How to Answer Case Sarah Year Questions (Complete Guide)
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What This Question Is About
This question relates to case sarah year and requires a structured academic response.
How to Approach This Question
Structure your response with introduction, analysis, and conclusion.
Key Explanation
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Original Question
Case: Sarah 38-year-old Hispanic female who works as a cook in a restaurant cut her thumb while preparing vegetables. This morning, her thumb was sore and the skin surrounding the cut is red. She needed to work so she returned to work this afternoon. By the time she returned home at the end of the night, her thumb was swollen and throbbing, and yellowish-white pus is oozing out of the injured area. She also noticed two red streaks going up the inside of her forearm. She thought about getting some medical attention for her thumb in the morning when she began having chills and becomes queasy. Her roommate decided to bring her to the Emergency Department for evaluation. Sarah has a history of hypertension but does not routinely take medication to manage the hypertension. She reports she does not usually get sick and had been in her usual state of health until this evening. She is single, with no children. She has a dog. She does not smoke or use drugs but drinks socially. She does not have health insurance through her job but buys insurance through the health insurance marketplace. Upon their arrival at the ER, Sarah’s temperature is 39.7ºC, heart rate 125, respiratory rate of 24,O2 saturations 97% and blood pressure of 85/55 mm Hg. (Her normal BP is 145/85 mm Hg.) She reports she is very tired and would like to sleep. There are no other remarkable findings on physical examination. The NP suspects bacteremia and orders labs, antibiotics, and a fluid bolus. She is placed on 2 liters/minute nasal cannula. Labs are obtained and include: arterial blood gas pH: 7.32, PaCO2: 40, PaO2: 115. HCO3: 22, Base excess: -3.5, Lactate: 2.3, Na: 140, K: 3.7, Cl: 111, CO2: 38, BUN: 20, Creatine: 0.7, Glu: 193, WBC: 14,500 with differential 69 segs, 12 bands, 13 lymphs, and 6 monos, Hgb 14.1, Hct42.2, MCV 90, and Platelet count: 230,000. Blood cultures are also obtained but results are pending at this time. Questions: 1. What specific diagnosis is most consistent with the clinical scenario above? 2. What specific data (history, subjective and objective, laboratory/studies) in the case supports your diagnosis? Please include how that data specifically supports yourdiagnosis in question 1. 3. This clinical scenario is most consistent with which type of acid base disorder? What is the most likely cause or contributing factor to this acid base disorder? 4. Sarah is at risk of developing shock. Given this clinical scenario, which type of shock is she most at risk for developing? 5. Describe the following key pathophysiologic concepts: a. Describe the pathophysiologic mechanism that results in bacteremia evolving to become your diagnosis in question 1. b. Given the risk of shock in this scenario, describe the pathophysiologic, cellular changes that occur because of shock. c. Explain the clinical stages of infectious diseases and identify which stage you believe Sarah is in at this time. d. Discuss the pathophysiology of fever and its benefits in bacteremia. 6. Given the use of antibiotics in the Emergency Department, list 2 key considerations related to ongoing use of antibiotics to manage Sarah’s bacteremia.
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