ASSIGNMENT INSTRUCTIONS:
\nCASE STUDY
\nPRESENTING COMPLAINTS- Difficulty breathing
\nICU clinical summary-
\n1) Decompensated heart failure due to medication noncompliance and likely community-acquired pneumonia pulmonary edema and desaturation.
\n\u2013 Started on CPAP
\n\u2013 STAT IV furosemide given.
\n\u2013 Started on levofloxacin for CAP.
\n2) Severe hypertension \u2013 On GTN infusion
\nMr. Michael Bush a 69-year-old man from north London had been admitted to the hospital due to shortness of breath, paroxysmal nocturnal and peripheral edema with cough and fever, found by the ambulance crew to be pyrexial, tachypnoea (RR28\/min) and desaturated to 80%on room air. Known severe heart failure with reduced ejection fraction who had been refusing to take his medication at home or in A&E due to concerns around side effects and was lost to cardiology follow up
\nPAST MEDICAL HISTORY
\n1) Ischemic cardiomyopathy with severe heart failure with a reduced ejection fraction
\n\u2013 Coronary angiogram- May 2022: severe LCX and RCA stenosis.
\n\u2013 CTA February 2023: LV ejection fraction 33%. Moderately severe functional mitral
\nregurgitation. All myocardium viable
\n2) Chronic kidney disease stage 3
\n3) Type 2 diabetes mellitus
\n4) Hypertension
\n5) Gout
\n6) Previous long RP supraventricular tachycardia
\n7) Current smoker
\nThis visit
\nAt the risk of venous thromboembolism
\nongoing
\nAcute heart failure
\nAcute pulmonary edema Diabetes mellitus
\nHTN- hypertension sciatica
\nDrug History
\n\u2013 Aspirin 75mg OD
\n\u2013 Clopidogrel 75 mg OD
\n\u2013 Atorvastatin 40 mg OD
\n\u2013 Gliclazide 80mg BD
\n\u2013 Bisoprolol 5mg OD
\n\u2013 Tamsulosin 400mg mcq OD
\n\u2013 Bumetanide 1 mg OD \u2013 stop taking since December 2022
\nIntolerant of amlodipine and penicillin
\nSOCIAL LIFE
\n\u2013 Smoking status: Current smoker- 4-5 cigarettes a day and previously a heavy smoker (40-50)
\n\u2013 Alcohol consumption: occasional alcohol consumption
\n\u2013 Occupation: Retired \u2013 previously worked in catering
\n\u2013 Lives alone. No formal POC- Independent ADLS. Mobilise with a stick. No next of kin is listed.
\nUnder cardiology team
\nREVIEW OF SYSTEM
\nA) Self-ventilating
\nB) Nasal cannula RR 15-28bpm FI02 2L sats 94% reasonable arterial gas exchange, slightly
\nreduced air in both lungs bases
\nC) On GTN intermittently B\/P 145\/65mmhg, HR 62 bpm, sinus lactate 1.6
\nD) GCS 15\/15 no sedation
\nE) Mld limb edema, calves SNT
\nF) Currently FB-VE 450mls
\nG) Glucose 14mmols\/dl
\nH) Prophylactic Tinz, INR 1.0, HB 105, no bleeding
\nI) Apyrexial Levo D4, vacate and CVC D2, WBC 6.7(6.5) crp 59(119)
\nOBSERVATIONS AND MEASUREMENT
\nTemp 36.4 oC HR:68( monitored) RR: 19 BP: 192\/95, BP: 135\/64 (line) SPO2: 99% WT:100kg BMI: 33.95<\/p>\n
Based on the information provided, Mr. Michael Bush is a 69-year-old man with a history of ischemic cardiomyopathy with severe heart failure with a reduced ejection fraction, chronic kidney disease stage 3, type 2 diabetes mellitus, hypertension, gout, and previous long RP supraventricular tachycardia. He was admitted to the hospital due to shortness of breath, paroxysmal nocturnal and peripheral edema with cough and fever, found by the ambulance crew to be pyrexial, tachypnoea (RR28\/min), and desaturated to 80% on room air. He has been diagnosed with decompensated heart failure due to medication noncompliance and likely community-acquired pneumonia pulmonary edema and desaturation, for which he has been started on CPAP and given STAT IV furosemide. He has also been started on levofloxacin for CAP and is on a GTN infusion for severe hypertension. His drug history includes Aspirin 75mg OD, Clopidogrel 75 mg OD, Atorvastatin 40 mg OD, Gliclazide 80mg BD, Bisoprolol 5mg OD, Tamsulosin 400mg mcq OD, and Bumetanide 1 mg OD, which he stopped taking since December 2022. He is intolerant of amlodipine and penicillin. He is a current smoker, previously a heavy smoker, and occasionally consumes alcohol. He is retired, previously worked in catering, lives alone, and has no formal POC. He is independent in ADLs, mobilizes with a stick, and has no listed next of kin.<\/p>\n","protected":false},"excerpt":{"rendered":"
ASSIGNMENT INSTRUCTIONS: CASE STUDY PRESENTING COMPLAINTS- Difficulty breathing ICU clinical summary- 1) Decompensated heart failure due to medication noncompliance and likely community-acquired pneumonia pulmonary edema\u2026<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[5616,5610,5241,5243,4206,5239,5612,5240,5615,5617,5608,5618,5613,5609,5242,5244,5614,5611],"tags":[5621,2336,5623,5624,689,4067,1787,5285,5619,5620,5604,5225,5622],"class_list":["post-13689","post","type-post","status-publish","format-standard","hentry","category-can-someone-do-my-homework","category-case-study-answers-examples","category-custom-essay","category-dissertation-topic","category-free-essays","category-help-in-assignment","category-help-of-a-essay-writing-service","category-help-with-class","category-i-need-help-with-my-homework","category-ill-pay-someone-to-do-my-hw","category-online-essay-writing-service","category-order-cheap-essay-online","category-pay-to-write-essay","category-professional-paper-writing-help-service","category-term-paper","category-thesis-writers","category-write-essay-online","category-write-my-essay-for-me-online","tag-app-for-college-students-essays","tag-assignment-helper-for-students","tag-buy-essay-online-from-pro-essay-writers","tag-essay-example","tag-i-need-help-with-my-homework","tag-i-need-help-writing-an-essay","tag-in-a-page-paper","tag-in-a-word-essay","tag-order-an-essay-online-from-top-quality-writers","tag-paper-writing-service-with-good-writers","tag-pay-someone-to-write-my-paper","tag-write-a-page-assignment","tag-write-my-essay-with-top-writers"],"_links":{"self":[{"href":"https:\/\/www.colapapers.com\/uk\/wp-json\/wp\/v2\/posts\/13689","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.colapapers.com\/uk\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.colapapers.com\/uk\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.colapapers.com\/uk\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.colapapers.com\/uk\/wp-json\/wp\/v2\/comments?post=13689"}],"version-history":[{"count":0,"href":"https:\/\/www.colapapers.com\/uk\/wp-json\/wp\/v2\/posts\/13689\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.colapapers.com\/uk\/wp-json\/wp\/v2\/media?parent=13689"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.colapapers.com\/uk\/wp-json\/wp\/v2\/categories?post=13689"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.colapapers.com\/uk\/wp-json\/wp\/v2\/tags?post=13689"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}