Febrile Case Study

On December 1, 2015, 65 year-old Loretta Macpherson arrived at the emergency room of St. Charles Health System, located in Bend, Oregon. Ms. Macpherson arrived to the emergency room complaining of anxiety. When interviewed about her medication history, Ms. Macpherson was unable to identify the medications which she had been prescribed after her recent hospitalization at St. Charles for brain surgery. After examination, the emergency room physician ordered fosphenytoin, an anti-seizure medication, to be administered via intravenous infusion to Ms. Macpherson. In error she received rocuronium, a paralytic drug, causing her to stop breathing and suffer a cardiopulmonary arrest. Ms. Macpherson suffered irreversible brain damage and was placed

0900 Pt in her room lying on her bed with watching TV. Good appetite this morning, Ate 100% of her breakfast. Alert and oriented x 4 and follow commands. Vital sign T96.9, P 72, R 18, BP 113/61, O2 Sat 97 RA. Pt complained pain on her back and rate 6/10 on scale of 0 to 10. skin warm to touch and redness on the area. Lung sound clear and even to auscultated in all lobes. Breath sound regular and even. S1 and S2 auscultated. Abdominal sound presents and actives in all four quadrants. ABD soft, non-tender, no distended to palpate. Pt denied ABD pain. Pt stated last bowel movement yesterday night, medium, soft and formed. Call light within her reach, nonskid socks on, bed in down position. Will continued to monitor……………………….L.Gotora PNS2/WATC

She converses appropriately. Blood pressure 92/60 supine. Blood pressure decreased to 72/50 standing. Pulse is 90 and regular. Weight 113 pounds. She has a normal appearance of her face and does not have a masked appearance of her face. She has good strength throughout her face. She has good strength of her extremities. She has only minimal cogwheel rigidity at the left wrist, but no cogwheel rigidity at the right wrist. She has no tremor of her hands. She moves her extremities freely and with normal speed. She is able to rise on her own from a sitting to a standing position, only minimal bradykinesia of standing. She walks fairly freely and there is a normal cadence of her gait. She did not have dyskinetic movements of her extremities. She is able to walk, including turning without losing her balance. She does not shuffle her feet when walking. She does not have en bloc turning. She has good posture stability

The patient is an 85-year-old female who is brought to the ED by her family because of increasing confusion and supposedly she had a degree of altered mental status of two hours previous to presentation. In the ED she is completely worked up. CT shows advanced atrophy with microvascular changes and several lacunar infarcts nothing acute. Specific gravity in the urine reveals her to be markedly dehydrated. She culture completely, started on IV antibiotics, IV fluids and B12. On the day after admission she still presents as persistently confused. She is evaluated by PT. The patient who was formerly ambulating with a walker and allegedly driving a car is unable to be ambulated. Before the history indicates that she has a slow downward

A review of her medical records indicates that she has not had any significant health events, such as falls or hospitalization since her last visit. She suffers from chronic stable hypothyroid, chronic DM which is mange with medication and chronic neuropathy.

Patient 1: monitor B/P, pulse, respirations, skin appearance and touch, notable changes in neurologic function, ECG, lab

Patient was in the ER room when first seen. PT was with her family members and family states that she speaks little English and that she has had abdominal pain for the past day along with bloody stools. Family states that she is on calcium supplements and no other medications. Last oral intake is 24 hours ago. Family states no known past medical history. Pt is in the hospital bed in the fetal position and towards the right side. Patient's airway is clear and breathing is normal. Skin is warm and dry. Patent is AAOx4. Assessment of head, neck, and chest show no signs of deformities. Abdominal area not assessed due to severe pain. Back is without deformity. The upper extremity shows no sign of deformities or trauma. The lower extremity shows

Mrs. Wilson is seen in her room at Glenbridge Nursing Home on 02/28/2018. She had an episode last night of chest pain. She is so ebullient and distracted that it is hard to get a straight history, it came on when she was asleep but she may been sitting up. She was seen by a nurse, a sat was taken. I am not sure if there were other orders taken, but there is none on the chart. She says that she spent most of this morning in the bed and still feels tired, but she does not think she broke out in a sweat. She was more short of breath. She is calling it is a "stroke." I had tried to begin tapering her diazepam by discontinuing the morning dose and apparently all daytime clorazepate was discontinued by error and she gets it only at night.

Blood pressure -138/88, HR 71, Lung sounds –clear, temperature 98.8 F, radial pulse and pedal pulses +1 bi-laterally, normoactive bowel sounds. No history of smoking, drugs, alcohol use or diabetes; takes no daily medications. Surgical history: Hernia surgery September 2016 and cataract surgery September 2013. Moderately active, walks every day, sometime incorporating hand weights. Patient presents with minimal trembling unilaterally, (left side) when fingers stretched out, reports movements have been slower than normal. Patient’s wife reports “He’s been eating more slowly and it has been taking longer for him to get dressed in the morning.”. Upon examination it was determined that patient has reduced arm swing, slight stiffness in neck, difficulty rising from sitting position in the chair, masked facial features and deteriorated balance. No signs or symptoms of stroke.

To temporarily solve a more serious problem, they gave her medication, and we were on our way. When the time finally came to see the neurologist, they had hooked her up to an EEG, which monitored her brain waves. They found nothing in this EEG, until a different hospital performed a 24-48 hour EEG. She was in the hospital trying to make sure she had her homework completed and was caught up, when the machine caught strange brain waves when she was doing her math homework. This was the first time the doctor told us it wasn’t seizures due to stress, but partial onset seizures. Her brain looks normal, but when a seizure hits, it starts in the left temporal lobe and travels to the right side of her brain, lighting up like a firework. This affects her mood and emotions, to where her brain must reboot in order for her to

At today’s visit she is accompanied by her husband and private aide. Her husband reports that she is doing much better. He states that her pain has improved and she has not taken her pain medication since last visit. He states that her anxiety had improved extremely with the recent change in her Xanax. He states that he has hired 24 help for the patient and since she has not fallen. She reports that she is feeling well. The caregiver reports that the patient continue to suffers from hypotension and hypertension with variation in blood pressure. The patient also continues to suffer from chronic tremors as a result of her Parkinson.

They give a long list of diagnoses but the most prevalent is the fact that she has a rapidly progressing dementia. Note that she has a rapidly progressing dementia as well as a B12 deficiency. They describe a subdural hematoma in the CT scan reports. The one on 01/03 shows a lot of microvascular changes, a lot of cortical atrophy, and apparently, she had bilateral subdural hematomas that had converted to hygromas, but apparently the larger one on the left side still had some blood in it. When they repeated the CT scan of the head on 01/19, they commented that the hygromas were still present but there was less blood in the larger subdural. She had extensive blood testing, which basically was unremarkable. It did not appear that she had a urinary tract infection. Appears that since she has been here her status has been fairly stable. She was weak, but apparently, underwent physical therapy and made some improvement to where she became ambulatory in her gait. It looked like from the very beginning she was having a day/night confusion, was having a lot of un purposeful movements that might be have been contributed to either delusions or hallucinations. They gave her some Risperdal for the behavioral problems, but according to Cynthia she had taken Risperdal in the past and had an allergic reaction, and today when I have seen the patient there is a marked amount of periorbital edema

My patient has a history of stroke 2012 and her condition is not getting better. Her RBC is low 3.79, hemoglobin is low (10.9), hematocrit is low (35.1). Oxygen saturation is 95. Some of the signs and symptoms in my textbook are speech and memory deficits, generalized weakness, incoordination, sudden onset severe headache, trouble walking.

Pt lived on her own until 4-27-12 when her family found her lying on the floor in her home. Pts family brought her to live with them but pt continued to have episodes of falling and hitting her head. Pt was taken to the ER and given a Ct of the brain where all results turned up normal. After at least 5 more falls the pts family took her back to the hospital with complaints of chest pain and palpitations. Pt was more confused than usual & and was having increased difficulty in

The following case scenario is based on a fictitious patient, and it would be use on this paper as a guidance to develop a patient and family teaching plan. The situation: Mrs. Marquez, a 39-year-old Caucasian female was admitted into the Emergency Department due to complains of shortness of breath and anxiety. Patient cannot take deep breaths, appears overweight and denies Allergies to medication. The background: Patient has medical history for panic attacks, atrial fibrillation, and Grand Mal seizures; however, patient is not constantly taking her seizure medication. Patient previously had a cholecystectomy, and smokes 1 pack of cigarettes per day for 12 years. The Assessment: Patient vital signs 98.8° F oral, 109 heart rate, 26 respiratory rate, 150/86 blood pressure, SaO2 97% on room air. Denies pain. Neurological; Patient is 65 inches tall, weighing 246 lbs. She is able to move all extremities with strong pushes and pulls. States her “last seizure was two months ago.” Respiratory; Respirations are even, deep, and rapid. Lungs are clear on auscultation. Cardiac; EKG reveals atrial fibrillation; patient states, “It feels like my heart is racing at times.” Pulses are palpable +3 all extremities; capillary refill is instant. GI; Abdomen soft, no distended, and no tender with bowel sounds present in all four quadrants; skin is intact and warm. Current medications: Dilantin 400mg PO BID, Lexapro 20mg PO daily, Metoprolol 25