This document describes the hospital course of a 57-year-old male with end-stage liver disease and a history of alcoholism. He was admitted with gastrointestinal bleeding from esophageal varices caused by cirrhosis. During his hospital stay, he developed worsening encephalopathy and required placement of a jejunostomy tube and later total parenteral nutrition (TPN) using Hepatamine. His condition stabilized and he was discharged on a soft diet with nutrition counseling and follow up.
Pneumonia is an inflammatory condition of the lung
affecting primarily the microscopic air sacs known as
alveoli.
Pneumonia is the most common infectious cause of death
in the United States.
It occurs in persons of all ages, although the clinical
manifestations are most severe in the very young, the
elderly, and the chronically ill.
Pneumonia is usually caused by infection with viruses or
bacteria and less commonly by other microorganisms,
certain medications and conditions such as autoimmune
Diseases
Pneumonia is an inflammatory condition of the lung
affecting primarily the microscopic air sacs known as
alveoli.
Pneumonia is the most common infectious cause of death
in the United States.
It occurs in persons of all ages, although the clinical
manifestations are most severe in the very young, the
elderly, and the chronically ill.
Pneumonia is usually caused by infection with viruses or
bacteria and less commonly by other microorganisms,
certain medications and conditions such as autoimmune
Diseases
An assignment to write a case study for medical terminology as if I were responsible for writing the patient\'s medical record. An assignment at Colorado Technical University online.
Polymyositis is an idiopathic inflammatory myopathy that causes symmetrical, proximal muscle weakness; elevated skeletal muscle enzyme levels; and characteristic electromyography (EMG) and muscle biopsy findings
This file offers information regarding the chronic pancreatitis disease, as well as a case study of a chronic pancreatitis patient in a soap format. Please go over all of the slides to get a complete picture of the situation.
If any queries or suggestions please drop down in the comment section.
Thank you!
The recent definition, concept and terminologies of septic shock, surviving sepsis campaign, management techniques, SOFA score. Also includes antibiotics and supportive modalities.
An assignment to write a case study for medical terminology as if I were responsible for writing the patient\'s medical record. An assignment at Colorado Technical University online.
Polymyositis is an idiopathic inflammatory myopathy that causes symmetrical, proximal muscle weakness; elevated skeletal muscle enzyme levels; and characteristic electromyography (EMG) and muscle biopsy findings
This file offers information regarding the chronic pancreatitis disease, as well as a case study of a chronic pancreatitis patient in a soap format. Please go over all of the slides to get a complete picture of the situation.
If any queries or suggestions please drop down in the comment section.
Thank you!
The recent definition, concept and terminologies of septic shock, surviving sepsis campaign, management techniques, SOFA score. Also includes antibiotics and supportive modalities.
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Background
A 32 year-old female presented to the emergency department complaining of 12 hours upper abdominal pain accompanied by 2–3 episodes of vomiting.
Case report
The patient had a heavy meal a few hours before. There were no signs of peritonitis. Routine laboratory examinations revealed leukocytosis, hyperglycemia and hyperamylasemia (serum amylase: 336 mg/dL).
Conclusion
The lipid profile revealed an impressive elevation of triglycerides (4240 mg/dL). The serum was extremely lipemic. The abdomen computed tomography confirmed the diagnosis of pancreatitis.
1. End Stage Liver Disease with GERD and Bleeding Esophageal Varices
FSHN 450
Fall 2016
Due Date: October 28, 2016
Admission Data: 57 year old male admitted from ES c/o N&V, and abdominal pain radiating to Rt
side. Patient presented with scleral icterus, increased abdominal girth secondary to ascites, black
stools.
Current Dx: Upper GI Bleed, Cirrhosis
MedHx: Htn, cholecystectomy, alcoholism
Social: Divorced for past 15 years. Mother living. Father died at age 65 from CHF. 4 living
siblings: brother 53 has atherosclerotic heart disease, brother 40 and sister 46 in apparent good
health, sister age 48 is obese.
Medications at home: TUMS, Zantac, Lisinopril
Medications: Lactulose, Octreotide, Vitamin K, Compazine, Morphine, albumin iv, furosamide iv
Physical: Ht. 5'7” Current BW 190 # BP 128/80 Pulse 90 RR 16 Temp 98.9
Hospital Course:
6/17 Admission Laboratory:
Na 120 mEq/L
K 4.7 mEq/L
Cl 87 mEq/L
CO2 19.3 mmol/L
Glu 91 mg/dl
BUN 13 mg/dl
Creat 1.6 mg/dl
PTT 43.1 seconds (reference: 23.7 - 32.7 seconds)
RBC 2.88 x106
/mm3
Hgb 9.1g/dl
Hct 26.9 %
Albumin 2.3 g/dl
Triglycerides 325 mg/dl
Total Cholesterol 250 mg/dl
HDL-Cholesterol 40 mg/dl
Physical and Neurological Exam: 0 Asterixis 0 edema of extremities
Gastroscopic Examination showed bleeding esophageal varices
2. Diet History reveals the following usual intake:
8am 1 cup black coffee with 1 shot bourbon
10 am 1cup cornflakes with ½ c 2% milk
12 noon 1 hot dog on bun with relish and mustard
2 cans beer
30 potato chips
2 pm 1 snickers bar
Afternoon 3 shots bourbon
6 pm 1 cup pasta or baked macaroni and cheese
2 cans beer
Evening 2 cans beer
3 shots bourbon
6/28 Patients’s condition continues to deteriorate. Current BW : 194 pounds. Diet: NPO.
Surgical jejeunostomy tube placed and nutrition support consult ordered.
What was the cause of the weight gain????
What is the purpose of each of the patient’s medications? List any important
drug:nutrient interactions.
Why was a surgical jejeunostomy tube placed?
Evaluate the patient’s nutrient needs and prescribe a tube feeding including type and
brand name, total volume and rate. Include a start rate and progression. Include
ONLY the Assessment section of the ADIME at this point.
7/1 Laboratory
Na 122 mEq/L
K 4.1 mEq/L
Cl 98 mEq/L
CO2 10 mmol/L
Glu 93 mg/dl
BUN 18 mg/dl
Creat 1.6 mg/dl
PTT 43.1 seconds (reference: 23.7 - 32.7 seconds)
RBC 2.88 x106
/mm3
Hgb 9.1 g/dl
Hct 26.9 %
Albumin 2.6 g/dl
Tube feeding is not well tolerated. Patient disoriented to time and place. Mild asterixis and 2+
3. edema present. Patient transferred to ICU. Tri-luminal catheter placed and nutrition support consult
ordered for TPN with Hepatamine®, limit 1500 ml.
List the probably reasons for the tube feeding intolerance in this patient?
You do not need to calculate a TPN but you should reevaluate protein and Kcal needs.
Why was Hepatamine® ordered and what at is the drawback to using this product?
7/11 Patient stabilized. TPN tapered and patient diet order changed to clear liquid progressing to
oral diet as tolerated. Fluid restricted to 2000 ml/day, 2300 mg sodium, soft diet. Prepare to
discharge to home. Dx: chronic alcoholic cirrhosis with stable encephalopathy and esophageal
varices.
Why was a soft diet ordered?
Conduct a follow-up nutrition assessment and report in ADIME format for transition
to oral diet (on 7/11)
Develop three PES statements, one in each domain and plan an intervention and
follow-up for each nutrition diagnosis.
*** DO NOT forget to answer all the questions.