Nursing 235: Adult Health II

Nursing 235: Adult Health II

Laboratory Analysis Case Scenario

Patient Initials: KH   Age: 60           

Height: 65 in             

Weight: 67.13 kg

HPI

KH presented to the ED with c/o bug bite on L thigh that occurred about 10 days ago that has turned into an abscess “as big as a personal sized watermelon.” Patient also reported urinary burning, frequency, and urgency. The ED, WBC 37,000, glucose 317, bicarbonate 13, anion gap 25, large amount of acetone, HgbA1C 10.3. Patient was admitted to the hospital for evaluation and management of DKA, DVT, abscess, and UTI.

Past Medical/Surgical History:

  • Type 2 Diabetes Mellitus
  • Previous tobacco use (1/2 pack per day)
  • MVA 7/13/20: pain in pelvis and knees since accident

Significant Clinical Events:

8/23/20

  • Wound culture: staph aureus, methicillin sensitive
  • Blood culture: no growth after 5 days (determined on 8/28/10)
  • Urine analysis indicates infection and DKA
  • Insulin drip for DKA
  • IV antibiotics for UTI, multiple abscesses
  • IV antifungals for multiple abscesses & topical antifungal for yeast infection

8/24/20

  • Deep muscle abscess extends to femur (visualized via CT)
  • I&D done in OR discovered diffuse myositis & muscle necrosis
  • S/p insulin drip for DKA treatment
  • Wound nurse consult
  • Infectious disease consult

8/26/20

  • I&D done in OR on L thigh, R groin abscess
  • Patient experience bleeding post-op
  • SCD and TED hose prescribed for DVT

8/28/20

  • d/c Coumadin due to post procedure bleeding, switched to Lovenox

8/29/20

  • bleeding from wound, changed lovenox to heparin
  • anemia due to blood loss s/p I&D, received 2 units packed RBC
  • Constipation for 1 wk, senna, colace, lactulose

8/30/20

  • blood glucose 340-360 mg/dL all day
  • patient complains of recent onset visual disturbances (since hospitalization on 8/23/10)
  • notify MD, increase levemir to 32 units daily
  • MD d/c IV antibiotic and heparin, change to PO antibiotics and coumadin
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