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  • Room 36: Visit Reason: Acute Medical

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    debbh25
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    A 58-year-old morbidly obese male presented to the emergency department with altered mental status. He had been progressively less responsive for two days after quitting eating, drinking, and taking his medications upon discharge from the hospital last week. Physical exam found some erythema and induration on his abdomen and chest but was otherwise baseline. Labwork found a slightly low sodium of 127 and slightly elevated glucose of 131, as well as an elevated ammonia level of 94 and a urinary tract infection. The patient's primary care physician agreed to admit him for further evaluation and treatment of potential hepatic encephalopathy or a psychological issue, as his wife was uncertain of his intent in refusing to care for himself.

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    PT 36

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    A 58-year-old morbidly obese male presented to the emergency department with altered mental status. He had been progressively less responsive for two days after quitting eating, drinking, and taking his medications upon discharge from the hospital last week. Physical exam found some erythema and induration on his abdomen and chest but was otherwise baseline. Labwork found a slightly low sodium of 127 and slightly elevated glucose of 131, as well as an elevated ammonia level of 94 and a urinary tract infection. The patient's primary care physician agreed to admit him for further evaluation and treatment of potential hepatic encephalopathy or a psychological issue, as his wife was uncertain of his intent in refusing to care for himself.

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    Attribution Non-Commercial (BY-NC)
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    Sinalizar o conteúdo como inadequado
    18 visualizações2 páginas

    Room 36: Visit Reason: Acute Medical

    Enviado por

    debbh25
    A 58-year-old morbidly obese male presented to the emergency department with altered mental status. He had been progressively less responsive for two days after quitting eating, drinking, and taking his medications upon discharge from the hospital last week. Physical exam found some erythema and induration on his abdomen and chest but was otherwise baseline. Labwork found a slightly low sodium of 127 and slightly elevated glucose of 131, as well as an elevated ammonia level of 94 and a urinary tract infection. The patient's primary care physician agreed to admit him for further evaluation and treatment of potential hepatic encephalopathy or a psychological issue, as his wife was uncertain of his intent in refusing to care for himself.

    Direitos autorais:

    Attribution Non-Commercial (BY-NC)
    Baixe no formato DOC, PDF, TXT ou leia online no Scribd
    Sinalizar o conteúdo como inadequado
    de 2

    ROOM 36

    58 yr old male WR 536 lb full code admit 2/5 Had flu vaccine

    Visit Reason:
    mental status change: 02-05-2013

    Acute Medical:
    Acute hyponatremia Morbid obesity: Acute urinary tract infection:, Acute hepatic encephalopathy,

    Chronic Medical:
    Chronic hepatitis C Chronic airway obstruct Depressive disorder Respiratory arrest Anemia CHF DMII wo cmp nt st uncntr:

    Surgical HX
    History of surgical procedure on cervical spine History of lumbar spine surgery: Hernia repair: Cholecystectomy:

    Dx
    Chest xray----all cancelled
    Best practice would indicate that we should do a CT of his head as well as chest x-ray with his altered mental status. Unfortunately the patient is to obese to fit on the CAT scan table, we are unable to get him completely over on his back due to shortness of breath to get a proper chest x-ray. These were not accomplished

    2/5 EKG (chest pain) No results 2/5 Blood culture- no results yet 2/5 Microscopic- trace bacteria in urine 2/5 Urine culture-colony count is >100,000/ML Organism- gram negative rod 2/5 urine drug screen-all negative

    Orders
    Non rebreather mask Bedrest Cardiac monitor Neuro Q2hrs Continuous pulse ox Vitals q4HRS DIET- 2/5 NPO 2/6 Diabetic restrictions 1800 calories, fluid restrictions 1200 ml daily 2/7-Diabetic 2200 calories

    Essentially a 58-year-old white male, morbidly obese, presents to the emergency department this evening via EMS from Eagle Pointe nursing facility due to altered mental status. His wife at the bedside states that since he was discharged from here last week states that he has quit eating and drinking, quit taking and he has refused to take his medications and for the last two days has progressively become less responsive. The patient is unable to provide any history at all. He does arouse to painful stimuli yelling, but only gives one or two word answers. Airway is intact. On physical exam, the exam is essentially baseline for him. There is some continued erythema and induration about the abdomen and chest wall. His CBC is essentially unremarkable. His CMP is also fairly good for him with the sodium down slightly at 127, glucose up slightly at 131. Liver enzymes are at about baseline for him. His ammonia level was elevated at 94. Urine was found to be nitrite positive and urine drug tox was negative. Discussed the case with Dr. Barton, his primary care physician, who agrees to admit may need to seriously considering if this is the patient's desire to pass away or should he truly need a psych consult or whether this is from his UTI as well as hepatic encephalopathy. Further evaluation and treatment will be needed. Wife is uncertain as to his intent and whether his failure to take his medications and eat and drink is a giving up effort on his part

    ENTIRE STAY INTAKE- 2035 OUTPUT-5601 (-3566)

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