04/12/2023 1

Case Study: Patient B

Robin Lukas

04/12/2023 2

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

04/12/2023 3

Admission Diagnosis:

CABG 3x with Resp. Failure

04/12/2023 4

History of Present Illness~Summer 2009Small bowel obstruction

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

04/12/2023 5

History of Present IllnessRespiratory failure–Trach tube placed

Dysphagia–PEG tube placed–Tolerating PEG feeds well

04/12/2023 6

04/12/2023 7

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

surgical fixationAcute renal failureChronic kidney diseasePulmonary distressPulmonary failure with trach

placement

04/12/2023 8

Past Medical HistoryDiabetesHypertensionHyperlipidemiaCOPDPast MI

04/12/2023 9

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

leg–Chronic neuropathy

04/12/2023 10

Family HistoryDiabetesHypertension

04/12/2023 11

MedicationsAspirin: CV protector–Insure adequate fluid

intake/hydrationBethanechol: Urinary

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

abdominal pain, cramps

04/12/2023 12

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

04/12/2023 13

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

04/12/2023 14

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

04/12/2023 15

04/12/2023 16

04/12/2023 17

04/12/2023 18

04/12/2023 19

04/12/2023 20

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

2

3

4

5

6

04/12/2023 21

ConclusionPatient B is on a NDD Level 2

Regular Liquid DietDischarged with only flushes

for PEG tubeDischarged with only 4

medications