Answer Happy

1. What manifestation by patient 777 that leads the doctor to conclude that he is having Hyperphosphatemia? 2. Knowing the land o monitoring is very important. Based on the drop rate. How many ml of IVF per hour should patient 777 received? 3. Stool exam with occult in the morning was ordered to patient 777, knowing that the condition of the patient is primarily based on Renal Parenchymal and imbalances of electrolytes, why do you think the physician ordered the diagnostic test to the patient? 4. Formulate plan of care for the patient.(SOAPIE) THE PECULIAR CONDITION OF PATIENT A The patient is 41 years old male Working as a Clerk in a private sector Married with 3 children with the age of 20 (male), 17 (female), and 12 (female) Wife is Supervisor in one of the hospitals in the city He was born via NSVD to a birth attendant He is complete with all immunization - Loves process meat and soda - Loves fast foods and salty foods - Likes to eat nuts when working - Has a sedentary lifestyle Smokes 3-4 sticks a day - Occasionally drinks alcohol or wine His father died Cardiac Arrest, also is Hypertensive and Diabetic Mother underwent llena dialysis for 3 years eventually died because of complications. Past Surgery: Appendectomy when he was 17-year-old Difficulty voiding because of the demand of his works Last 2 years ago He was diagnosed with Renal Calculus and underwent percutaneous nephrolithotomy in Shanghai, China and the doctor orders Alusetinal 300mg for 1 month Height 5'7 Weight 88 kg Last month Patient & experienced hematuria and burning sensation was felt and dysuria. He seeks medical advice from Dr. Lee (Nephrologist) and was diagnosed with Urinary Tract Infection; Dr. Lee given patient A Phenazopyridine (risalu 199mg OD x1 week) Patient A has also longstanding history of hypertension and diabetes and presents with a complaint of pruritis, lethargy, lower extremity edema, nausea and emesis. On August 5, 2021 at 7:30 am, he was brought to the Emergency raam because Patient A experiences Chronic Pain due to his Gouty Arthritis plus severe itching on the entire body, perioral numbness, muscle cramps and severe rashes. According to his wife he was not able to walk because of joint pain and inflammation of his both legs An evident deformity of his left index finger and tophi formations was noted by the ER dactor. Vital Signs: - Temp: 36.6 degree Celsius Pulse Rate: 68 beats/min
Respiratory Rate: 20 GOD - Blood Pressure: 100/60mmHg - 02 Sat: 97% He was advised for admission in the medical surgical unit. - Chief complaint Joint pain, Severe itching (whole body) - Admitting diagnosis: Gouty Arthritis plus Pruritus Endorsement Phase Started IVF bottle #1 of PNSS 1L at 20 ctts/minute plus PB of Ds water + 150 NaCO3@ 10cc/ Time taped according Assess the grade of edema both leg V/S monitoring I and monitoring 02 2LMP if 02 sat is below 93% Hydrocortisone Crim 1% TID UTZ done whole abdomen Low Purine Diet -Oph, Calcium, Albumin, osag done to refer result once available Abe Uricais. CBC, Creatinine, BUN, ESR, Uric, GFR and Panel C-2 d ECHO care of Cardio doctors Initial Round Temp: 36.7 degree Celsius Pulse Rate: 66bmp Respiratory Rate: 19cpm Blood Pressure: 100/60mmHg O2 sat: 98% IVF level @ 820; INFUSING WELL Lying on bed Weakness appearance and pale Complaints of itching the entire body Joint pain was claimed a pain scale of 8/10 Pitting Edema G2 both legs were assessed Rashes that are flaking is seen A foulador smell nated because of 2mm abrasion left lower leg "My taste feels weird. It tastes like bitter", as verbalized by Patient A "My body is so itchy. Is this because of the chicken I ate last night?", asked by Patient A to the student nurse Claimed that Patient A has not defecated for approximately 1 week already 9:00 am Patient A was seen and examined by Dr. Mel Present IVF to decreased to 10gtts/min Limit oral intake into 800 ml/day Pireccilia Sodium+Tazobactam Sodium (VIGOCID) 4.5 grams q Shrs () ANST
Paracetamol plus tramadol HCL (Dutca 325 mg/27.5 mg Tab QID) Colchicine 0.5mg tab BID Sevelamer (Beroela 200 mg 1 tab with food) (12 noon) Calcium Carbonate CalciAid Soomg 1 tab with food) (12 noon) Ketoanalogues. Iseteste 600 mg 2 TABS OD) (Give 2 tabs on 12 noon) Febuxostat (Cebuane 40mg 1 tab OD) (Start itab by 12) Repeat S/E with Occult in Morning Ambulate on wheelchair QID Possible for IC c/o Dr. Gina (Surgeon) Repeat Creatine in AM Repeat CBC in am if HGB is decreased kindly 2 SECURE 2 UNITS of PRBC plus Furosemide 40 mg IVTT 10AM Temp: 36.9 degree celsius Pulse rate: 68 bpm Respiratory rate: 19cpm Blood pressure: 110/60mmlig O2 sat: 98% "I feel so tired", as Patient A verbalized You helped patient apply the cream to the attentes area Patient A reported of consuming 10ml of water He is still unable to defecate and you referred the condition to Dr. Mel IVF level at 780 11am Temp: 37 destes. Celsius Pulse rate: 79bmp Respiratory rate: 19cpm Blood pressure: 110/60mmlig 02 sat: 94% Bisacodyl (Dulcolax) was ordered and given Patient was lying on bed Still weak and pale appearance is noted According to Patient A 'I feel a little okay now. The itch in my body is almost gone 12noon Temp: 37.3 degree Celsius PR: 70 bpm RR: 19cpm BP: 100/70mmHg 02 Sat: 95%
Medication were given You helped the patient ambulate to wheel chair I level is at 700ml Reported that he consumed 10ml when his lunch 1pm Temp: 37 degrees Celsius PR: 74 bmp RR: 222 BP: 100/70mmHg 02 Sat: 96% He reported that he was able to defecate Condition is more stable "I feel better now' as verbalized by Patient A 2pm Temp: 36.8 degree celsius PR: 68 bpm RR: 20 com 9: 110/70mmHg 02 Sat: 95% His wife estimated that the total output she recorded were 90ml for the entire shift IVF was monitored according