Download NUR 6104 iHuman Case Study Dorothy Markham, 78 yrs Female CC Diarrhea 2 DIFFERENT VERSIONS and more Exams Nursing in PDF only on Docsity! NUR 6104 iHuman Case Study Dorothy Markham, 78 yrs Female CC: “Diarrhea” 2 DIFFERENT VERSIONS OF THE ANSWER EXPERT FEEDBACK(SOLUTIONS)2023 UPDATE CONTENTS : QUESTIONS ,OLD-CARTS for the HPI,(PMH,FH,SH as Needed),PHSICAL EXAM,EXAMS FEEDBACK,CASE FINDINGS,FEEDBACK,DIFFERENTIAL RANKING ,DIAGNOSIS,CASE PLAN, List the differential diagnoses (Must not Miss/Leading/Alternate/Concluding) VERSION A Dorothy Markham Patient is 78 yo female who currently resides in a nursing home. Recently treated with antibiotics for UTI. History of GERD, HTN, osteoporosis, she is a former smoker: 20 pack-year history who admits to have 1 drink per week. Ms. Markham presents to ED with acute, non-bloody, diarrhea, bloating, nausea and diffuse abdominal pain of 2 days in duration. She had multiple bowel movements on the first day and she reports cramps, which come and go, pain level 6/10 and rest makes it better. She denies blood in stool, or fecal incontinence has little appetite caused by nausea. She denies sick outbreak at rehab facility or recent travels. She has not been able to associate her symptoms with dietary triggers. Not sure about fevers but states that she felt warm for last couple days, complains of dizziness and being lightheaded. She has clinical signs of orthostatic hypotension with volume depletion due to her inability to maintain adequate oral hydration and her ongoing use of diuretics. Skin tenting is present on the back of the hand, capillary refill is greater than 2 seconds. Patient MMSE 28/30. WBC 18,000 without left shift, elevated lactate 2.5 mmol/L, elevated BUN and creatinine ratio > 20:1, concentrated urine and positive clostridial toxin assay indicating C. diff organism. Both parents deceased, father died of heart attack at 60 yo, children are ok, HTN runs in her family and both her and her brother. Assessment/Plan: Primary Diagnosis: C. difficile colitis. Acute renal failure from dehydration/hypovolemia secondary to acute diarrhea Status/Condition: Stable Code Status: Full Allergies: NKDA Admit to Unit: Medical-surgical Precaution: Contact isolation Activity Level: Bedrest with commode, call for assistance Diet: CC2, No Gastric irritants IVF: NS@100 notify NP if patient able to tolerate diet and has no nausea Critical Drips: NONE Respiratory: NONE Medications: Hold home medication Vancomycin 125 mg PO q 6 h PRN: Zofran 4 mg IV q 6 h for nausea Ketorolac 15 mg IV Soln q 4 pain (4-6) Ketorolac30 mg IV Soln q 4 pain (7-10) Nursing Orders: Orthostatic Vital signs Q shift Skin care, toileting, ambulation etc. Encourage oral hydration as tolerated, monitor I&O DVT/PE prophylaxis- Teds Follow Up Lab tests: CBC, Lactic acid, Diagnostic testing: CT-Scan of abdomen and pelvis with contrast- if clinically safe. Consults: ID- C. diffcile management and care in and outpatient Patient Education and Health Promotion: *If you are given medicine to treat C. diff, take it as directed. *Wash your hands with soap and water often. *Wash after you go to the bathroom and before you touch food. *People who live with you should also wash their hands with soap and water often. * Remind visitors to wash their hands with soap and water as they come and go. *Wash your hands often. *Wash after you use the bathroom and before you touch food. * Do not actively seek antibiotics for common, often viral infections (head cold). * Only take antibiotics as prescribed by your doctor. *Stay in your room except when you need to go for a test or procedure. *Before leaving your room, put on a clean robe. *No alcohol-based sanitizers. Discharge planning and required follow-up care *Schedule appointment with primary MD for follow-up within 7-10 days after DC if diagnosis is unclear or symptoms do not abate with conservative treatment *DC to rehab facility after resolution of diarrhea.
