Pathophysiology Case Study

Patient Case Question 1: For which condition is this patient likely taking nifedipine?
Nifedipine is a calcium channel blocker used to treat high blood pressure and chest pain. Patient’s past medical history indicates that he has had hypertension “for years,” the patient is most likely taking Nifedipine to manage this condition. May also be taking nifedipine so as to prevent chest pain from his past condition of Coronary Artery Disease (CAD).

Patient Case Question 2: For which condition is this patient likely taking lisinopril?
Lisinopril is an ACE inhibitor that treats high blood pressure and heart failure.

Patient could be taking lisinopril in tandem with nifedipine to manage his hypertension and Coronary Artery Disease.

Patient Case Question 3: For which Condition is this patient likely taking paroxetine?
Paroxetine is used to treat various mood disorders. It is most likely that the patient is taking paroxetine to treat his generalized anxiety disorder, which he has been experiencing for the past 18 months (according to his past medical history).

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Patient Case Question 4: What is meant by “tenting of the skin” and what does this clinical sign suggest?
“Tenting of the skin” involves a skin turgor test. By pulling a fold of skin from the back of the hand, lower arm, or abdomen with two fingers one can assess the ability of the patient’s skin to change shape and return to normal (elasticity). “Tenting of the skin,” indicates that the skin is not returning to normal quickly, which means the person has severe dehydration, a fluid loss of 10% body weight.

The result of his skin turgor test indicates late signs of dehydration (patient had skin with poor turgor), and the presence of tenting in the skin indicates the severity of his dehydration. Patient Case Question 5: Are the negative Grey Turner and Cullen signs evidence of a good or poor prognosis?

A positive test for Cullen sign occurs when a patient has superficial bruising in the subcutaneous fat around the umbilicus. A positive Grey Turner test occurs when a patient has bruising of flanks (last rib to top of hip), which indicates a retroperitoneal hemorrhage. Both Cullen and Grey Turner signs are used to indicate/predict acute pancreatitis, when these signs are present one has a high rate of mortality (37%). The patient tested negative for both Grey Turner and Cullen signs, so his prognosis is good.

Patient Case Question 6: Identify THREE major risk factors for acute pancreatitis in this patient.
Patient has sinus tachycardia, paired with the patient’s severe dehydration the patient is showing signs of having acute pancreatitis. Patient also has a history of alcohol abuse and is regularly taking ACE inhibitors, which puts him at a high risk of developing acute pancreatitis. Patient also has diminished bowel sounds that indicate possible acute pancreatitis.

Patient Case Question 7: Identify TWO abnormal laboratory tests that suggest that acute renal failure has developed in this patient.
Patient’s Blood Urea Nitrogren (BUN) level is 34 mg/dL; which indicates decreased kidney function. Patient has a potassium level of 3.5 meq/L which is below normal range (3.7- 5.2 meq/L), this indicates possible renal artery stenosis. Both of these lab results suggest that the patient has developed acute renal failure.

Patient Case Question 8: Why are hemoglobin and hematocrit abnormal? Patient’s hemoglobin level is 18.3 g/dL, normal hemoglobin levels for men are between 14 and 18 g/dL. Patient’s hematocrit level is 53%, normal hematocrit levels are 40-50%. This abnormally high lab results indicate early stages of kidney disease and anemia. Patient has developed acute renal failure, so these test results are as expected for a patient under such conditions.

Patient Case Question 9: How many Ranson criteria does this patient have and what is the probability that the patient will die from this attack of acute pancreatitis?
Patient has seven points of Ranson criteria. Patient’s WBC count was over 16K, patient is over age 55, patient’s blood glucose level was higher than 200 mg/dL, patient’s LDH level was over 350, patient had high BUN level, and Patient had high fluid needs due to his dehydration. Patient’s predicted mortalitiy is 100% based upon the Ranson criteria, so it is very likely that the patient will die from this attack of acute pancreatitis.

Patient Case Question 10: Does the patient have a significant electrolyte imbalance?
Patient has a sodium level that is 1 meq/L below normal range, and a potassium level 0.2 meq/L below normal range. This indicates that the patient is having renal complications that are interfering with electrolyte balance. Patient Case Question 11: Why was no blood drawn for an ABG determination?

No blood was drawn for an ABG determination because patient’s lungs were clear to no auscultation, so no test was needed to test patient’s blood PH. Also patient had urine with a PH within normal range, so an ABG test was not really needed.