Case Study!!

Please do the following for each slide:

#1: Read the ​slide that has the information

#2: The yellow words or abbreviations are what you will be working on

#3: The following slide will have you fill in the answer to each yellow word!

#4: Make sure to do the work because I will be looking at them!​

Mrs. Ono

• Pt. was brought to the ED after being found down @ home by a neighbor. Unknown how long pt. was down. Mr. Ono is deceased. Hx was obtained from their daughter.

• H&P is as follows: ​

Mrs. Ono

• Reason for admission:

  • pn! and bruising in area of right trochanter w/ fall

  • disorientation

    • R/O acute vs. chronic

  • R/O rhabdomyolysis

Mrs. Ono

• Hx is provided by pt's daughter, as pt. is an unreliable historian due to dementia/disorientation

• Mrs. Ono is an obtunded 80 y/o female who was found down @ home after a fall

Mrs. Ono

• She is 5 ft 2 in and 110 lbs, multigravida, multiparous, post-menopausal and estrogen replacement

• No other PMH or medication Hx was available at time of admission

Mrs. Ono

• ROS

• HEENT

  • Normocephalic, atraumatic. Oropharynx is clear, with moist mucosa. No septal hematoma to suggest facial injury with fall

• Neck

  • Supple, carotid pulses delayed with bruit on left, jugular venous pressure WNL​

Mrs. Ono

• Lungs

  • Clear to A&P, airway appears unobstructed

• Heart

  • normal heart sounds​

• Abdomen

  • soft and benign​

Mrs. Ono

• Extremeties/Skin

  • obvious ecchymosis @ right trochanter with pn! and guarding on palpation, distal pulses are intact, right sided edema in both UE and LE.

Mrs. Ono

• Neurologic

  • Pt. responds appropriately to pain, otherwise is not oriented to place or time. Does appear to recognize daughter

  • Minimal movement of RLE

Mrs. Ono

• Assessment / Plan

  • likely FX of right femoral neck, radiographs pending

    • will discuss with daughter about pinning, and if she agrees, will secure Op permit

    • Judicious use of narcotics for pain control

Mrs. Ono

• Assessment / Plan

  • dementia/delirium

    • will obtain EEG and carotid doppler study to evaluate for ischemia

    • will discuss with daughter- carotid endarterectomy vs. conservative Tx

Mrs. Ono

• Assessment / Plan

  • rhabdomyolysis

    • IV fluids and sodium bicarbonate, Foley catheter. Monitor BUN and creatinine for signs of glomerular dysfunction

I hope to see you all soon!!