Reference no: EM133602507
Assignment:
Mrs. Miller is a 70 year old female with a history of COPD, CHF, and known hepatic cirrhosis from chronic alcohol abuse. She was admitted to the hospital after a fall while intoxicated and she sustained a right hip fracture. She underwent an open reduction and internal fixation of her right hip 2 days ago and was admitted to the orthopedic unit. Immediately postop, she complained of difficulty breathing which improved if she laid flat.
On POD#1, she became acutely hypoxic while getting out of bed with physical therapy. Her ABG at that time revealed respiratory acidosis with a pH of 7.31, hypoxia with a pO2 of 62, and hypercarbia with a pCO2 of 60. She was transferred to the SICU for closer monitoring.
- What are the differential diagnoses for this patient's symptoms? (HINT: don't just think GI...think about what you learned about last semester too).
- What sort of work-up would you order to make a more definitive diagnosis? Remember, you're working up her symptoms and trying to narrow down your diagnosis.
The patient's initial work-up is essentially negative except for the abnormal ABG and elevated LFTs which is to be expected given her underlying cirrhosis.
- What is your most likely diagnosis?
- How could you prove this more definitively?
During the work-up for the patient's dyspnea and hypoxia, it is also noted by the nursing staff as well as the patient's family that she is becoming progressively more confused. The family reports a significant personality change over the past few weeks and this has been intensified during her hospitalization. She was found naked and trying to get out of bed this morning by her son.
- What do you suspect is the cause for the patient's confusion (be specific)?
- Given the patient's current hospitalization and surgery, what may have precipitated or intensified this problem?
- Are there any tests or procedures that you feel are indicated to work-up this problem?
- How would you treat the patient's confusion?
- What are the short and long term goals for this patient?
- Identify the one therapeutic intervention that may improve survival and reverse most of the patient's acute issues.
When answering these questions, please number each response, use APA and provide a reference list for any references listed. This is an evidence based exercise and your references should not be older than 5 years.