Case Study for Clinical Rotation
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Transcript of Case Study for Clinical Rotation
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
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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
2
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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