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BT is a 95 year old Caucasian female that lives with her husband and has spent 39 years working as a missionary. She presented to the emergency room at Milford Memorial Hospital on March 17, 2012 complaining of diarrhea for the past 6 days, up to 5 times a day. She also reported loss of appetite and weakness; upon admission to the emergency room she vomited once and verbalized cramping in the upper abdominal region. She was admitted with acute infectious colitis, acute renal failure, and dehydration. Past surgeries include an appendectomy (removal of the appendix), hysterectomy (removal of the uterus), abdominal hernia repair, and bladder suspension (replacement of a sagging bladder into the normal position). BT reported a family history of heart disease, hypertension, and cancer (MMH, 2012). BT has 4 children, 2 sons and 2 daughters. While caring for BT, I had the pleasure to meet one of her sons, a daughter, and a granddaughter. Many of her family members are also missionaries and the granddaughter that I met has served her current mission in Paraguay for 11 years. She is retired and insured through Medicare; she has a living will, her son is executor, and she is full code unless it is going to be prolonged. Medical History

BT denied use of tobacco or alcohol and stated that she has never used any type of illegal substances. She lives with her husband and prior to her admission she was able to provide 100% of her care at home, including activities of daily living (ADL’s). She is able to walk unaided and she stated that she does not normally have any shortness of breath (SOB), chest pain, nausea, vomiting, or abdominal pain or distention. There has not been any dramatic change in her weight prior to admission and no evidence of edema.

Past medical history includes hypertension, asthma, hyperlipidemia, coronary artery disease in which she suffered a myocardial infarction in 2006 and received cardiac catherization, transient ischemic attack, and heart murmur. Hypertension is defined as systolic (top number) blood pressure of 140 mmHg or higher, or diastolic (bottom number) pressure of 90 mmHg or higher, based on the average of three or more readings taken on separate occasions (LeMone & Burke 2012). Blood pressure that is not controlled leads to coronary artery disease, peripheral artery disease, and increases her risk for stroke and kidney disease. Upon admission, her blood pressure was 89/55 and her heart rate was 86 (MMH, 2012). She has been managing her blood pressure at home with the following antihypertensive medications: Metoprolol 25 milligrams and Benicar 10 milligrams, and she has had low blood pressure prior to and during her stay in the emergency room. (MMH, 2012). Hypertension usually develops in middle aged and older adults and sustained hypertension leads to atherosclerosis, increases ventricular workload, and can lead to renal insufficiency (LeMone & Burke 2012). Category| Systolic (Top Number)| Diastolic (bottom number)| Normal| Less than 120| Less than 80|

Pre-hypertensive| 120-139| 80-89|
High Blood Pressure (Stage 1)| 140-159| 90-99|

Asthma is a chronic inflammatory disorder of the airways characterized by recurrent episodes of wheezing, breathlessness, chest tightness, and coughing. Bronchoconstriction, edema and inflammation, and mucous secretion narrow the airway. Airway resistance increases, limiting airflow and increasing the work of breathing. The cause of asthma is unknown but some risk factors include allergies, genetic predisposition, air pollution, occupational exposure, respiratory viruses, exercise and stress (LeMone & Burke 2012)

Hyperlipidemia is defined as having too many lipids, or fats, in the blood. It is used to collectively describe high cholesterol and high triglycerides. High lipid levels can speed up a process called atherosclerosis, or hardening of the arteries. Arteries are normally smooth and are not obstructed...
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