Doris

Doris

1. Cardiac Event

   • Vitals: 60/40, 37.2-150-30, Sat 92% on 3L
     • Sudden complaint of chest pain, weakness and shortness of breath
       • Doctor notified of findings and arrived to assess patient
         • Moved to trauma room
         • Sedated with Versed
         • Electrical Cardioversion at 200J
           • Reverted to Normal Sinus Rhythm and recovering
             • Vitals: 90/50, HR 100, RR 30 Sat 100% on 8L
             • Bolus of 750cc NS
             • 14F Foley Catheter inserted
         • Put on telemetry
       • STAT Labs
         • ECG showed new onset uncontrolled A-fib
         • Troponin 0.6 - Positive, indicator for cardiac damage
         • CBC, Chemistry: no significant changes
     • Anxiety

2. Dementia with Paranoia

   • Blames Medications for unrelated symptoms
     • Poor Compliance
   • Doesn't trust staff

3. Health History

   • Dislipidemia
   • Anemia with previous rectal bleed
   • Renal Insufficiency
   • Rheumatoid Arthritis

4. Cardiac History

   • Previous MI
   • Ex-smoker 3 years ago
   • Severe Aortic Stenosis
     • 3/6 Ejection Fraction
   • Hypertension

5. Medications

   • No known allergies
   • C.difficile orders: Vancomycin PO, Metronidasole IV, IV Fluids
   • Furosemide, Ramapril
   • Atorvstatin, Ezetrol
   • Hydroxychloroquine
   • Ferrous Gluconate
   • Quetiapine, Galantamine

6. Main Complaint: abdominal pain, diarrhea over 4 months, genaralized weakness

   • Initial Assessment
     • Vitals: 102/52, 36.8-80-20, Sat 92% on 3L
     • Lungs clear, occasional cough,regular heart rhythm
     • Abdominal pain, bowel sounds present, abdomen distended
     • Not oriented to place or day, lethargic, confused
     • 90 year old female, lives alone, DNR
     • Fall Risk
       • Rheumatoid Arthritis stiffness
       • Frequent diarrhea
       • Confusion
       • Polypharmacy
       • Weakness
   • Strain on Body
   • Diagnosis: C. Difficile colitis

7. Initial Labs

   • WBC 24.7 - Elevated, sign of infection
     • Lactate 0.9 - Normal, rule out sepsis
   • Liver function tests normal
   • Chemistry: Na 132, K 4.1, Normal
   • Urea 23, Creatinine 199, Expected high
   • Hgb 107 - Result good considering anemia, also rules out rectal bleed