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and harder to
breathe.
Acute Respiratory Failure secondary to Chonic
Obstructive Pulmonary Disease, Community
Acquired Pneumonia Moderate Risk Cardiac
Dysrhythmia (!AC" #rom $lectrolyte %mbalance,
Coronary Artery Disease,
&eni'n Prostatic (yperplasia
Objectives
General Objective:
+, year old
male
-ido-er
Roman Catholic
(t 0 123 cm
4t 0 33 k'
&M% 0 ,5/6
Occasional Drinker
(ypertension 0 ,511
(ypertension
Diabetes
Assessment 0 April ,5, ,51,
%nitial ital )i'ns
!emperature 0 72
de'rees celcius
(eart Rate 0 63
beats per minute
Respiratory Rate 0
,7 breaths per
minute
&lood Pressure 0
122>+?
(ead to toe
;eurolo'ical
$ye response 0 ?
spontaneous
erbal response 0 1
presence o# $! tube
Motor respose 0 2
obeys commands
@C) 0 11>13
Assessment 0 April ,5, ,51,
isual>Auditory
)pontaneous movement
o# le#t eye -ith pupillary
siAe o# positive ,B7mm
Ri'ht eye, :8ed
;o auditory impairment
Mouth>Dentures
;o dentures
4ith presence o# $!
tube at ,1 lip level
Aller'ies
;o kno-n aller'ies
Pulmonary
4ith mechanical
ventilator
AC ,1
F%5, 73C
! ?,5
&.R 12
Peep 3
Presence o# -heeAes
Assessment 0 April ,5, ,51,
Cardiovascular
Re'ular pulses
Re'ular rhythm
;o chest pain noted
;o peripheral edema
Peripheral pulses palpable
Musculoskeletal
Moves all e8tremities
;o -eakness noted
%nte'umentary
&raden )cale )core 0
13>,7
@astrointestinal
)o#t abdomen, non
tender, non distended
Presence o# bo-el sounds
;o &M #or , days
4ith presence o#
;aso'astric !ube
@enitourinal
&ladder distended
Continent
4ith presence o# a
condom catheter
Cloudy urine output
Functional abilities
&raden )cale
)ensory perception 0 ?
no impairment
Moisture 0 7
occasionally moist
Activity 0 1 bedrest
Mobility 0 7 sli'htly
limited
;utrition 0 , probably
inadequate
Friction and )hear 0 ,
potential problem
13 0 At risk
Risk #or #all assessment
(istory o# #allin' -ithin 7
months 0 5
)econdary dia'nosis 0 13
Ambulatory aid 0 5
%>(eplock 0 ,5
@ait>!rans#errin' 0 15
?3 0 lo- risk #or #allin'
Functional assessment
&ed Mobility B
@roomin' 0 8
Ambulation 0 8
Cranial nerves 0 not
applicable
Course in the -ard
Day 1 0 ?>1D>,51, B 6*35 pm
Patient -as admitted to the $R
under the service o# Dr/& and
-as re#erred to Dr/!/
ital si'ns and % E O
monitorin' #or every hour/
For his diet, he -as ordered OF
o# 1255 Fcal in 2 equal
#eedin's/
For his laboratory test, he -as
ordered #or C&C, ;a, F,
Creatinine, .A, $!A @)>@),
!rop ! !)(, F!?, A<!, Chest GB
ray, A&@, 1,B <ead $C@/
%F -as Plain ;ormal )aline
)olution 1< #or 6 hours
(is medicines -ere*
For'ram , 'rams % every ,? hours
AAith 1 tab once a day
(ydrocortisone 155 m' % every 6
hours
Combivent 1 nebule every 2 hours
Acetylcysteine 255 m'>tab
dissolved in H 'lass o# -ater once
a day
%mdur 75 m'>tab once a day
<isinopril 3 m'>tab once a day
Pravastatin ,5m'>tab once a day
!amsulosin 5/? mc'>tab once a day
Finasteride 3m'>tab once a day
Aspirin 65 m'>tab once a day
Course in the -ard
D*55 pm
Falium Durule 1 durule 7
times a day #or 7 doses
Pantoloc ?5m'>tab once a
day/
15*,5 pm
A&@s in AM
trans#er to C side %C.
nebuliAation and
hydrocortisone be
continued #or no-
head elevation 73 de'rees
C&@ monitorin' preBmeals
every 6 hours
revised #eedin' via enteral
pump -ith 15 ml Iushin'
MidaAolam 1m' % #or
di9culty o# sleepin'
11*55 pm
Decrease F%5, to 25C
Course in the -ard
4/20/2012
1,*55 mn
Decrease F%5, to ?5C
6*55 am
Diet o# 1255 Fcal>day Prosure 65'm
protein to be delivered at a rate o# 37
ml>hour 1/,2*1 dilution
6*?3 am
Mechanical ventilator settin's
decrease F%5, to 73C AC Mode !
?,5ml RR 12>min P$$P 3
Do8o#ylline ?55 m'>tab , times a day
<evodropopirine 15 ml 7 times a day
Montelukast 15 m'>tab once a day
secure previous dia'nostic results
done on the patient
11*55 am
% Iuid to #ollo- -as P;))
1< #or 6 hours
Continue Falium Durule
every 6 hours/
7*75 pm
PeriBolimel 1/? Fcal to run
#or ,? hours
decrease %F to FO once on
PeriBolimel
bed turnin' to sides every ,
hours/
Course in the -ard
3*55pm
Mr/ $<$ e8perienced di9culty
o# breathin' )!A! dose o#*
hydrocortisone 155 m' %
nebuliAation o# combivent
MidaAolam 3m' %
)hi#ted Combivent to
)albutamol K , ml o# normal
saline solution every ? hours
and as needed #or dyspnea
%ncreased (ydrocortisone to
155 m' % every 2 hours
%ntermittent strai'ht
catheteriAation every 6 hours
6*?3 pm
)trai'ht catheteriAation at 15 pm
&lood -orks o# serum potassium and
creatinine at 3 am
MethimaAole 3m'>tab once a day
)!A! dose o# %sordil 3m'>tab #or increased
&P
15*75pm
)!A! dose Morphine 1m' %
#or 1, <ead $C@,
blood-orks o# !roponin %, CF at 1*75am
)albutamol -as decreased to every 6
hours/
(R slidin' scale*
'reater than 165 m'>dl L , units
subcutaneously
'reater than ,,5 L ? units
subcutaneously
Course in the -ard
4/21/12
7*,5 am
Medicine service su''ested #oley
catheter insertion once sur'ery
service consents/
)!A! dose o# <actulose 75 ml,
then once a day at bedtime
2*35am
Cle8ane 5/2 ml subcutaneously
once a day
Clopido'rel +3m'>tab once a day
&lood -orks o# P!, P!!
+*75am
Medicine service su''ested
cardiolo'y re#erral
,d echo at bedside
6*55am
re#erred to Dr/P #or cardiolo'y
mana'ement
)albutamol -as discontinued, shi#ted
to Combivent 1 nebule K ,ml nss
every 2 hours and as needed #or
dyspnea
Chest GBray is scheduled #or the
#ollo-in' day
For $!A @)>C)
D*55am
)tart -ith beta blockers
)u''est salmeterol
D*?5am
Carvedilol once ok -ith cardio service
Maintain mechanical ventilator
settin's
Course in the -ard
15*55am
(old lisinopril #or no-
Olmesartan ?5 m'>tab once a day
%soket drip B D5ml P;)) K 15m'
%sordil 8 15 ml>hr, titrate to
maintain )&P M1?5
%vabradine 3m'>tab no-, then ,8
a day
4ill not start beta blockers #or
no-
11*55am
Discontinue Pravastatin
)tart <ipitor 65 m'>tab once a day
Cle8ane 5/2 ml subcutaneously
every 1, hours
(old imdur -hile on isoket drip
!rop ! and 1, lead $C@ at , pm
Amlodipine 3m'>tab once a day
<ast dose o# kalium durule
For <ipid Pro:le
1,*55nn
Aspirin 65 m'>tab once a day
Clopido'rel +3m'>tab once a day
For PC% on Monday ?>,7>1, 0 15 am
Re#er to cardiac rehab c>o Dr/&
,*55pm
Dr/ & #or anesthesia
Dr/ $ #or cardiac rehab
Course in the -ard
4/22/12
6*75am
Additional amlodipine 3m' this am
%soket drip to consume
)tart %mdur 25m'>tab once a day
PreBcatheteriAation orders
P;)) 1< 8 65ml>hour
Diphenhydramine 35 m' per
orem
%n#orm cath lab
%n#orm cardio #ello-
1,*55nn
)ave ri'ht radial artery
(old levopront #or no-
Fluimucil 255m'>tab in H 'lass ,8 a
day
3*55pm
AntiBhypertensive medication at
?>,7>1, 3am via ;@!
6*35pm
C&@ every ? hours -hile on ;PO
Maintain (R slidin' scale
D*13pm
Amlodipine K Olmesartan
(!-ynsta" 65>15 >tab once a day in
AM
;icardipine 1 m' % push no-
Restart isoket drip 15 m' isordil K
D5ml P;)) >m'>hr #or )&P 8 1?5
mm('
Course in the -ard
4/23/12
,*75am
;icardipine , m' % no-
+*55am
De#er coBmana'ement -ith Dr/A
6*55am
Combivent nebuliAation every 2
hours
Continue % hydrocortisone
Dr/ ! to cover
6*75am
;icardipine 1 m' % push no-
15*55am
Patient is under'oin' PC%
11*55am
Post CatheteriAation orders*
$levate not more than 75 de'rees
Re#er #or &P less than D5 (R less
than 35
Resume diet
Replace -ith the same %F every 6
hours
Replace -ith !R band -ith &andBAid
in AM
!R band release at ?pm
%soket drip ,5m' in 65ml P;)) 8 ?5
ml>hour (6m'>hour" then titrate to
maintain )&P less than or equal to
1?5
Course in the -ard
11*75am
!o %C.
For urine ;@A<
For creatinine ?>,?>1, am
%nclude C&C
Clopido'rel +3m'>tab , times a
day
CilostaAol 35m' >tab , times a
day
Aspirin 65m'>tab once a day
Cle8ane 5/2 ml , times a day
(old %mdur
Continue !-ynsta
Add Methyldopa ,35 m' > tab ,
times a day
P;)) 1< 8 6 hours
3*55pm
!eraAocin ((ytrin" ,
m'>tab once a day
4/24/12
6*55am
Decrease %F to ?5
ml>hour
%ncrease methyldopa to
355m' , times a day
Course in the -ard
6*75am
(ydrocortisone 155m'>%
no-
CPR no-
Amiodarone 15m'>%
no-
C&C to blood-orks
For A&@
MidaAolam 7m'>%
no-
Amiodarone 255m' K
,35ml D3 4ater 8 ,?
hours
Course in the -ard
D*,5am
Ma'nesium )ul#ate 1 'ram K D5 ml
D3 4ater #or 1 hour
Dolcet 1 tablet no-
(old ivabradine
(old methyldopa
15*55am
Potassium Chloride 15 meqs K D5 ml
o# P;)) #or 7 cycles
7 tabs o# Falium durule per ;@! no-
Falium durule , tabs every 6 hours
#or 7 doses
@ive , tabs o# Falium durule at 3 pm
Repeat potassium at 2 pm toni'ht
%ncrease combivent nebuliAation to
every ? hours #or no-
,*55pm
3*?3pm
De#er cardiac rehab until
hemodynamically stable
Course in the -ard
2*75pm
(ydrocortisone 35 m' % every 6
hours
Discontinue do8o#ylline
Ce#tria8one #or + days
+*75pm
Potassium 15 meqs K D5 ml
P;)) 8 1 hour #or , cycles
Repeat potassium ?>,3>1, AM
11*55pm
@ive nicardipine 1m'>ml no-
Dolcet 1 tab every 6 hours #or
pain as needed
Course in the -ard
4/25/12
2*?3am
Potassium Chloride drip 15 meqs K
D5ml ;)) #or 1 hour #or 7 cycles/
%F to #ollo- P;)) 1< 8 ?5 ml>hour
+*75am
%mdur 75 m' once a day
!itrate nicardipine drip
%ncrease Falium Durule , tabs every 2
hours #or ? doses, 'ive , durules no-
Aldactone ,3 m'>tab every 1, hours
#or , doses
For potassium and ma'nesium
?>,2>1, am
Dolcet 1 tab no-/
Amiodarone drip to consume
then start Amiodarone
,55m'>tab 7 times a day
)hi#t %F to Plain <actated
Rin'ers K ?5meqs FC< 8 ?5
ml>hour
Decrease Cle8ane 5/2 ml
subcutaneous once a day
startin' ?>,+>1,
Cold compress to le#t hand 78
a day until s-ellin' resolves
D*55am
Consume dose o#
Acetylcysteine then
discontinue
;PO #or no-
)uction secretions thorou'hly
Revise dose o# (ytrin to
3m'>tab once a day/ @ive 1
st
dose no-
Course in the -ard
11*55am
;o obNection to
-eanin'
)@P! to ne8t
blood-orks
Medical mana'ement
<aboratory
?>1D>,51,
$!A @)>C)
;ormal Flora
?>1D>,51,
Chest GBRay
%mpression*
Post sur'ical chan'es in the
ri'ht upper lobe and hilium
Mild tracheal narro-in' ,
may also be due to post
sur'ical chan'es
Probable nodule, le#t
!ortous and atherosclerotic
aorta
C! correlation is su''ested
and clinically -arranted
Medical mana'ement
<aboratory
()*+),-*,
.hemistry / (:01 pm
Test Result
SGPT Within normal range
Creatinine Within normal range
Sodium Within normal range
Potassium Within normal range
Medical mana'ement
<aboratory
()*+),-*,
.omplete 2lood .ount / (:01 pm
Test Result Normal Range Interpretation
Hemoglobin 131 g/L 13 ! 1"#
$lood loss and bone marro%
suppression redu&e total R$C
&ount and there'ore lo%er total
hemoglobin &ontent(
Hemato&rit #(3) (*# ! (*
+e&reased hemato&rit indi&ates
anemia- su&h as that &aused b.
iron de'i&ien&. or other
de'i&ien&ies(
R$C *(1 /1#011/L *(2# 3 2(1#
4 de&reased number o' R$Cs
results 'rom eithera&ute
or&hroni&blood loss( 4&ute
blood loss is a rapid depletion o'
blood 5olume( Chroni& blood loss
stems 'rom 5arious &onditions
that o'ten results in some 'orm
o' ananemia(
6ean Corpolar
hgb
31 1" ! 31
7le5ated 6CH is asso&iated %ith
ma&ro&.ti& anemia-
H.perlipidemia ma. gi5e a 'alse
ele5ation o' the 6CH
R+W 1(1 11( 3 1*(
R+W test results are o'ten used
together %ith
mean &orpus&ular 5olume86C9:
results to 'igure out %hat the
&ause o' the anemia might be
Medical mana'ement
<aboratory
"pecial .hemistry / 3:14
pm
Test Result
Troponin T Negati5e
Medical mana'ement
<aboratory
(),-),-*,
5rinalysis / *,:*4 am
Test Result Normal Range Interpretation
Color .ello% amber
Rea&tion (#
7r.thro&.tes Positi5e 8;;;:
It ma. beidiopathi&and/or
benign- or it &an be asign
that there is a<idne. stone
or atumorin the
urinar. tra&t8<idne.s-
ureters-urinar. bladder-
prostate- andurethra:-
ranging 'rom tri5ial to
lethal(
Protein Positi5e 8;;:
Possible %ith renal anomal.
Medical mana'ement
<aboratory
(),-),-*,
5rinalysis / *,:*4 am
Test Result Normal Range Interpretation
Glu&ose Positi5e 8;;:
Sin&e blood glu&ose is high
probabl. it &onne&ted to
ele5ated blood glu&ose
Leu&o&.tes Positi5e 8;:
4 positi5e leu<o&.te esterase test
results 'rom the presen&e o'
%hite blood &ells either as %hole
&ells or as destro.ed &ells(
R$C 12/ul #!11
Hematuria is the presen&e o' abnormal
numbers o' red &ells in urine due to an.
o' se5eral possible &auses- e(g(
glomerular damage- tumors %hi&h erode
the urinar. tra&t an.%here along its
length- <idne. trauma- urinar. tra&t
stones- renal in'ar&ts- a&ute tubular
ne&rosis- upper and lo%er urinar. tra&t
in'e&tions- nephroto/ins- and ph.si&al
stress 8li<e a &onta&t sport- or long
distan&e running 'or e/ample:( Red &ells
ma. also &ontaminate the urine 'rom
trauma produ&ed b. bladder
&atheri=ation(
Medical mana'ement
<aboratory
(),-),-*,
5rinalysis / *,:*4 am
Test Result Normal Range Interpretation
W$C 33/ul #!11
P.uria re'ers to abnormal
numbers o' leu<o&.tes 8%hite
&ells: that ma. appear %ith
in'e&tion in either the upper or
lo%er urinar. tra&t or %ith a&ute
glomerulonephritis(
7pithelial 33/L #!11
S>uamous epithelial &ells 'rom
the s<in sur'a&e or 'rom the
outer urethra &an appear in
urine( The. represent possible
&ontamination o' the spe&imen
%ith s<in ba&teria(
Medical mana'ement
<aboratory
(),-),-*,
62G / 0:0+ am
Test Result Normal Range Interpretation
PH "(3"? "(3 ! "(*
PaCo1 3(1 3 ! * mmHg @n&ompensated
PaA1 1""(" ?# 3 1## mmHg 6etaboli&
Standard
$i&arbonate
1#(" 11 3 1" mmol/l 4&idosis
A1 saturation !3(1 # ; (1
$ase 7/&ess ))(1B CD ) B
Medical mana'ement
<aboratory
(),*),-*,
"pecial .hemistry 7 (:(- am
Test Result Normal Range Interpretation
CE Total 2#"(# 3# ! 1##
It indi&ates the a&ti5it. o'
the 66- 6$- and $$
isoen=.mes
CE 3 6$ *1(# # ! 1*
CE!6$ is &onsidered the
ben&hmar< 'or &ardia&
mar<ers o' m.o&ardial
inFur.
CE 3 66 22(# 3# ! 1"2
CE ! 66 e/plains tissue
inFur. and ma. be ele5ated
as earl. as one hour a'ter
m.o&ardial inFur.- though it
ma. also be ele5ated due
to s<eletal mus&le trauma(
Medical mana'ement
<aboratory
(),*),-*,
.hemistry 7 (:(- am
Test Result
Potassium Within normal range
Creatinine Within normal range
(),*),-*,
"pecial .hemistry 7 (:(- am
Test Result %nterpretation
Troponin I Positi5e indi&ate a person has
had a signi'i&ant
m.o&ardial inFur.
Medical mana'ement
<aboratory
(),*),-*,
"pecial .hemistry / *:0+ pm
Test Result Normal Range Interpretation
Troponin T #(12 ng/ml #(1 ng/ml
8onsetG 3!* hrs-
pea<G
1#!1* hrs-
return to
normalG 1#!1*
da.s:
High ris<
m.o&ardial
damage has
been dete&ted
Medical mana'ement
<aboratory
(),*)*,
"pecial .hemistry / *:0+ pm
Test Result Normal Range Interpretation
CE Total **1(# 3# ! 1##
It indi&ates the a&ti5it. o' the
66- 6$- and $$ isoen=.mes
CE 3 6$ **(# # ! 1*
CE!6$ is &onsidered the
ben&hmar< 'or &ardia&
mar<ers o' m.o&ardial inFur.
CE 3 66 3)"(# 3# ! 1"2
CE ! 66 e/plains tissue inFur.
and ma. be ele5ated as earl.
as one hour a'ter m.o&ardial
inFur.- though it ma. also be
ele5ated due to s<eletal
mus&le trauma(
Medical mana'ement
<aboratory
(),*),-*,
.hemistry 7**:-0 pm
Test Result
Cholesterol Within normal range
L+L Cholesterol Within normal range
H+L Cholesterol Within normal range
Trigl.&erides Within normal range
9L+L Within normal range
Medical mana'ement
<aboratory
?>,,>,51,
Chest GBRay
%mpression*
Post sur'ical chan'es in the ri'ht upper lobe
and hilium
Mild tracheal narro-in' , may also be due to
post sur'ical chan'es
Consider pulmonary nodule versus en #ace,
le#t
Atherosclerotic aorta
Medical mana'ement
<aboratory
(),(),-*,
.hemistry / (am
Test Result Normal Range Interpretation
Creatinine (2 u6ol/L 21 3 11 +e&rease in serum
&reatinine is seen
in &onditions
&hara&teri=ed b.
mus&le %asting
@rine NG4L 11() # 3 131("# +e5iation ma.
indi&ate
a&ute <idne. inFur
.
Medical mana'ement
<aboratory
(),(),-*,
.omplete 2lood .ount 7 + am
Test Result Normal Range Interpretation
Hemoglobin 111 g/L 13 ! 1"#
$lood loss and bone
marro% suppression
redu&e total R$C &ount
and there'ore lo%er
total hemoglobin
&ontent(
Hemato&rit #(3* (*# ! (*
+e&reased hemato&rit
indi&atesanemia- su&h
as that &aused b. iron
de'i&ien&. or other
de'i&ien&ies(
Medical mana'ement
<aboratory
(),(),-*,
.omplete 2lood .ount 7 + am
Test Result Normal Range Interpretation
R$C 3(2 /1#011/L *(2# 3 2(1#
4 de&reased number o'
R$Cs results 'rom
eithera&ute
or&hroni&blood loss( 4&ute
blood loss is a rapid
depletion o' blood 5olume(
Chroni& blood loss stems
'rom 5arious &onditions
that o'ten results in some
'orm o' ananemia(
Neutrophil ( (2 ! (22
Neutropeniama. be
parado/i&all. seen in
&ertain in'e&tions-
in&luding 5iral illnesses(
Ather &auses in&lude
aplasti& anemia and
th.roid disorders
Medical mana'ement
<aboratory
(),(),-*,
.omplete 2lood .ount 7 + am
Test Result Normal Range Interpretation
L.mpho&.te (#) (11!*#
It is also seen in
a&ute in'e&tions-
%ith administration
o' &orti&osteroids(
7osinophil # #(*
7osinopeniais seen
in the earl. phase o'
a&ute insults- su&h
as sho&<- maFor
p.ogeni& in'e&tions-
trauma- surger.-
et&( +rugs produ&ing
eosinopenia in&lude
&orti&osteroids(
Medical mana'ement
<aboratory
(),()*,
"pecial .hemistry / + am
Test Result Normal Range Interpretation
CE Total 11*(# 3# ! 1##
It indi&ates the a&ti5it. o'
the 66- 6$- and $$
isoen=.mes
CE 3 6$ *)(# # ! 1*
CE!6$ is &onsidered the
ben&hmar< 'or &ardia&
mar<ers o' m.o&ardial
inFur.
CE 3 66 "(# 3# 3 1"2
CE ! 66 e/plains tissue
inFur. and ma. be ele5ated
as earl. as one hour a'ter
m.o&ardial inFur.- though it
ma. also be ele5ated due
to s<eletal mus&le trauma(
Medical mana'ement
<aboratory
(),()*,
"pecial .hemistry / + am
Test Result Normal Range Interpretation
6agnesium (?" (22 3 1(#" Within normal
range
Sodium 1*2 13 3 1*
In&reasein serum sodium is seen in
&onditions %ith %ater loss in e/&ess o'
salt loss- as in pro'use s%eating- se5ere
diarrhea or 5omiting- pol.uria and
inade>uate %ater inta<e( +rugs &ausing
ele5ated sodium in&lude steroids %ith
mineralo&orti&oid a&ti5it.- and
meth.ldopa
Potassium 1(? 3( 3 (1
+e&reasein serum potassium is seen
usuall. in states &hara&teri=ed b.
e/&essE;loss- su&h as in 5omiting-
diarrhea- &ertain renal tubular
de'e&ts(Redistribution h.po<alemia is
seen in glu&ose/insulin therap.- al<alosis(
+rugs &ausing h.po<alemia in&lude
&orti&osteroids- diureti&s(
Medical mana'ement
<aboratory
(),(),-*,
62G / + am
Test Result Normal Range Interpretation
PH "(*#1 "(3 ! "(*
PaCo1 *#() 3 ! * mmHg Normal
PaA1 123(1 ?# 3 1## mmHg
Standard
$i&arbonate
1(3 11 3 1" mmol/l
A1 saturation 1(1 # ; (1
$ase 7/&ess ))(1B CD ) B
Medical mana'ement
<aboratory
(),(),-*,
.hemistry / 4pm
Test Result Normal Range Interpretation
Potassium 3(1# 3( 3 (1
+e&reasein serum
potassium is seen
usuall. in states
&hara&teri=ed b.
e/&essE;loss- su&h as
in 5omiting- diarrhea-
&ertain renal tubular
de'e&ts(Redistribution
h.po<alemia is seen in
glu&ose/insulin therap.-
al<alosis( +rugs &ausing
h.po<alemia in&lude
&orti&osteroids-
diureti&s(
Medical mana'ement
<aboratory
(),0),-*,
.hemistry / 0am
Test Result Normal Range Interpretation
Potassium 3(# 3( 3 (1
+e&reasein serum
potassium is seen
usuall. in states
&hara&teri=ed b.
e/&essE;loss- su&h as
in 5omiting- diarrhea-
&ertain renal tubular
de'e&ts(Redistribution
h.po<alemia is seen in
glu&ose/insulin therap.-
al<alosis( +rugs &ausing
h.po<alemia in&lude
&orti&osteroids-
diureti&s(
Medical mana'ement
<aboratory
(),4),-*,
.hemistry 70 am
Test Result
Potassium Within normal range
6agnesium Within normal range
Medical mana'ement
<aboratory
(),4),-*,
.hemistry
Test Result Normal Range Interpretation
SGPT 12? # !
4 number o' &onditions &an
&ause damage to li5er
&ells- resulting in an
in&rease in 4LT le5els( The
test is most use'ul in
dete&ting damage due to
hepatitisand drugs or other
substan&es to/i& to the
li5er( 4LT- ho%e5er- is not
entirel. spe&i'i& 'or the
li5er- and mild to
moderatel. in&reased
le5els ma. also be seen in
&onditions a''e&ting other
parts o' the bod.(
+iagnosti&s
4/19/2012
CBC
Na
K
Creatinine
UA
ETA GS/GS
TSH
FT4
ALT
Trop T
Chest Xra!
ABG
12 Lea" ECG
CBG
4/20/2012
#otassi$%
Creatinine
12 Lea" ECG
Troponin &
CK
4/21/2012
#T
#TT
2" E'ho
ETA GS/CS
4/22/2012
Chest Xra!
+iagnosti&s
4/2(/2012
#C&
CBC
Urine NGAL
4/24/2012
Crea
&'a
)*
Na
K
CK en+!%es
CBC
ABG
12 Lea" ECG
,epeat K at
-p%
4/2./2012
K
SG#T
Treatment
?>1D>,51,
Patient -as initially dia'nosed as acute respiratory #ailure
probably secondary to COPD in acute e8acerbation/
)tarted -ith P;)) 1< 8 6 hours
;@! -as inserted
laboratory blood tests -ere requested
)tarted on antibiotics, steroids bronchodilators alon' -ith
antihypertensive medications, 'astric protectant, electrolytes
and medications #or his &P(
started on continuous #eedin'
C&@ monitorin' -as started
dru' #or di9culty o# sleepin' -as also ordered
!here -as also constant chan'in' o# the mechanical ventilator
settin's/
Treatment
?>,5>,51,
PatientPs diet -as revised
Mechanical ventilator settin's -ere a'ain adNusted
AntiBasthma medications started
$lectrolyte supplement -as continued
)tarted on parenteral nutrition
Ordered #or bed turnin'
At 3 pm he e8perienced di9culty o# breathin'* steroids and
bronchodilators -ere ordered alon' -ith antiBa'itation meds
)teroid dose -as also increased to every 2 hours #rm every 6
hours/
%ntermittent strai'ht catheteriAation every 6 hours -as ordered #or
bladder distension/
!he patient complained o# chest pain and -as ordered pain meds
and 1, lead $C@
Cardiac enAymes at 1 am
&ronchodilator -as decreased to every 6 hours and a (R slidin'
scale -as started/
Treatment
?>,1>,51,
!he medicine service su''ested #oley catheteriAation i# ok -ith
sur'ery service
)!A! dose o# la8ative -as 'iven
)tarted on lo-BmolecularB-ei'ht heparin and blood thinners
&lood-orks #or bleedin' and clottin' time -as ordered
Medicine ordered cardio re#erral since patient does not have a
consistent blood pressure
,D echo at bedside -as also done
!he bronchodilator -as chan'ed to another
PatientPs settin' o# the mechanical ventilator -as maintained
)tarted on oral and % antihypertensive medications
)hi#ted antiBlipids to another and increased the dose o# the lo-B
molecularB-ei'ht heparin
Ordered #or $C@ and lipid pro:le
)cheduled #or PC% on the ,7
rd/
Treatment
?>,,>,51,
?>,?>,51,
?>,3>,51,