In the scenario below, Differential diagnoses: List a minimum of three differential diagnoses. Your primary or presumptive diagnosis should be at the...

Question Answered step-by-step In the scenario below, Differential diagnoses: Patient Information:GH, 82, Male, CaucasianSCCHPI: List a minimum of three differential diagnoses. Your primary or presumptive diagnosis should be at the top of the list. For each diagnosis, provide supportive documentation with evidence-based guidelines : Son reports he found the patient lying on the floor beside the bed The patient is an 82 y/o male relocated from California, who was found beside his bed by his son. The patient had been lying beside his bed for an unknown amount of time. The patient was taken to his primary care physician and recommended to come to ER for evaluation. The patient was initially taken to a local ER and was hypotensive with a B/P of 68/48, HR 68. The patient initial workup showed elevated Troponin of 121, CK of 4140, BUN of 25, and Creatinine of 2.15. The patient was also found to have elevated AST of 274, ALT of 48, Total bilirubin 2.6, WBC of 29, and Lactic acid of 3.6. His UA was consistent with a UTI, and EKG showed no ST changes. CT of the head was negative. The patient was transported from the local ER to our facility as a direct admit for close monitoring and Critical care.Current Medications: Include dosage, frequency, length of time used, and reason for use; also include over-the-counter (OTC) or homeopathic products.1) Melatonin 3 mg 1-tab PO at bedtime for Insomnia2) Oxybutynin 5 mg 1-tab PO bid for overactive bladder.3) Gabapentin 300mg 1 cap PO at bedtime Neuropathy4) Aspirin 81mg 1-tab PO daily blood thinner5) Protonix 40 mg 1-tab PO daily GERD6) Docusate Sodium 100 mg as needed PRN Stool softener7) MiraLAX 17 gm 1 cap daily as needed for constipation.8) Magnesium hydroxide 30 ml PO as needed for constipation.9) Tylenol 1000 mg Q 6 hours as needed for pain and fever. Allergies: Penicillin ( Breaks out in a rash, itching)PMHx: 1) Hypertension 2) Dyslipidemia 3) GERD 4) BPH 5) Severe aortic stenosisImmunization status: Reports receiving both doses of Covid vaccine (Moderna), PNA vaccination up to date, Tetanus shot Unknow status, Flu vaccination not in season at this time.Soc and Substance Hx: The patient is retired and has just relocated from California to be close to his grandchildren. He is currently married and was living in a single-story home prior. The patient wife has currently admitted inpatient at the rehab center across the street. He has a son that lives next door and a daughter that lives out of state. Son is the biggest support system at this time. He denies alcohol, tobacco, or illicit drug use. Fam Hx: Father died at 72 of a heart attack, and Mother died at 84 from natural causes. No other health concerns notedSurgical Hx: 1) Left Cataract removal2) IOL implant3) Right cataract/IOL implant4) Colectomy secondary to traumatic perforation of the bowel5) Colostomy reversal6) Pyloromyotomy7) Right knee surgery8) Eyebrow lift Mental Hx: The patient is currently emotional at this moment. Reports his wife is at the rehab dying. Before his wife’s admission to the hospital, he had no history of anxiety or depression. No suicidal or homicidal ideationViolence Hx: Family reports that patient was safely staying at home with wife before his hospitalization and was safe at home prior Reproductive Hx: Unknown if sexual activeROS:· GENERAL: Reports no recent fever or chills. Denies any weight gain or loss. Patient lethargic· HEENT: No recent sinus tenderness or sore throat. No hearing loss. He wears glasses, reports blurred vision on occasion.· SKIN: There is no recent skin rash or skin breakdown. The patient with fragile skin· CARDIOVASCULAR: Denies chest pain or palpitations.· RESPIRATORY: Denies SOB, no coughing, no hemoptysis. · GASTROINTESTINAL: No nausea, no vomiting, no diarrhea· GENITOURINARY: Denies any dysuria or hematuria. · NEUROLOGICAL: There is no headache. One report syncope spell by the family found lying by the bed. Mild dizziness. No changes to bowel or bladder control· MUSCULOSKELETAL: Complaining of generalized weakness and joint aches· HEMATOLOGIC: Reports bruises to BUE, no anemia, or any other active forms of bleeding· LYMPHATICS: No enlarged lymph nodes. No surgical history of splenectomy· PSYCHOLOGICAL: The patient has been emotional per family. The family states the patient wife is at the rehab dying.· ENDOCRNOLOGIC: No cold intolerance or heat intolerance. · REPRODUCTIVE: Sexually active status unknown currently· ALLERGIES: Denies asthma, eczema, or hives .O VITAL SIGNS: 69/40, 94% RA, 86bpm, 22 RR, T 99.1, 198lbs, Ht. 5’10 inches, BMI 28.4GENERAL APPEARANCE: 82-year-old Caucasian male. The patient is lethargic, lying in bed. Son is present at the bedside to assist with answering questions. HEENT: Normocephalic and atraumatic. Pupils are equal, round, and reactive to light. Extraocular muscles are intact. No significant sinuses tenderness or mouth lesions were noted. NECK: There is no elevated jugular vein distention. No thyromegaly.CARDIOVASCULAR: S1 and S2 heard. Capillary refill delayed to upper and lower extremities. RESPIRATORY: Diminished and coarse on auscultation with no accessory muscle use.ABDOMEN: nontender, bowel sounds normal active x 4 quadrants. GENITOURINARY: Foley inserted on arrival, dark yellow urine present in the catheter bagEXTREMITIES: There is no clubbing, no cyanosis. There is a trace of bilateral lower extremity edema. MUSCULOSKELETAL: No calf pain or joint deformity, weakness depressedNEUROLOGICAL/CNS: Lethargic, decreased orientation at this time, goes in and out. Normal tone. Normal sensory system SKIN: Scattered bruising to BUE, no skin breakdown present PSYCHIATRY: Not homicidal or suicidal ideations. No hallucinations or deliriums. The wife is currently, per son, inpatient at rehab with health declining. Diagnostic results:Labs: Troponin: 121, CK- 4140, BUN 25, CR 2.15, Elevated AST 274, ALT 48, Bilirubin 2.6, WBC 29, Lactic acid 3.6, EGFR 60, PLT 122,000Blood cultures- pending.UA- Loaded with WBC, large leukocyte esterase. Positive for nitrates with 10-20 RBCsEKG- showed nonspecific ST changes.CT HEAD- NormalCXR- NormalECHO Impression: Shows an Ejection fraction of 40-45 % with mild concentric left ventricular hypertrophy. Health Science Science Nursing NRNP 6540 Share QuestionEmailCopy link Comments (0)