Case Study for Clinical Rotation

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Case Study: Patient B

Robin Lukas

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Medical DiagnosisCoronary Heart Failure,

Critical illness myopathy 2nd to respiratory failure

Status Post 3-vessel Coronary Artery Bypass Graft with respiratory failure

Co-morbidity: diabetes

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Admission Diagnosis:

CABG 3x with Resp. Failure

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History of Present Illness~Summer 2009Small bowel obstruction

Emergency surgery Placed ICU Developed pneumonia Became septic several times x2-3 MI episodes possibly

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History of Present IllnessRespiratory failure–Trach tube placed

Dysphagia–PEG tube placed–Tolerating PEG feeds well

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Past Medical HistoryS/P CABG 9-15-09Small Bowel obstruction with

surgical fixationAcute renal failureChronic kidney diseasePulmonary distressPulmonary failure with trach

placement

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Past Medical HistoryDiabetesHypertensionHyperlipidemiaCOPDPast MI

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Past Surgical HistoryCholecystectomyCABG x3Small Bowel lysis of adhesionsVein harvest on bilateral lower

leg–Chronic neuropathy

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Family HistoryDiabetesHypertension

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MedicationsAspirin: CV protector–Insure adequate fluid

intake/hydrationBethanechol: Urinary

retention, GI motility–Avoid in COPD,–Side effects: diarrhea,

abdominal pain, cramps

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MedicationsBudesonide/formoterol: COPD–Contradicted in pt w/ diabetes–Side effects: diarrhea,

hyperglycemia, nausea, and vomiting

Digoxin: CV protectant–Caution with Ca and vit D suppl–Side effects: diarrhea–Monitor electrolytes

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MedicationsFerocon: anemia–Iron, folic acid, vit C, vit B12,

and intrinsic factorPrednisone: corticosteroid–Increases appetite, weight gain,

negative nitrogen balance due to protein catabolism, can increase blood glucose

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MedicationsSimvastatin: hyperlipidemia–Take with food, but avoid fiber–Side effects: nausea, abdominal

pain, constipation, diarrheaTamsulosin: improving urinary

flow–Side effects: decreased blood

pressure, dizziness, weakness

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Glucerna 1.2 Cont 70 cc/hr

Glucerna 1.2 Bolus 1.5 cans

3x day and Cont 6pm-6am

76 cc/hr Glucerna 1.2 Bolus 1 can

5x day

Glucerna 1.2 Bolus 1 Can

6x day

NDD2 Regular Liquid

Glucerna 1 can 3x day if <50%

Glucerna 1.2 Cont 80 cc/hr

1

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6

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ConclusionPatient B is on a NDD Level 2

Regular Liquid DietDischarged with only flushes

for PEG tubeDischarged with only 4

medications