Question

ACUTE CARE CASE STUDY

Patient and Setting: CM is a 45-year-old man, on an inpatient surgical unit

Chief Complaint: Sudden onset of nausea/vomiting, some difficulty breathing, change in status

History of Present Illness: CM is in hospital, day 2 post-ORIF fractured femur with significant haemorrhage and other soft tissue injuries, sustained in an MVA.  CM reports that his feet are swelling, (+) fatigue, (+) nausea and vomiting, and (+) SOB. He has also noticed a decrease in urine output , although he reports he has not been eating or drinking much.

Medical History: Hypertension (×5 yrs), MVA

Surgical History: N/A (other than current hospitalization)

Family History: Mother: DM; Father: died at age 50 due to MI

Social History: Ethanol intake: Nil; tobacco: once/month

Medications:

Lisinopril 40 mg PO BID for 5 years

ASA 81 mg po daily

Rosuvastatin 20mg po daily

Amlodipine 10 mg PO QD for 2 years

Ibuprofen 800 mg PO TID for back pain

Centrum One 1 tab PO QD

Allergies: Morphine (tongue swelling, itching, rash, SOB)

Physical Examination:

GEN: Well-developed, nourished man

VS: BP 190/100, HR 83, RR 26, T 37.3°C, Wt 80 kg, Ht 182 cm

HEENT: WNL

CHEST: Small crackles, rales, and wheezing

ABD: WNL

EXT: Bilateral LE swollen with fluid, 3+ pitting edema

NEURO: A & O ×2 (place, time)

Results of Pertinent Laboratory Tests, Serum Drug Concentrations, and

Diagnostic Tests:

Na 132 K 5.9  

Hgb 88 Hct 0.34   Creatinine 189 BUN 23  

Blood Gas: pH 7.3; pCO2 40; HCO3 18; pO2 97

Urine Output: 300 mL/24 hr

CASE QUESTIONS:

1. List the physical assessment and laboratory findings in CM consistent with Fluid overload.  Why is he presenting with these findings?

2. What type of anemia is CM manifesting? What is the etiology and associated symptoms?

Rubric:

1. Identifies all of the assessment/lab findings in CM that are consistent with fluid overload, and provides a comprehensive pathophysiologic rationale for these findings

2. A comprehensive of the type of anemia and the etiology & associated symptoms

Note: please add the citation or website you get the information as I have to cite them for my assignment. Please answer these 2 questions with great detail as they are worth 10 marks each for the case study above for the pathophysiology class. Thank you so much.

Answer 1

Ans) Anemia (also spelled anaemia) is a decrease in the total amount of red blood cells (RBCs) or hemoglobin in the blood, or a lowered ability of the blood to carry oxygen.

- CM reports that his feet are swelling, (+) fatigue, (+) nausea and vomiting, and (+) SOB.

- Fluid overload (hypervolemia) causes decreased hemoglobin concentration and apparent anemia: General causes of hypervolemia include excessive sodium or fluid intake, sodium or water retention and fluid shift into the intravascular space.

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