Critical Pathway : Hiv. Desiree

The WBC and platelets are high because the Pt.’s body is trying to fight an infection.

Chweyah, dated 08/11/2017, indicated that the claimant presented for a follow-up visit after his discharge from the hospital on 08/08/2017. He was admitted on 08/04/2017 due to normocytic anemia, pain in both knees, starvation ketoacidosis, hypertension, gout with tophus, and duodenitis. The esophagogastroduodenoscopy revealed erythematous duodenopathy, erythematous mucosa in the antrum, and small hiatal hernia. He had a colonoscopy which revealed internal hemorrhoids. Objective findings showed blood pressure of 112/86 with a pulse of 105. He was diagnosed with quadriceps weakness, pain in both knees, normocytic anemia, type 2 diabetes mellitus, hypertension, stable chronic kidney disease stage III, and bilateral impacted cerumen. It was noted that he can return to work on 08/16/2017 with limitations of not standing for more than 10 minutes at a time for 1

CBC showed leukocytosis with a left shift, hyperglycemia, uremia, high ALT and ALP, hypercholesterolemia and lipemia.

This is an 82-year-old gentleman, who was referred from Dr. Gretchen Marsh’s office because the patient’s BUN and creatinine were high, as he has acute kidney injury. The patient went to Dr. Marsh’s office yesterday and was having generalized weakness. He does not have any vomiting. No diarrhea. No fever. No cough with expectoration. No sharpness. No wheezing. No headache. No dizziness. No passing out. No rectal bleeding. No hematemesis. No abdominal pain. No sore throat. No stuffy nose. No cough with expectoration. No burning, frequency, or

7. J.H. 's laboratory findings: The urine, hemoglobin (Hgb) and hematocrit (HCT) are standard. The elevated white blood cell (WBC) count is from infection, and the sodium might be low, depending on his hydration status and vomiting (Al Bekairy, Al Harbi, & Aikatheri, 2014 ).

Client M.E.’s laboratory values are all within defined limits except for her WBC. Her WBC is elevated; this is known as leukocytosis (Pagana & Pagana, 2014). An elevated WBC could be caused due to several reasons such as infection, myeloproliferative disorders, malignancies, trauma, stress, hemorrhage, inflammation, dehydration, thyroid storm and even steroid use (Pagana & Pagana, 2014). However, in the case of patient M.E. the most probable cause of her elevated WBC would be because of infection caused by the pathophysiologic process of cholecystitis. White blood cells function as part of the body’s immune system and work by fighting infection and reacting against foreign bodies or tissues Pagana & Pagana, 2014). So with this being said, during

P.M is 4 years. She has sore throat and cough but her rapid strep culture is negative. Strep is a bacteria infection and this means that P.M’s sore throat and cough is not a bacteria infection. Her test results are Hemoglobin 9.2, Hematocrit 28, platelets 100,000 and a total WBC of 24,000. WBC differential indicates an elevated lymphocyte count (right shift) which indicates viral/fungal infection while the RBC and platelets counts are below normal. Acute lymphocytic leukemia is a cancer that starts from early version of white blood cells in the bone marrow. Leukemia cells usually invade the blood quickly and spread to other parts of the body, including the lymph nodes, liver, spleen, central nervous system, and testicles. P.M has elevated

His course has been complicated by one episode of dactylitis and two episodes of acute splenic sequestration. Therefore, he had a single lumen port placement surgery for chronic transfusion therapy. Also, he had a partial splenectomy in 8/23/2016. Mariano is maintained on Amoxicillin for prevention of further sickle cell complications. The first Acute sickle cell splenic sequestration crisis was in 7/9/2014 that involved Initial Hgb 5.8, PLT count 153, splenic palpation presents 2 finger breadths below the left costal margin. He received two 5 mL/kg antigen matched, leuko reduced packed red blood cell transfusions spaced with a number of hours between transfusions. He was discharged with Hgb of 8.5. The second splenic sequestration crisis was in 8/14/2014 with initial Hgb 5.0, PLT count 62 and the spleen was palpable 3 cm below the left costal margin. He received 1 packed red blood cell transfusion. Upon discharge Hgb 7.5 and the spleen tip was not palpable. In 12/6/2015 he was admitted to the hematology unit for three days due to fever 102, positive culture of Rhinovirus and viridans group streptococci, and right leg pain crisis. In 11/17/2015 he was admitted for 2 days for fever of 101, but blood cultures and chest X-ray were negative. Ultimately, in 8/23/2016 when he became 3-year-old, he had a partial splenectomy. He is maintained on Amoxicillin for prevention of further sickle cell

Positive ANA titer (1:1280); elevated antibodies against double-stranded DNA; low C3 level (73 mg/dl); all else (platelets, direct/indirect Coombs tests/anti-phosopholipid Abs) normal.

B.R. is a 10-year-old previously healthy female that presented with persistent cough after a failed outpatient therapy for pneumonia. Two weeks ago she developed a sore throat and intermittent fever. She was seen by her PCP, where her strep test tested negative; therefore, she was diagnosed with a viral upper respiratory infection. She later developed significant left upper quadrant abdominal pain and was in bed for two days. She was seen again by her PCP, where she was diagnosed with constipation. She continued to have pain and fever; therefore, her parents took her to Kaweah Delta Hospital where and ultrasound was done. The ultrasound, monospot test, and strep test performed at Kaweah Delta were all negative. They then performed a CT and

The patient had no systemic symptoms and denied any unexplained abdominal pain. Physical examination was negative for cervical lymphadenopathy and salivary gland swelling. Computer tomography (CT) of the thorax, abdomen, and pelvis and bloodwork to evaluate renal, liver, and thyroid were ordered. The IgG4 serum level was found to be elevated at greater than 3.30 g/L (normal range was between 0.03 to 2.01 g/L). Given that bloodwork for renal, liver, and thyroid function was normal and that the patient was asymptomatic at the time, immunosuppressant therapy was not started and a 3 month follow-up was

Alex Frank is a 78-year-old man who came in today with a rash. The patient stated that the rash began about one week ago and first it appeared on his back and expanded to his abdomen on the left side. He noticed the rash while fixing his car. The first two days, he did not experience any symptoms, however on the third day, the patient started to experience severe discomfort. The discomfort worsens in the evenings and he has trouble sleeping. Every 4 hours, he is using Tylenol and Vitamin E lotion with minimum

According to kim et al. (2014), A 59-years-old man with account of alcohol addiction offered to an emergency room having dyspnea supplementary with diarrhea, malaise, a 40 pound weight loss and nausea for 4 months. He was hypoxic in ambulation. A CT of chest revealed borderline mediastinal lymphadenopathy. Lipase was raised to 1000. He was discharged numerous days once conservative treatment for recognized viral gastroenteritis, acute bronchitis, and pancreatitis. He improved to some extent but after three weeks, he returned to ER with persistent signs and a new-fangled bullous skin rash of his right ankle was found to be an eosinophillic vasculitis on skin biopsy. Moreover, He had a

Three days prior to admission, the patient suffered from fever, cough, and colds. He didn’t receive any medications or even consulted a physician.