare for the cardiac catheterization that is scheduled?
