Irene, a 68 year old female, is admitted to the hospital due…
Irene, a 68 year old female, is admitted to the hospital due to complaints of persistent vomiting and abdominal pain for the past 2 weeks. She was subsequently diagnosed with severe colitis and went to surgery to resect (take out) that portion of her bowel. Ht: 5’2” Wt. on admission: 94 lbs. Weight 2 weeks ago: 100 lbs. (has been stable for the past 3 years) Diet: has been NPO since admission – IV is currently running at 80 mL/hr with D5W & ½ normal saline + 20 mEq/L of K+Cl- (this is hospital day number 5) – the plan is to advance her diet today to clear liquids and see how she tolerates it. Physical Examination: no significant signs of fat or muscle loss noted on admission; no edema noted on admission but dry mucous membranes and poor skin turgor assessed. Clinical status: stable following surgery 4 days ago; 5” of her transverse colon was removed Past Medical History: early COPD (chronic obstructive pulmonary disease – she takes the corticosteroid prednisone at home to help with the airway inflammation); gastroesophageal reflux (take a proton-pump inhibitor for management) Current medications: solumedrol (I.V. form of prednisone), esomeprazole (proton-pump inhibitor to prevent gastrointestinal bleeding); starting on some Lasix today (loop-diuretic) – she will be going home on lasix Diet History (for the past 2 weeks): Breakfast: 1 piece of white toast w/small amount of butter & jelly; cup of tea Lunch: Campbell’s chicken noodle soup with 4 saltines & tea; OR Campbell’s vegetable soup with 4 saltines, tea and 1 small container of applesauce Dinner: frozen dinner such as Lean Cuisine (chicken teriyaki/broccoli/rice) or Weight Watchers’ frozen dinner (mini-rigatoni in cream sauce, chicken ranchero mini wraps, etc. – typically provides 220 calories and 12 g protein per frozen dinner; drinks tea with dinner – eats all the frozen meals. Intake and ouput (I/O) data since admission: Hospital Day #1 Fluid intake/output: 1800 mL (In)/1000 mL (out) Weight: 93 lbs. Hospital Day #2 Fluid I/Os: 2200 mL/1000 mL Weight: 95 lbs. Hospital Day #3 Fluid I/Os: 1800 mL/1200 mL Weight: 98.8 lbs. Hospital Day #4 Fluid I/Os: 1920 mL/1250 mL Weight: 102 lbs. List SMART goals for Irene to achieve at home (5 points):
Read DetailsCASE STUDY Irene, a 68 year old female, is admitted to the…
CASE STUDY Irene, a 68 year old female, is admitted to the hospital due to complaints of persistent vomiting and abdominal pain for the past 2 weeks. She was subsequently diagnosed with severe colitis and went to surgery to resect (take out) that portion of her bowel. Question 1: What does her laboratory data below suggest on admission to surgery. How about on post op day 5? (10 points) Labs: on admission: Sodium 148 (135-145); Chloride 107 (95-105); Glucose 99 (70-99); BUN 20 (8-18); Albumin: 5 (3.5-5.0); C-reactive protein 22 (CRP) (
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