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The patient is a 35 yo female with cirrhosis and hepatic encephalopathy residing in a nursing home. On the day of admission, the patient was noted to have difficulty breathing. She was given an albuterol nebulizer without significant benefit and sent to the emergency room.
Vitals: T 37.3C, RR 30, BP 120/57, HR 112, SAO2 97% on 100% FM
GEN: alert but confused, oriented to self and place, not time, appears older than stated age.
HEART: Tachycardic with 2/6 Systolic murmur heard best at LLSB.
LUNGS: Bibasilar rhonchi and rales. Clubbing of fingers and toes.
Name |
Result/Unit |
|
Ref Interval |
FiO2 |
21 % |
|
|
pH |
7.43 |
|
7.35-7.45 |
PaCO2 |
29.4 mmHg |
L |
35-39 |
PaO2 |
28.5 mmHg |
LL |
61-82 |
tHb |
9.2 gm% |
L |
13-19 |
HCO3 |
19.2 mEq/L |
|
19-25 |
BE |
-3.9 mEq/L |
L |
-2.5-2.5 |
Name |
Result/Unit |
|
Ref Interval |
WHITE BLOOD CELL COUNT |
13.96 K/uL |
H |
3.20-10.60 |
HEMOGLOBIN |
9.6 g/dL |
L |
12.1-15.9 |
HEMATOCRIT |
30.1 % |
L |
34.3-46.6 |
MEAN CORPUSCULAR VOLUME |
97.3 fL |
H |
77.8-94.0 |
PLATELETS |
216 K/uL |
|
177-406 |
| GRANULOCYTES % |
87.4 % |
H |
44.0-76.0 |
BANDS % |
17% |
H |
<12 |
Name |
Result/Unit |
|
Ref Interval |
ALBUMIN |
1.8 g/dL |
L |
3.5-4.6 |
BILIRUBIN, TOTAL |
4.7 mg/dL |
H |
0.2-1.3 |
ALKALINE PHOSPHATASE |
273 U/L |
H |
38-126 |
ASPARTATE AMINOTRANSFERASE |
95 U/L |
H |
14-50 |
ALANINE AMINOTRANSFERASE |
42 U/L |
|
9-52 |
BILIRUBIN, DIRECT |
2.4 mg/dL |
H |
0.0-0.4 |
TOTAL PROTEIN |
4.9 g/dL |
L |
6.3-8.2 |
Name |
Result/Unit |
|
Ref Interval |
SODIUM |
126 mmol/L |
L |
136-144 |
1. What is your assessment?
2. Why is she at risk for respiratory disease?
3. What should you do next?
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