Question

What is going on with this patient?

The female patient was admitted to the ER with shortness of breath, chest pain, and increased sputum production. The patient's husband states that the symptoms began when lawn care was mowing near their door at their apartment. A chest x-ray was performed and cardiomegaly and mild congestion was found. The patient is on PEG tube feedings, and has a foley catheter. The patient is unable to clear secretions by coughing and requires suctioning. The patient is nonverbal and bed-bound.

In addition to the above assessment findings, this patient opens her eyes to verbal commands. Her lungs are diminished at the bases and at times rhonchi can be heard. She is on 2LNC and has a productive yellow cough. When assessing her heart, she has a normal rate and rhythm, but her heart sounds are distant. Her foley has dark amber urine with noted sediment in the tubing. She is incontinent of bowels and is also having smalls amounts of watery stool. She has not had a large bowel movement for me. She does have hyperactive bowel sounds. Her tube feedings are working well and there are no large amounts of residual. Her abdomen does appear distended and firm.

Lab values for patient:

LAB	NORMAL VALUE	Day 1	DAY 2
HEMATOLOGY
WBC	4-10	13.5 (high)	10.8 (slightly high)
RBC	4-5.2	2.7 (low)	2.5 (low)
HGB	12-16	10.7 (low)	9.2 (low)
HCT	37-47	32.9 (low)	24.3 (low)
PLTS	150-350	320	225
CHEMISTRY
GLUCOSE	60-140	277 (high)	204 (high)
BUN	8-20	20	16
CREATININE	.7-1.3	0.9	0.8
BUN/CREAT RATIO
Na	136-145	142	131
K	3.5-5	3.4 (low)	3.3 (low)
Cl	98-106	113 (high)	95 (low)
Ca	8.7-10.7	8.3 (low)
Mg
Ph
TOTAL CO2
AST
ALP
ALT
TOTAL PROTEIN
ALBUMIN	3.5-5.5	3.2
BILIRUBIN
Total Bilirubin
LIPID PANEL
CHOLESTEROL	Less than 200	245 (high)
HDL	Greater than 40	32 (low)
LDL	Less than 130	106
TRIGLYCERIDES	Less than 250	230
COAGULATION
PTT	26-40	26
PT	11-13	9 (blood clots too fast)
INR	.7-1.8	1.6
Other
CK	30-170	202 (high)
Troponin	0- 0.5	0.6 (high)

Answer 1

Answer: In the above mentioned case, the symptoms such as coarse rhonchi in lung fields, tachypnia as the abnormal breathing rates as well as sounds reveals that there is anykind of abnormality in lungs. Patient have problem in breathing and unable to speak. This is due to insufficient supply of oxygen to the lungs.

The symptom that would have the highest priority for this assessment is the rhonchi sounds. These sounds usually resembles to the snoring and it occurs due to any type of obstruction in the lungs where there is a pitch of sound while breathing.

Patient having symptoms of the rattled sound indicates that there is presence of fluid or the obstruction in the airways of the lungs. This occurs in the patient suffering from constructive pulmonary disease, pneumonia etc. This can be due to excessive smoking, lung infection etc.