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List three specific laboratory test results that are consistent with development of a bacterial infection CASE...

Question

List three specific laboratory test results that are consistent with development of a bacterial infection CASE...
List three specific laboratory test results that are consistent with development of a bacterial infection
CASE STUDY CYSTIC FIBROSIS Berial mised o For the Disease Summary for this case study se the CD-ROM this PATIENT CASE cient l
PART 2 RESPIRATORY DISORDERS haracterized by poor At 8 months of age, the child presented with failure to thrive characterize
CASE STUDY 15 CYSTIC FIBROSIS I 67 Fluticasone propionate 100 p. 1 puff BID Piednisone 4 mg po 6h P elipase: 8000 USP units l
68 PART 2 RESPIRATORY DISORDERS • No oral lesions or erythema - Secretions noted in posterior pharynx Neck/LN Neck supple wit
CASE STUDY 15 CYSTIC FIBROSIS 69 patient Case Table 15.2 Laboratory Blood Test Results 137 megl MCHC 29 g/dl. 3. mellt 187.00
ESPIRATORY DISORDERS d. both a and b e. a, b, and c Patient Case Question 4. Which of the following clinical manifestations m
CASE STUDY CYSTIC FIBROSIS Berial mised o For the Disease Summary for this case study se the CD-ROM this PATIENT CASE cient lent Patient's Chief Complaints Provided by patient's mother: "I noticed a let-down in T's exercise tolerance level a week ago and the last couple of days his cough and sputum production have gotten much worse. When he started having breathing problems, I brought him in immediately. T is normally a bubbly and lively little boy and it is obvious when he isn't feeling well. I think that he has another infection." HPI T.B. is a 6 yo Caucasian male with a history of CF. He was diagnosed with CF at 8 months of are. He had been doing well until five days ago, when his mother noticed that he became tired very easily while playing. She also reported an increasing cough productive of very dark-colored sputum but that he had no fever. The patient also has not had much of an appetite during the past week and has lost 2 pounds. His oxygen saturation is currently 87% and he was immediately placed on oxygen via nasal cannula. PMH T.B. was born (74 months ago) a 6 lb-7 oz white male to a 23 yo mother. A normal vaginal delivery followed an uncomplicated pregnancy. The infant had Apgar scores of 8 and 9 at 1 and 5 minutes, respectively. The initial physical examination was unremarkable, but at 30 hours following delivery, the infant developed abdominal distension and began vomiting bile. No bowel movements had occurred since birth. A second physical exam disclosed an afebrile, well-developed infant with a tense abdomen from which only occasional faint bowel sounds were heard. The anus was patent, lunes were clear to auscultation, and the cardiac exam was unremarkable. There were no neurologic abnormalities. Radiography of the abdomen revealed distended loops of bowel without air. Both the CBC and serum chemistry panel were normal Exploratory Laparotomy disclosed meconium ileus and atresia of the dis- al lleum. The narrowed segment of ileum was successfully resected and the infant recovered without complications. An attempt to collect a swent sample for chloride analysis was unsuc. cessful. After discharge the infant was lost to follow-up. abdomen rendremarkable. There were nolumes were cle
PART 2 RESPIRATORY DISORDERS haracterized by poor At 8 months of age, the child presented with failure to thrive characterized b weight gain. His appetite had been stood, but for several months he had been he to 6 pale and foul-smelling bowel movements daily. During that time, he had also enced several episodes of bronchitis. Physical examination revealed a small, frail pale child who appeared malnourished with little subcutaneous fat and a protul abdomen. There was a scattering of crackles in both lungs consistent with pulme edema or pneumonia. The cardiac exam was normal. Chest x-rays showed markings in lung fields. The patient's WBC was 8.3 X 10 mm. serum albumin was 1.9 g/dl S chloride was 99 meg/L and a stool smear was positive for tal. The child was hospitali and 24 hours later became febrile with tachypnea and increasing signs of respirator de tres. Auscultation revealed poor breath sounds in the right lung. Radiographs of the chest revealed consolidation of the right lung consistent with pneumonia. The WBC increased to 19.3 x 10mm' with an increase in band forms (i.e., immature neutrophill in the peripheral blood to 16%. Sputum cultures were positive for both Pseudom animosa and Staphylococcus aureus. With intensive support and aggressive intraveno antibiotic therapy, the infection resolved and the patient recovered fully. A diagnosis of CF was established and the patient was referred to the regional CF center for follow During the next six years, the patient was hospitalized three times for respiratory infer tions and one spisode of hemoptysis. The infections required hospitalization for up to weeks at a time and IV antibiotics. He was also diagnosed with bronchiectasis and pancre atic insufficiency. His mother has been administering postural drainage to her son three times daily for approximately 30 minutes each. Some of the positions are obviously uncom fortable, but I never complains. He is being maintained on a high-calorie, high-protein, and unrestricted fat diet that is supplemented with fat-soluble vitamins and iron. who app roo • Father has HTN; mother is well • Mother knew that she was a carrier for CF when they married, but father did not • The patient is the only child born to a 24 yo father and 23 yo mother • A maternal uncle died at age 16 from pneumonia secondary to CF . The remainder of the FH is unremarkable SH • Patient lives at home with his father and mother and attends first grade; he is doing well in school • Father is a full-time evening custodian at a local community college • Mother is currently a "stay-at-home mom," but is also a registered nurse • Family has city water and no pets • Father smokes but only outside of the home ROS • Patient complains of chest pain when coughing • Reduced ability to perform usual daily activities due to SOB • C) vomiting, abdominal discomfort pain, dianthea constipation change in urina quency, increase in thirst change in urinary fre Meds • Aerosolized tobramycin 300 mg BID • Albuterol 2.5 mg via nebulizer TID • Dornase alfa 2.5 mg via nebulizer QD
CASE STUDY 15 CYSTIC FIBROSIS I 67 Fluticasone propionate 100 p. 1 puff BID Piednisone 4 mg po 6h P elipase: 8000 USP units lipase 30.000 USP units amylase + 30.000 USP units pro- with each meal: 4000 USP units lipase + 12.000 USP units amylase + 12.000 USP units protease with each snack . Ferrous sullate 15 mg po 8h ADEK Multivitamin Pediatric Chewable Tablets tab po RID Pseudo All NKDA 1 PE and Lab Tests Gen The patient is a pleasant, thin, 6 yo white male who has difficulty breathing and gasps for air when his oxygen cannula is removed. He seems small for his age. His color is pale and he appears frail and tired. The patient is sitting up on the examiner's table in the emergency room. Vital Signs See Patient Case Table 15.1 Sao, 95% with 1.5 LO, 88% on room air P Patient Case Table 15.1 Vital Signs BP 105/68 sitting) T 98.4'F 1 22 (regular) WT 29 h (normal forag: 36.60 ) RR 33 labored) HT normal for age: 364 doing Skin • Color pale Cool to the touch, dry, and intact • (-) rashes, bruises, and other unusual lesions • Good turgor HEENT • Pupils equal at 3 mm, round, and reactive to light and accommodation • Extraocular muscles intact Funduscopic exam unremarkable • White sclera . Conjunctiva pale and non-edematous •TMs clear throughout, translucent, and without drainage Nares with dried mucus in both nostrils
68 PART 2 RESPIRATORY DISORDERS • No oral lesions or erythema - Secretions noted in posterior pharynx Neck/LN Neck supple without masses • (-) lymphadenopathy, thyromegaly. JVD, and carotid bruits Lungs • Crackles heard bilaterally in upper lobes • Decreased breath sounds in lower lobes • Wheezing noted without auscultation • RLL and LLL dull to percussion posteriorly Heart • Tachycardic with regular rhythm • (-) murmurs and rubs • S, and S, normal • (-) S, and S, Abd • Abdomen soft, NT/ND • (+) BS • (-) HSM, masses, and bruits Genit/Rect • Stool heme negative • Normal penis and testes MS/Ext • Mild clubbing noted • (-) cyanosis, edema, and femoral bruits • Capillary refill WNL at < 2 sec Age-appropriate strength and ROM • Radial and pedal pulses WNL at 2+ throughout Neuro Awake, alert, and oriented • CNs intact • DTR 2+ • No gross motor or sensory deficits present • Somewhat uncooperative with full neurologic exam Laboratory Blood Test Results See Patient Case Table 15.2
CASE STUDY 15 CYSTIC FIBROSIS 69 patient Case Table 15.2 Laboratory Blood Test Results 137 megl MCHC 29 g/dl. 3. mellt 187.000mm 102 megt WBC 18.00mm HOO, 24 mg/L . PMNS 1 19 BUN d . Bands 0.7 mei . Lymphs 17% Gli fasting 109 mld . Monos h 118 pdl. Ca 8. med. 35.1% PO, 2.9 mardi. MCV 77 EL Mg 2.1 mg/dl. AST ALT T Bilirubin T Pro Alb Vitamin A Vitamin D 250H Vitamin E PT PTT 16 TUL 20 IU/L 10 mg 7.3 L 3.8 de 40 mg/dl. 43 ng/ml. 02 made 11.4 sec 348 sec Sputum Culture Results (+) Pseudomonas aeruginosa, Sterotrophomonas malrophilia, and Staplıylococcus aureus Pulmonary Function FEV, 63% of predicted Chest X-Rays Consolidation of lower lobes of both lungs consistent with double pneumonia Peripheral Blood Smear Microcytic hypochromic red blood cells Patient Case Question 1. Which of the following best explains why the patient in this case study has cystic fibrosis? a. development of meconium ileus soon after birth b. failure to thrive c. both parents are carriers of a mutation for cystic fibrosis d. frequent infections early in life c. malabsorption of fats and proteins Patient Case Question 2. Why would you expect the patient in this case study to be malnourished? a. malabsorption of fats and proteins b. deficiency of vitamins and minerals c. significant use of calories to maintain breathing d. both a and b e. a, b, and e Patient Case Question 3. Why does the patient in this case study receive postural drainage? a. to loosen secretions from the lungs and remove them from the airways b. to facilitate the exchange of gases c. to strength chest muscles
ESPIRATORY DISORDERS d. both a and b e. a, b, and c Patient Case Question 4. Which of the following clinical manifestations might the patient demonstrate with the development of cor pulmonale? a. jugular venous distension b. edema of the ankles and feet c. hepatomegaly d. both a and b e. a, b, and c Patient Case Question 5. Based on laboratory test results, which types of nutritional supplementation should be enhanced? Patient Case Question 6. List three specific laboratory test results that are consistent with development of a bacterial infection. Patient Case Question 7. Which two specific laboratory test results above suggest that the patient is not vitamin K deficient? Patient Case Question 8. Describe the pathophysiology that is causing pallor in this patient. Patient Case Question 9. Which clinical evidence indicates that cirrhosis has not devel oped in this patient as a result of cystic fibrosis? Patient Case Question 10. Which clinical evidence indicates that hypoproteinemia secondary to cystic fibrosis is not an issue in this patient? Patient Case Question 11. Which clinical evidence indicates that diabetes mellitus has not developed in this patient as a result of cystic fibrosis? Patient Case Question 12. Is this patient hyponatremic or hypochloremic?

Answers

lab test of bacteria infection is mainly white blood cells count in the blood it indicates the infection in the body

  • white blood cells normal count is 4000 - 11000mm3...but in this patient have 18900 mm3...
  • sptutum culture test....presence of pseudomonas aeruginosa ,stenotrophomus maltophilia, staphylococcus aureus.
  • viral infections


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