Pathology Case Study

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Scenario One *58 y/o individual was found lying on their face outside a restaurant in a comatose state. Witnesses could not provide information on how long the victim was unconscious. *Allergies: None Past Medical History: 30 years of smoking, hypertensive, coronary artery disease, noncompliance with prescribed medication and a 25 year history of alcohol abuse. *Medications: not known at this time *Family History: unknown at this time *Social History: Postal worker, lives in a efficiency apartment in an urban area *Physical exam: Vital signs: temp of 97.2, pulse 64, pulse ox 90% on room air. BP 90/30, respiratory rate 4. Pupils: Left is 8 mm and not reactive, Right is 4mm and sluggish when exposed to light. Lungs clear to…show more content…
Define the pathology or pathologies. Then cite 4 consideration that were used when identifying the pathology. Identification of the pathology or pathologies is worth 3 points and each consideration is worth 3 points. All pathologies must be identified to receive points. Cirrhosis- Chronic, progressive disease that causes the formation of fibrous connective tissue that distorts the liver's normal lobular structure. These irregular lobular shapes results in an impeded blood flow (portal hypertension), poor cellular nutrition, and hypoxia (scar tissue doesn't allow for "normal" gas exchange). •Cirrhosis- As evident by decreased ALT, AST, positive wave test, and decrease in platelets. Increased ICP: Cerebral edema (volume increase of brain tissue, blood or CSF) caused by injury, stroke, hemorrhage tumor or CSF leakage. •Increased ICP- As evident by Cushing's Triad, non-reactive/sluggish pupils,and the patient's fall. COPD-inflammatory respiratory disease characterized by chronic and progressive obstruction of airflow in the lungs. Chronic…show more content…
Identify at least three diagnostics that could be considered with rationale on why they would be used. Each rationale is worth 2 points or a total of 6 points. MRI/ CT (of the head)- to see what the extent of the injury from the fall is. (Or if the possible increase of ICP is caused by hepatic encephalopathy.) Ultrasound (of the abdomen) or a Diagnostic paracentesis: ultrasound to see what is causing the distention of the abdomen, Paracentesis: fluid removal, the wave test was positive Additional blood work- Liver function tests, coagulation tests, CBC w/diff.. 4. Identify 7 treatment options and or medications that should be considered with rationale. Each treatment option with rationale is worth 2 points. Paracentesis- drain fluid Intubation- ICP related complications may require mechanical ventilation and it may be necessary to initiate hyperventilation therapy. ICP catheter- to decrease ICP Vitamin therapy/ Nutritional referral- because of her BMI and nutritional status r/t her pathologies. PPI- Esophageal varices are likely with cirrhosis and it is necessary to decrease stomach acid to prevent rupture of varices. IV fluids- Because of the ascites it is necessary to replace the fluid into the vascular space. Inotropics such as Dopamine- They will improve the BP and Cardiac

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