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- Case #2Mr. H is a 52-year-old male who presents to the emergency department. His left leg is in a cast, and he states that 1 week ago he was in an automobile crash and broke his upper leg. Since that time he has had difficulty “getting around” and has mostly been lying on the couch watching television. On the evening of admission he noticed a sudden onset of dyspnea and chest pain. He denies having orthopnea, cough, hemoptysis, or wheezing. He smoked two packs of cigarettes a day for 19 years, but quit 3 years ago. Mr. H suggests hypoxemia and respiratory alkalosis which might be an indication of serious illness such as pulmonary embolism. Part 1: His arterial-venous oxygen content (Ca-vO2) difference is 5.73 mL/dL Part 2: His extraction ratio (ER) 0.276 or 27.6% What is clinically happening to the patient? Please explain.Case #2Mr. H is a 52-year-old male who presents to the emergency department. His left leg is in a cast, and he states that 1 week ago he was in an automobile crash and broke his upper leg. Since that time he has had difficulty “getting around” and has mostly been lying on the couch watching television. On the evening of admission he noticed a sudden onset of dyspnea and chest pain. He denies having orthopnea, cough, hemoptysis, or wheezing. He smoked two packs of cigarettes a day for 19 years, but quit 3 years ago. Part 1: What is his arterial-venous oxygen content (Ca-vO2) difference? Part 2: Calculate his extraction ratio please.Case #2Mr. H is a 52-year-old male who presents to the emergency department. His left leg is in a cast, and he states that 1 week ago he was in an automobile crash and broke his upper leg. Since that time he has had difficulty “getting around” and has mostly been lying on the couch watching television. On the evening of admission he noticed a sudden onset of dyspnea and chest pain. He denies having orthopnea, cough,hemoptysis, or wheezing. He smoked two packs of cigarettes a day for 19 years, but quit 3 years ago.Blood work values on room air:Blood Gas Blood Gas Arterial Venous pH 7.51 7.40 PaCO2 30 mmHg 45 mmHg PaO2 60 mmHg 30 mmHg HCO3 24 mEq/l 21 mEq/l BE - 1 - 4 SaO2 90% 60% Hb 15 g/dl 15 g/dl Part 1: Interpret the ABGPart 2: What is the arterial- venous oxygen content (Ca-vO2) difference for this patient?
- Patient is a 70 year old male with Parkinson’s disease, depression, HTN, and insomnia. He fell at hometwo weeks ago fracturing his forearm and bumping his head. He states that he was going into the kitchento make breakfast and his slipper caught the corner of the floor rug. He has no known drug allergies.Allergies NKDA Current MedicationsLevodopa/Carbidopa (Sinemet®) 25/250mg po TIDFluoxetine (Prozac®) 20mg po daily at bedtime (started 2 weeks ago)Amlodipine 5mg PO once dailyKetorolac (Toradol®) 10mg po every 6 hours prn arm pain x last two weeksDiazepam (Valium) 10mg po at bedtime for sleepPMH Parkinson’s DiseaseDepressionHTNInsomnia1. Discuss possible reasons this patient fell.2. List common side effects of Levodopa/Carbidopa3. He states that he doesn’t think his antidepressant is working. How will you address his concern?4. Which of his medications might be causing the insomnia? How could this be addressed?5. List some general education points regarding sleep hygiene.6. Do you have…Patient is a 70 year old male with Parkinson’s disease, depression, HTN, and insomnia. He fell at hometwo weeks ago fracturing his forearm and bumping his head. He states that he was going into the kitchento make breakfast and his slipper caught the corner of the floor rug. He has no known drug allergies.Allergies NKDA Current MedicationsLevodopa/Carbidopa (Sinemet®) 25/250mg po TIDFluoxetine (Prozac®) 20mg po daily at bedtime (started 2 weeks ago)Amlodipine 5mg PO once dailyKetorolac (Toradol®) 10mg po every 6 hours prn arm pain x last two weeksDiazepam (Valium) 10mg po at bedtime for sleepPMH Parkinson’s DiseaseDepressionHTNInsomnia 1. His wife tells you that he has started having hallucinations. Which medication might be causing this?Discuss why this happens.Patient is a 70 year old male with Parkinson’s disease, depression, HTN, and insomnia. He fell at hometwo weeks ago fracturing his forearm and bumping his head. He states that he was going into the kitchento make breakfast and his slipper caught the corner of the floor rug. He has no known drug allergies.Allergies NKDA Current MedicationsLevodopa/Carbidopa (Sinemet®) 25/250mg po TIDFluoxetine (Prozac®) 20mg po daily at bedtime (started 2 weeks ago)Amlodipine 5mg PO once dailyKetorolac (Toradol®) 10mg po every 6 hours prn arm pain x last two weeksDiazepam (Valium) 10mg po at bedtime for sleepPMH Parkinson’s DiseaseDepressionHTNInsomnia 5. List some general education points regarding sleep hygiene
- Patient is a 70 year old male with Parkinson’s disease, depression, HTN, and insomnia. He fell at hometwo weeks ago fracturing his forearm and bumping his head. He states that he was going into the kitchento make breakfast and his slipper caught the corner of the floor rug. He has no known drug allergies.Allergies NKDA Current MedicationsLevodopa/Carbidopa (Sinemet®) 25/250mg po TIDFluoxetine (Prozac®) 20mg po daily at bedtime (started 2 weeks ago)Amlodipine 5mg PO once dailyKetorolac (Toradol®) 10mg po every 6 hours prn arm pain x last two weeksDiazepam (Valium) 10mg po at bedtime for sleepPMH Parkinson’s DiseaseDepressionHTNInsomniaWhich of his medications might be causing the insomnia? How could this be addressed?Patient is a 70 year old male with Parkinson’s disease, depression, HTN, and insomnia. He fell at hometwo weeks ago fracturing his forearm and bumping his head. He states that he was going into the kitchento make breakfast and his slipper caught the corner of the floor rug. He has no known drug allergies.Allergies NKDA Current MedicationsLevodopa/Carbidopa (Sinemet®) 25/250mg po TIDFluoxetine (Prozac®) 20mg po daily at bedtime (started 2 weeks ago)Amlodipine 5mg PO once dailyKetorolac (Toradol®) 10mg po every 6 hours prn arm pain x last two weeksDiazepam (Valium) 10mg po at bedtime for sleepPMH Parkinson’s DiseaseDepressionHTNInsomnia Do you have any concerns about his pain medication?Mr. Reddy is a 62 yo presenting to ED at 1500hrs. He was preparing the gas cylinder for a Sunday BBQ when it suddenly exploded while he was trying to connect the hose. Family standing by tried to extinguish the fire with their hands and tried to remove his clothing. Burns 30% TBSA – Face, hands, bilateral lower limbs. Complaints of severe pain and burning 10/10. Past Medical History: Hypertension, Type II DM Regular medications – Candesartan 8mg, Glimepiride 4mg, Metformin 500mg and Pravastatin 20mg. Fully vaccinated against COVID. Airway. - Patent, superficial burns to right side of face Breathing. - Spontaneous, RR-22mt, SPO2-92% RA, air-entry equal Circulation- Lower limb odema, cap refill 3 seconds, bilateral dorsal pedis pulses weak. BP- 88/50 mmHg, HR- 127/mt, sinus tachycardia, Disability - GCS-15 E4V5M6, PEARL- 3mm, Exposure - Temperature 35.9 deg Celsius. Full thickness burns to right lower limb and right arm, partial thickness burns to left lower limb, bilateral hands.…
- Case #2 Mr. H is a 52-year-old male who presents to the emergency department. His left leg is in a cast, and he states that 1 week ago he was in an automobile crash and broke his upper leg. Since that time he has had difficulty “getting around” and has mostly been lying on the couch watching television. On the evening of admission he noticed a sudden onset of dyspnea and chest pain. He denies having orthopnea, cough, hemoptysis, or wheezing. He smoked two packs of cigarettes a day for 19 years, but quit 3 years ago. Blood Gas Arterial Venous pH 7.51 7.40 PaCO2 30 mmHg 45 mmHg PaO2 60 mmHg 30 mmHg HCO3 24 mEq/l 21 mEq/l BE - 1 - 4 SaO2 90 % 60 % Hb 15 g/dl 15 g/dl Interpret his ABGPt who was at home treating her right foot infection with VNA support. VNA recommended she return to the hospital because she was not caring for herself. The pt has not been able to get up and walk around including going to the bath. She complains of discomfort with swallowing and so she is not consistently taking her medication. She denies chest pain and shortness of breath. She is dysphagia, stage 2 plantar heel ulcer and at her butt. Has bruises on both hands, both legs is discolor and peeling. High fall risk and wear diapers. Pain is 7 on a scale of 0-10 at her coccyx wound. Normal bowl sounds and lungs sounds and heart sound. Cellulitis of right lower extremities. Cardiac diet and hypertension. Base on this information please do the concept map in the imagePt who was at home treating her right foot infection with VNA support. VNA recommended she return to the hospital because she was not caring for herself. The pt has not been able to get up and walk around including going to the bath. She complains of discomfort with swallowing and so she is not consistently taking her medication. She denies chest pain and shortness of breath. She is dysphagia, stage 2 plantar heel ulcer and at her butt. Has bruises on both hands, both legs is discolor and peeling. High fall risk and wear diapers. Pain is 7 on a scale of 0-10 at her coccyx wound. Normal bowl sounds and lungs sounds and heart sound. Cellulitis of right lower extremities. Cardiac diet and hypertension. Vitals at 800: Vitals at 11:20Am: Pulse: 99 HR: 72 SPO2: 99. BP: 144/97 BP: 135/82. R: 17 Temp: 95:4 HR:70 R: 16 Base on the information above can you please do a intervention for each body system. Neurological, Musculoskeletal, cardiovascular, respiratory, integumentary, GI, GU Patient…