Osteomyelitis Case Study

The history, briefly, this is a 66-year-old gentleman who presented to the hospital for an elective admission because he was failing outpatient diuresis. The patient complained of increased shortness of breath, weight gain and lower extremity edema for 3 weeks. He had no (UI) symptoms, no chest pain. He did have (dyspnea exertion) at 8 blocks, now worse, and had recently gone from 2 pillow orthopnea to (three) pillow orthopnea. He denies post-op PND. He also complained of skin lesions over his chest, back, arms and upper thighs, which were new onset and pruritic.

A visit note from Dr. Robert Hendren (Urology), dated 09/20/2017, indicated that the claimant continued to have urinary frequency, urgency, and urge incontinence that required her 2 pads per day. She had microscopic hematuria noted on 08/31/2017. She had 3+ blood on urinalysis during the visit, but she had been undergoing her menstrual period. She had complaints of pain in the stomach, left arm, right leg, and foot. Urinalysis showed moderate blood with 30+ protein. Her BMI was 32.12. She was diagnosed with urge incontinence and hematuria. Cystoscopy was recommended.

Introduction: Jessie Buchanan, an 80-year old female, was admitted to Bethany Care Society in room 3088-1 at the center unit. She is an extensive assist, requires 1 staff assistance and uses the transfer belt to transfer from bed to her wheelchair. She was admitted here because none of her family members can look after her because they are all busy with their own personal life. Jessie prefers to stay at Bethany because she receives full-time care from the health care providers. Jessie had a history of edema on her right ankle because she was experiencing hyponatremia. Currently, she is on fluid restriction and every morning I would put her compression stockings to prevent the occurrence of edema. Her condition worsens when she was diagnosed with osteoarthritis(OA), delirium, depression, type 2 diabetes mellitus, schizophrenia, hypertension, and urinary tract infections. Her recent urine culture shows that she is positive for urine nitrite and urine leukocyte which caused the UTI. Jessie is incontinent and she wears an indwelling catheter. Jessie said that sometimes her knees are painful. She takes an analgesic to relieve the pain that she feels. Jessie 's blood sugar level is within the range. She is not taking insulin or any oral medications like metformin because she knows how to control it, by following the proper diet. Jessie always have a good sleep and never complains about her sleeping pattern. She is taking medications for GERD, iron supplement, bone health,

M.T. has a 1-year history of atrial fibrillation. She takes warfarin daily, and her INR is within the therapeutic range, between 2 and 3. Her creatinine level is 1.3 mg/dL, and a normal level is 0.6-1.2 mg/dl for women. This indicates that she has slightly reduced renal function at this time, possibly due to her diabetes, medications, age, or urinary tract infection (UTI). She has been diagnosed with acute uncomplicated UTI. The 24-hour history of dysuria, urinary frequency, and urgency combined with the urinalysis result

Urinary System: Patient states that she urinates about 4 times a day without urgency. She denies having nocturia, dysuria, polyuria or oliguria, hesitancy or straining, narrowed stream, inconsistence, or pain in flank groin, suprapubic region, or low back. She states that her urine is clear, and it does not present hematuria. In order to avoid urinary tract infections, she states that she drinks about three liters of water every day. She had a UTI at age 18.

Mrs. P is a 63-year-old female who was not feeling well for a couple of weeks. She went to her Primary Care Physician (PCP) complaining of increased dyspnea on exertion, weakness, nausea, headaches, loss of appetite and periods of confusion. Since she has an extensive medical history that included pulmonary hypertension and emphysema, blood work was obtained. She was told that she had leukocytosis, hyponatremia (Sodium 126 mEq/L ), hypokalemia (Potassium 2.5 mEq/L) and an acute kidney injury (AKI). She was told to go to the emergency room and was admitted to the telemetry unit.

The patient is a 97-year-old female who presents to the ED because of urinary incontinence with hematuria and vaginal bleeding. The patient is very weak, unable to walk prior to admission despite her 97 years of age she is able to ambulate her home with the assistance for walker. In the ED she was found to be positive for influenza. The rest of her medical history she is chronic kidney disease, increased lipids, she is anemic and has hypertension. Urologic consultation indicates that catheterization of her urine in the ED showed it to be amber. Besides having influenza she probably is having vaginal bleeding. I believe that this patient warrants acute inpatient hospitalization. She is 97 years of age with a multiplicity of comorbidities

This is a 68-year-old gentleman who presents to the ED stating that his legs are really swollen and draining yellow stuff. It is to be noted this patient was originally placed in observation status by the attending physician. After my clinical review of the chart and discussion with him I believe this patient warrants acute inpatient hospitalization. In the ED on presentation he is found to be anemic with a hemoglobin of 8.9, hematocrit of 27.1. He is also dehydrated with specific gravity urine greater than 1030. He has a low-grade temp of 99. On his physical exam he is noted to have a 2+ bilaterally pedal edema from his feet up to his knees, as well as chronic bilateral stasis changes in his legs with erythema and increased warmth.

The patient is a 78-year-old female who had a recent fall. She fell on the left side. She has a very large left medial thigh hematoma. She continued to feel weak and unable to care for herself at home and presented to the ED. She is known to have hypertension, insulin dependent diabetes mellitus, a TIA in 1998 with some minimal left-sided weakness and she has had nephrolithiasis. In the ED she was found that her creatinine has gone from 1.2-1.82. Sodium on admission was 130 with a glucose of 360 which suggests that she has some hyponatremia not as profoundas the 130 would suggest. The patient has a complained of pain all over her body, her neck, her arms and her back. She is evaluated by physical therapy who feels that she is unsafe

Osteitis fibrosa cystica is a skeletal manifestation of advanced hyperparathyroidism. OFC was first described in the 19th century. It can be detected through a combination of blood testing, x-rays, and also tissue sampling. Did you know before 1950, around half of the people diagnosed with a disease called hyperparathyroidism in the United States saw it progress to OFC, but with early identification techniques and improved treatment methods, instances of OFC in developed countries are increasingly rare. OFC was discovered by Friedrich Daniel von Recklinghausen in 1890. Although a man name William Hunter who did in 1783 was first given credit for finding the first example of the disease.

Today, I observed Dr. Koch in podiatry again. The first patient I observed had half of their right foot amputated, which might have been from osteomyelitis. The patient received an operations to amputate half of their foot. The only problem was the recovery time after the operation. Normally, patients wait at least two weeks to remove any sutures on their feet after an operation. However, one of Dr. Koch’s assistants had removed the sutures from the operation one week after the operation instead of two. So when the patient tried to put any weight on the foot after removing the sutures, the wound instantly bursted open. Some time ago, a vascular surgeon bypassed the veins in the foot and removed the right big toe along with the metatarsal.

My assigned resident for next week is a 75 years- old woman. The resident has an allergy to blueberry however. It is important to make sure that the resident does not have any kind of food or desert that contains blueberry to avoid an allergy reaction. The resident was diagnosed with unspecified dementia as well as other specified intervertebral disc degeneration. Resident also has an umbilical hernia without obstruction or gangrene. The resident was also diagnosed with a urinary tract infection, but the site is unspecified however the resident is also incontinent of urine therefore. It will be important to watch for the urine output. Resident has benign hypertension therefore; it is important to monitor the resident's blood pressure. The resident

The patient is a 95-year-old female who is brought to the emergency room because of a fall at home and episodes of spacing out and staring. Her past medical history is absolutely negative for any previous and the patient is on no medications. There is a discrepancy in the history between what is described by the daughters, as well as what is documented in the ED records. and there is a question of did this patient have a seizure episode and fall or and did she simply loose her balance and fall. The patient herself was quite clear about her fall and does not have any recollection of any any other abnormal events. She sustained a fracture of the right superior and inferior pubic rami. She was markedly anemic with a hemoglobin of 7.1, which

This patient probably has kidney disease. A urine pH on the higher side, crystals in urine, and large amounts of protein in the urine are all common identifiers for kidney disease. Since this patient displays all three of these, it is very likely that he or she is afflicted with it.

Patient reports urinary burning, urgency, and frequency for 2 days. He admits that he had similar symptoms 2 months ago, but he did not seek treatment because he was on vacation. States that he passes one kidney stone 1 week ago. Denies fever, chills, flank pain, and hematuria.