Week 7 Case Study (1)
The following activity includes several case presentations of edema. Make a diagnosis for each case, remembering the following questions:
- Is the edema acute/sudden or chronic (e.g., duration, progression)?
- Is it unilateral or bilateral? Is the edema generalized or localized?
- Is it pitting or nonpitting?
- Is it dependent?
- In addition to edema, what other characteristics are associated with the edema (e.g., redness, pain)?
- What is the pertinent past or coexisting medical history? What medications is the patient taking?
You may want to refer to chapter 3 and chapter 4 to help determine the diagnosis.
Case 1
45-year-old Mrs. Rodriguez is complaining of intermittent mild bilateral feet/ankle swelling for the past 2 months, but it is worse on her right leg. She denies leg pain, but she does describe her legs as feeling heavy at times and reports standing for long periods worsens the swelling. She notes her veins are getting larger in her legs. For the past 8 months, she has been experiencing intermittent numbness in her feet and reports her left knee has been achy. She is a server at a busy restaurant and sometimes works 10-hour days. She denies any fever, warmth, erythema, or trauma.
- Past medical history: obesity (BMI 31); type 2 diabetes mellitus.
- Medications: metformin.
- Physical examination: vital signs are within normal limits; exam is unremarkable except for bilateral tortuous veins in both lower extremities, which are worse on the right leg, and decreased sensation in both feet.
- Note: Assume history and examination is within normal limits if not listed.
Activity
- Identify the probable diagnosis and what data support your decision.
- Describe the pathogenesis for the diagnosis.
- What data are inconsistent with your diagnosis?
- What diagnostic tests would you order, if any, and how would you treat this patient?
Case 2
68-year-old Mr. Quincy is complaining of left leg swelling for the past 2 weeks. The swelling started while he was on a cruise. The swelling is intermittent and below the knee to his foot. He describes a cramplike pain in his left calf. Lately, both legs have been cramping while walking, but it resolves when he sits. He denies any fever, warmth, erythema, or trauma.
- Past medical history: iliofemoral deep vein thrombosis of his left leg after he had left hip replacement for osteoarthritis 9 months ago; treated with rivaroxaban for 6 months; stable angina; obesity (BMI 31); dyslipidemia.
- Social history: quit smoking 4 years ago but resumed one-fourth pack per day 1 year ago.
- Medications: simvastatin; aspirin; metoprolol.
- Note: Assume history and examination is within normal limits if not listed.
Physical examination: vital signs are within normal limits; right leg is within normal limits except hairless, shiny skin; left leg has 1+ pitting edema in the pretibial area and foot; mild pain with left calf compression and one small tortuous vein on the medial aspect of his calf; left leg is also hairless and shiny. A venous duplex Doppler ultrasound of his left leg was done and reveals no deep vein thrombosis.
Activity
- Identify the probable diagnosis and what data support your decision.
- Describe the pathogenesis for the diagnosis.
- What data are inconsistent with your diagnosis?
- What diagnostic tests would you order, if any, and how would you treat this patient?
Part 2: Students are to complete Part 2
A 70-year-old woman was recently treated for pneumonia with antibiotics. After 1 week on antibiotics, she started developing severe diarrhea of 6–7 loose, watery stools per day. The diarrhea has been present for 3 days. She also has a decreased appetite, feels nauseous, and has not been drinking a lot of fluids. She feels very weak and dizzy. She lives alone, so she called 911 and was brought to the emergency department. She is diagnosed with diarrhea, presumptive Clostridium difficile.
- Patient medical history: Clostridium difficile 2 years prior.
- Physical examination: temperature 99.0°F; pulse 100 beats per minute; respirations 24 per minute; and blood pressure 90/50 mmHg, which dropped to 70/40 mmHg when seated. Examination unremarkable except for dry mucous membranes and generalized mild abdominal tenderness with palpation.
- Laboratory findings reveal:
- Chemistry panel: sodium 135 mEq/L; potassium 3.4 mEq/L; chloride 100 mmol/L; HCO3- 12 mEq/L; blood urea nitrogen 40 mg/dL.
- Creatinine: 1.2 mg/dL.
- ABG: pH 7.22, PaO2 85 mmHg, PaCO2 20 mmHg, HCO3- 12 mEq/L.
Activity
- Analyze the ABG and determine the acid–base disturbance.
- Calculate the compensation response and determine if it is appropriate.
- This item is optional. Calculate and interpret the anion gap.
- Discuss the diagnosis.
- Develop a treatment plan.
TEXTBOOK & READING:
From your textbook. Applied Pathophysiology for the Advanced Practice Nurse, read the following chapter:
- Urinary Functions
