Most Likely Diagnosis: A Case Study

You’re vomiting and you can’t keep anything down, even liquids. You could be at risk of dehydration and this could become a medical emergency. Your body must have fluids to work well and your doctor may need to give them to you through a vein.

In both conditions (and in a mixed picture of both), the dehydration can be further exacerbated by the resulting Nausea and vomiting, meaning further fluid loss, and critically decreased fluid intake (Lowth, M. 2012). Both conditions require emergency treatment.

The patient that I have chosen for my diagnostic reasoning paper is a 47-year-ol-Hispanic female. The presenting problem that I have chosen to use as my patient’s chief complaint is back pain. The only other clues that I have to use in order to help narrow my focus is that she is a female, she is 47-years-old, and she is Hispanic. I do not know how long she has been experiencing pain or how severe her pain is. Given these parameters, I will “cast a wide net” as I evaluate my patient and create my list of differential diagnoses.

Patients who experience both vomiting and diarrhea can lose critical fluids and electrolytes. This can cause a heart arrhythmia, which can lead to a heart attack. As a result, it’s very important to replace fluids and electrolytes lost due to diarrhea and vomiting. Doctors can also prescribe medications to reduce diarrhea, nausea, and vomiting.

If, these signs and symptoms go undetected, for a long period of time, they will result in chronic dehydration and cause several other medical issues. (Vasey, 2002) One of the results of chronic dehydration is fatigue or energy loss which resembles depression. (Vasey, 2002) Constipation is another result chronic dehydration, by removing too much excess liquid from stool making it hard to expel. (Vasey, 2002) Chronic dehydration also contributes to digestive disorders such as: poor digestion, gas, bloating, pain, nausea, ingestion, and loss of appetite. (Vasey, 2002) The average body produces 7 liters of digestive juices daily; but a dehydrated individual will secrete less, thereby causing improper digestion. (Vasey, 2002) Chronic dehydration causes high blood pressure due to low blood volume and the vessels sharply contracting. (Vasey, 2002) It can also cause low blood pressure in individuals, with weak vasoconstriction, who again, have a low blood volume. (Vasey, 2002) Chronic dehydration is also the culprit of gastritis and

Doctors misdiagnose between 10-15% of medical cases each year. These misdiagnosed patients have been linked to physicians being too overconfident. According to Psychology Today, in a study performed by a cognitive research psychologist, Ashley Meyer, Ph.D. and her colleagues, the researchers gave 118 physicians four cases to diagnose with two cases being easy to diagnose and the other two being difficult. The researchers asked the physicians how confident they were in their diagnosis. The results indicated that the physicians got 55% of the diagnoses correct for the two easy cases; 5% of the diagnoses were correct for the difficult cases. When asked to rate their confidence on a scale of 0-10, the physicians rated their confidence

The present project was relatively easy to complete. Some parts of it were a little more difficult than others, such as acting as a test administrator and as a patient to some of my classmates. As a test administrator, I had to take into consideration that there could be a provisional diagnosis for PTSD. Knowing this I had to try to offer a safe environment for the two patients that were taking the assessment. This part was difficult, to say the least because it was hard for me to focus while other classmates were also providing assessments, while it was also hard to present myself professionally like an actual therapist would. I think further training and education in test administration would be essential for me to provide a safe and

Choice “C” is the best answer. This patient has an anion gap (sodium (149)- (chloride (114) + bicarbonate (15))=20) lactic acidosis (serum lactate 5.6 mmol/L) most likely secondary to an infectious etiology. He also has an elevated white blood cell count, a CT scan and X-ray suspicious for multiple nodular pulmonary infiltrates. The patient also meets criteria for severe sepsis: pulse >90 beats/minute, temperature greater than 38.0 °C, respiratory rate greater than 20/min, WBC greater than 12,000 cells/mm3 with signs of sepsis-induced tissue hypoperfusion (elevated lactate).

Some mainstream treatments tied to diagnoses such as PDD, ODD and ADHD consist of a regimen of medication in some cases, behavior modification techniques to manage behavior and some prefer visiting a therapist to increase functional abilities. According to (“Disorders Symptoms, Causes,“ n.d.). treatments also include cooperative efforts from others who may interact with the individual. Mainstream treatments are reliable and provide validity to each specific diagnoses.

Symptoms, in more severe cases of SIADH, may include: nausea/vomiting; cramps/ tremors; depressed mood, memory impairment/irritability. Personality changes include combativeness, confusion, and hallucinations. Other changes include, seizures, stupor or coma. This is a predictable list of responses to increased water retention, as water retention results in a hypotonic environment for cells. In hypotonic environments, water moves into cells causing swelling and eventually cell lysis. Swelling of cells, especially in the brain, can cause edema, which is characterized by the neurological changes described above, including confusion, nausea and

The ABG testing above shows that this patient is experiencing respiratory acidosis. Respiratory acidosis is a respiratory dysfunction in which there is a retention of carbon dioxide (CO2) and a decrease in the blood pH leading thereby, in increased hydrogen. This dysfunction in the respiratory function decreases oxygen (O2) and CO2 exchange which leads to a sudden breakdown in the body ventilation causing hypoventilation (Ignatavicius & Workman, 2013). A PCO2 greater than 45mmhg with a pH less than 7.35 is considered an acute respiratory acidosis whereas chronic respiratory acidosis is a PCO2 greater than 45mmhg with normal or close to normal pH and an HCO3 greater than 30mmhg due to renal compensation (Byrd & Roy, 2015).

Dehydration (ICD 10 E86.0)- Dehydration is caused by negative fluid balance. This can be due to not taking in enough fluids. Weight change, appearance, mucus membranes, heart rate and urine output can all contribute to signs of dehydration (Al Sabbagh, 2013). S/S urine output has gone from 4 diapers yesterday to 1 today. Patient is lethargic and not playing. Mom states that he is not eating and drinking well.

Mahmoud Ibrahim9/23/17Diarrhea Case StudyThe significant losses resulting from diarrhea & feverFarthing et al., (2013) submit that two primary losses are attributed to diarrhea and fever.These include the loss of electrolytes and fluids such as potassium and sodium. There is also thepossible loss of the base, an event that might precipitate an accumulation of acids in the body.These losses often manifest in the form of confusion, irritability, dehydration and increased ratesof respiration.Other signs/data would provide helpful info Pulse rate: is a sign that is indicative of the loss of fluids. Sunken eyes Oral cavity and dry lips Skin elasticity (decreases upon dehydration)Reasons why infants become dehydrated very quicklyWhen children

But the first symptom a patient will show when dehydrated is thirst. The patient is then encouraged to increase their fluid intake. As fluid volume increases, the body then begins to lose fluid, primarily through urination. Other components that contribute loss of fluid include bowel movement elimination, exudation, and breathing. Fluid losses from sweat and the vapor from exhaled air are referred to as insensible losses because they are unnoticeable and unmeasurable. (Timby, pg. 204) However in certain situations if a patient is on a fluid restriction, or if the patient is NPO, meaning they can’t take anything my mouth, the patient may be put in an IV therapy called Total parental nutrition (TPN), in which it allows them to meet their nutritional needs and replenish

Prolonged bed rest is not essential for full recovery but patients feel better with restricted physical activity. A high calorie diet is a good idea and because many patients have nausea late in the day, the major caloric intake is best given in the morning. Intravenous feeding is necessary if the patient has continuos vomiting. Isolation of the patient to a single room and bath room is unnecessary, however the patient and other people in contact should be