Case Study 14
27 y/o African-American male, was admitted to the hospital because of an uncontrollable fever, he was transferred from a long-term care facility, he has a history of a gunshot wound to his left chest, following a cardiac arrest after the accident he developed hypoxic encephalopathy, he has a tracheostomy and GT in place, he has a history of MRSA in his sputum, family says that they visit him regularly and are very devoted to him. Pt is thin, cachectic in moderate respiratory distress, unresponsive to voice, touch, or painful stimuli, temp is 104F, heart rate is 120, resp rate is 30, and O2 Sat is 90% on room air, chest auscultation revealed crackles and scattered rhonchi in the left upper lobe, serum albumin 2.8 g/dl, WBC 18,000μl, sputum spec is thick, green, foul smelling with culture pending, ABG = pH 7.29, PaO2 80mm Hg, PaCO2 40mm Hg, bicarb 16 mEq/L, stool culture positive for C.diff, Chest x-ray revealed infiltrate in the left upper lobe, no pleural effusions noted.
Case Study 15
30 y/o African-American female mother of two preschoolers, comes to the emergency department with severe wheezing, dypsnea, andanxiety, she was in the ER only 6 hours ago with an acute asthma attack, treated in the ER previously with nebulized albuterol and responded
quickly, can speak only one-to-three-word sentences secondary to dypsnea, allergic to cigarette smoke, began to experience increased SOB and tightness in her chest when she returned home,
used albuterol MDI without spacer repeatedly at home with no relief, physical exam revealed using accessory muscles to breath, has audible wheezing, respiratory rate 34/min, auscultation
reveals no air movement in lower lobes, heart rate 126, ABG: PaO2 80mm Hg, PaCO2 35mm Hg, pH 7.46, PEFR: 150 L/min with her personal best 400L/min.
Case Study 16
Phillip Lockwood, a 66-year old African American married man, comes to the primary health outpatient clinic because of an inability to void for the past 12 hours and pain in the lower abdomen. He complains of the urge to void and is restless and agitated. His examination shows
he has prostate enlargement on digital rectal examination, hematuria and WBCs in urine, a tender and palpable bladder above the umbilicus, PSA test 6ng/ml. An indwelling catheter is inserted by a urology resident and he is admitted to the hospital.