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Original Question
Assignment instructions: Use the following clinical scenario to answer questions below. Please include a cover page, your case study answers, and an APA formatted reference page in your submission. Read the rubric carefully to see how points are allocated. Note for questions 1, 2, 3, 4 and 6 it is acceptable to use bullet point format with short answers and citations are not required. For question 5, please use complete sentences and include APA formatted citations in your response. Please put answers in your own words, DO NOT use direct quotes. I expect you will be able to answer each component of question 5 in 1-6 sentences. You will be graded on grammar, spelling and APA format for citations and references. Case: Sam is a 15-year-old male who enjoys working on cars after school. He was working on an old Jeep, that he will be driving when he gets his drivers license. The vehicle is an old 1980’s model. While working on the vehicle this afternoon, he suffered a laceration to the palm of his left hand. He wiped the area with a dirty shop rag and continued working. When he came in for dinner, his palm and hand was red, warm, swollen and throbbing, he washed the area, applied a band-aid and took two; 325mg Tylenol for the throbbing. When he woke in the morning, there was yellowish-white pus is oozing out of the injured area and he had red streaks going up the inside of his forearm. He let his mother know about the injury and that he was having chills and becomes queasy. His mother decided to bring him to the Emergency Department for evaluation. Sam has asthma but uses his rescue inhaler infrequently, mostly because he forgets to carry it with him. He has an older brother who is a senior in high school and in good health. Mother has hypothyroidism and father has hypertension. He has a dog. He admits to vaping but does not use alcohol. He has insurance under his mothers health insurance plan at work. He has no known drug allergies. Upon their arrival at the ER, Sam’s temperature is 39.7ºC, heart rate 125, respiratory rate of 24, O2 saturations 97% and blood pressure of 86/55 mm Hg. He reports he feels 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. He 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, Hct 42.2, 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 your diagnosis 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. Sam is at risk of developing shock. Given this clinical scenario, which type of shock is he most at risk for developing? 5. Describe the following key pathophysiologic concepts: a. Describe the pathophysiologic mechanism in bacteremia that led to 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 Sam 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 Sam’s bacteremia.
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