1. Base of the case study below explain why the doctor order a ABG…

  

1. Base of the case study below explain why the doctor order a ABG… 1. Base of the case study below explain why the doctor order a ABG and Anti- HCV for this patient.2. Base on the case study below explain the causes of the patients result in ABG. Leptospirosis Case Study: Diego, 54-year-old male came in due to body pains. 2 days PTA, patient had body malaise with associated bilateral lower extremity pain, abdominal pain, epigastric burning 5/10 radiating to chest, continuous, undocumented fever, LBM of 10 episodes. No other associated symptoms noted. Patient self-medicated with Ibuprofen, Loperamide, Paracetamol which provided no relief. No consult done.  During interim, progression of symptoms, now with difficulty in ambulation and DOB. This prompt consult and hence admission.PMHx: • No comorbids noted. No COVID vaccine  FMHx: • (+) heart failure – maternal • (+) CVD – paternal • No other heredofamilial diseases noted  PSHx: • 15 pack year smoker • Alcoholic beverage drinker, 10SD once a week for 30 years • History of illicit drug use, last intake >20 yrs ago • Currently works as construction worker • ROS: Unremarkable   PE: • Patient is awake, conscious, coherent, ambulatory, in cardiorespiratory distress • BP: 120/60, 118 bpm, 48 cpm, 38.0, 90% o2 sat at room air • (+) conjunctival suffusion, pink palpebral conjunctivae, no nasoaural discharge, no cervicolymphadenopathies, no neck vein distention • Symmetric chest expansion, (+) macular rashes at anterior chest, no retractions, no lagging, clear breath sounds • Adynamic precordium, normal rate and regular rhythm, no murmurs appreciated • Flat, normoactive bowel sounds, nontender abdomen • Grossly normal extremities, no cyanosis, no edema, (+) tenderness on palpation of calf and thigh, (+) purpuric rash at bilateral leg Laboratory 1. CBC WBC: 11.47 RBC: 4.44 HGB: 121 HCT: 35.8 PLT: 16Neutrophils: 92.3 Lymphocytes: 5.3 Monocytes: 2.2 Eosinophils: 0.2 2. Coagulation FactorsPT: 14.8 % Act: 73.03 INR: 1.15 aPTT: 25.8   3. Clinical Chemistry: BUN: 28.61 Crea: 646.37 BCR: 10.9 eGFR: 8 mL/min/1.73m2CrCl: 13 mL/min AST: 55.94 (1.39x elev) ALT: 28.64 TB: 73.42 B1: 76.07 B2: 2.67 LDH: 311.47 CRP: 23.874. ABG Fully compensated metabolic acidosis with adequate oxygenation5. CXR: Bilateral mid to lower lung pneumonia: Cardiomegaly, Tortous aorta Diagnosis: ✓ Septic Encephalopathy secondary to Leptospirosis, severe ✓ Acute Kidney Injury secondary to sepsis ✓ COVID suspectPlans: ✓ Admit to PUI ICU ✓ IVF: PNSS 1L to run at 100 cc per hour ✓ Diet: NPO temporarily ✓ For transfusion of 8 units platelet concentrate ✓ Diagnostics: o LeptoMAT o HBSAg, Anti HCV ✓ Patient is anuric upon insertion of Foley Catheter. Not responsive to hydration. ✓ Plan for emergency IJ catheter insertion and hemodialysis o Prescription: o Duration: 2 1/2 hrs o UF: 500 net o BFR: 150 o DFR: 500 o HCO3 bath o Low flux o NSS flushing o D5050 1 vial on 2nd hour of hemodialysis   Health Science Science Nursing NCMA 312 Share (0)