Case4ppt

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Case4ppt

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

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