Integrated Pathophysiology Paper
Integrated Pathophysiology 2
Mr. F. is a seventy-three year old Caucasian male who is twice divorced and lives alone in Sweetwater, Texas. He has two children living, and two deceased children. Both of his parents are deceased; his father died at the age of sixty-nine of prostate cancer, his mother at the age of seventy-two of a stroke. He is self-employed, owning a local dirt contracting company for about thirty years now. Mr. F. stands five-foot and nine inches tall and weighs two hundred sixty pounds, exhibiting moderate obesity and has been for the past twenty-five years. He has a longstanding history of hypertension; approximately twenty years as well as a history of diabetes mellitus type two for twelve years, never having been insulin dependant. He has a smoking history of about fifty years smoking two packs per day and has been diagnosed a few years ago with chronic obstructive pulmonary disease, making him oxygen-dependant for two years. He claims to only drink alcohol on a social basis. Prior to his current admission, he stated that he has not been compliant with his diabetic diet, that he does not check his blood glucose regularly nor has he been following his medication regimen as he should. His last doctors appointment was two years ago. On July 6, 2008, Emergency Medical Services was called to Mr. F.’s residence by a friend who found him in bed, conscious, but speaking incoherently. He had a nasal canula in place at three liters per minute. His glucometer done by emergency personnel showed a blood sugar of thirty-six. He was then given a bolus of dextrose fifty percent; he then returned to consciousness, but complained of some right arm and leg weakness. He had 3+ pitting edema bilaterally to lower extremities as well as 1+ presacral edema. He was then transported to Rolling Plains Memorial Hospital emergency room. Upon arrival to the hospital, his vital signs were as follows; blood pressure- 200/103, heart rate- 80, respirations- 18, and oxygen saturation at 95% on oxygen via nasal canula at 3 liters per minute. His right sided weakness seemed to resolve per patient. He denied headache, vertigo and tinnitus. Diagnostics done at the emergency room showed a white blood cell count of 7.8, hemoglobin of 12.4, hematocrit of 37.2, MCV of 95, and the platelet count along with coagulation studies showed to be normal. His renal function was abnormal at a BUN of 68 and a creatinine of 6.1. His potassium level was 5.4 and CO2 was 22.3. His sodium level was 133, phosphorus levels were elevated at 6.1, globulins were elevated at 4.3, troponin level was slightly elevated at 0.14 and CPK was normal. His BNP NT-Type was extremely elevated at 9674.5 along with his hemoglobin A1C was at 5.8. Thyroid studies were Integrated Pathophysiology 3
found to be normal. The total cholesterol was 127, with HDL only at 24, LDL at 79 and triglycerides at 136. A further diagnostic study revealed by way of chest x-ray has shown cardiomegaly with mild venous congestion. The EKG shows poor R wave progression and nonspecific ST wave changes from previous. The echocardiogram showed 2+ mitral valve regurgitation with mild aortic stenosis and also an ejection fraction of over 50%. A renal sonogram shows diffuse cystic changes. A CT scan of his head revealed mild white matter changes but no other abnormalities. The 24 hour urine shows a urinary creatinine of 1449 and a urinary protein of 190.3. The patient denied problems with urination such as frequency, urgency, dysuria, recurrent urinary tract infections or renal stones. Home medications included; Potassium chloride 10 mEq t.i.d. daily, Metformin 500 mg daily, Nifedipine 90 mg daily, Ramipril 10 mg b.i.d. for a total of 20 mg daily, Albuterol inhaler, Furosemide 80 mg in the am and 40 mg in the pm. Mr. F. was admitted into the intensive care unit from the...