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Case4ppt Case4ppt Presentation Transcript

  • Case #4 Sarah Tefft December 11, 2008
  • Introduction
    • African American male
    • 87 years old; born 9.09.21
    • Widowed; wife died abt. a month ago
    • Admitted 10.30.08 w/ diagnosis of recurrent pneumothorax & lung cancer
    • Complaint: Chest pain/angina
      • Pain score: 10
    • Temp: 98.0 °F
    • BP: 140/80; pulse of 73
  • History
  • While in the Hospital
    • C/O midsternum chest pain while talking
    • C/O clear productive cough
    • Claims was recently discharged from hospital “For his left lung”
    • Precautions (discussion prompt): suicide; isolation; seizure; aspiration; restraint; fall risk
    • Pulls out chest tube & uncomfortable with breathing mask
    • + for edema
    • Not a surgical candidate
  • Past Surgeries
    • Hernia repair
    • BIL Knee replacement
    • DVT
  • Lab Values
    • Glucose: high (132)
    • BUN: high (33)
    • Creatinine: high (1.8)
    • Coagulation: PT. INR, PTT all high
  • Medications
    • Aspirin- prevent hear attacks who have a history or angina; prevent ischemic stroke
    • Coumadin- anticoagulant
      • Caution with garlic, green tea, and ginkgo; and vitamin K (antagonist)
    • Verapamil- treat arrhthmias & HTN; relaxes blood vessesl
      • Take with milk
      • Increases Alk Phos
    • Allopurinal- treats gout
      • Drink at least 8 glasses of water
  • Medications
    • Metoprolol- alone or in combination to treat HTN
      • Slows HR and relaxes blood vessels
      • Increases Alk Phos
    • Simvastatin- reduce cholesterol in the blood
      • Avoid large quantities of grapefruit juice
    • Flomax- treat symptoms of enlarged prostate
      • Relaxes muscles in prostate & bladder
    • Spiriva- used to prevent whieezing, shortness of breath & difficulty breathing in pts. With COPD
    • Combivent-again used to treat COPD
  • Medications
    • Septra DS- combination drug
      • Eliminates bacteria that cause infections in urinary tract, lungs, ears, & intestines
      • Take with food
    • Naproxin- non-steroidals anti-inflammatory drug
      • Used to relieve pain caused by osteoarthritis & gouty arthritis
    • Indomethacin- NSAID
      • Treat pains, tenderness, swelling, & tightness related to arthrits
      • Increased levels of Alk Phos; Bilirubin; Glu; Urea N; K
    • Albuterol- bronchodialator
    • Used to threat COPD
    • Allergies: Penicillins, cephalosporins, carbapenem
      • Severity: unknown
      • No food related allergies
    • Appetite is fair; Pt enjoys eating; no complaints of N/D/V
    • Diet Prescription:
      • 25 kcals/kg; 2,546 kals
      • Protein: (0.6 g/kg) 76.38 (renal insufficiency)
      • Fluid: 1,605 cc
      • Avoid high sodium foods
      • Decrease saturated fat and cholesterol in diet
      • Increase whole grains
      • Chose lean and low fat meat choices
  • Care Plan
    • Short-term: Maintain proper hydration; remain healthy outside of the hospital
    • Long-term: Gradually lose weight (eventually want to be in healthy weight range); regulate HTN through diet modification; learn methods to prepare healthy foods at home