Husband / wife 72 year old female (multiple-races-black, caucasian,hispanic) Eva
ID: 128002 • Letter: H
Question
Husband / wife 72 year old female (multiple-races-black, caucasian,hispanic) Eva 76 year old male (white/European) Harry Husband /wife (above parents to female) 38 year old female (multiple races) Angela 37 year old male (Asian) Tran Children of the above 8 month old female Sophia 3 year old male Michael 15 year old female Asia 17 year old male Joe Case Study part 1 72 year old Eva comes to clinic today asking for a walk-in appt. She has multiple health problems. She is here for acute onset cough and shortness of breath, with low grade fever for 10 days. Patient Information Social: Lives with husband of 55 years at the home of her daughter 20 year pack smoker-quit 10 years ago Occasional ETOH No drugs PMH: Diabetes Type II Dyslipedemia Hypertension GERD Asthma Arrhythmia (Not defined yet) Mild CHF Chronic pain syndrome PSH: No surgeries Medication History: NKDA Aspirin 81 mg daily Albuterol Inhaler Statin Hctz Atenolol Glipizide Metformin Pepcid Vicodin Hydrocortisone cream to rash HPI: 10 day history of low grade fever, cough with occasional yellow sputum, wheezing on and off. Inhaler not helping (has used it 6 times since in past 8 hours). Mild SOB, feels tired and is not getting better. No known infectious exposures. ROS Pertinent positives: C/o chest tightness with pleuritic pain on the right side SOB with wheezing Cough with occasional sputum Fever with no chills (did get flu shot last week at drug store) Decrease appetite and malaise Coughing so hard she vomits ROS Pertinent negatives No abdominal pain nausea, vomiting or diarrhea No focal weakness, dizziness or headache 168/94, 118-reg, RR 21, 02 sat 92 % RA, 100.4, BG 186. Moist cough on with rhonchi and scattered wheezing bilaterally Yellow sputum. Tachycardia & tachypnea with accessory muscle use. HEENT-normal findings. Abdomen- soft, non-tender Heart-RRR S1 & S2 no murmurs, rubs or gallops Eva is seen by the provider and diagnosed with Bronchitis. The provider orders the following medications to be administered in the office and she will d/c home on the same. Tylenol 975 mg Q6 hours Duo nebulizer times 3 via inhalation now-- and then Q4 h at home Prednisone 60 mg po daily for 5 days Augmentin 875 mg po 3 times per day for 10 days Multi-symptom Robitussin every 4 hours Eva had labs done about 3 months ago: WBC 7.0- WNL HCT 32 Hgb 9.0 BUN 24- slightly elevated Cr 1.3 – slightly elevated Low albumin levels- consider with protein bound drugs She is to be discharged on the same medications that were administered in the office. What teaching needs to be done (include side effects) and what should be monitored? Eva comes back to the office in 3 days. She is not getting better. She continues with fever between doses of Tylenol up to 102. Inc. SOB, nausea, vomiting and diarrhea every time she eats. Her findings warrant hospital evaluation. She tells you she has been taking a lot of Maalox to sooth her stomach. She has also developed a hive like rash. Dry lips, RR 26, o2 sat 88% RA, HR 140, T-101.2, Wheezing with crackles in her bases. She is sent to the emergency department. Which medication would you be most suspect of?
Explanation / Answer
-Maalox would be the suspecting drug. This medicine can cause nausea, constipation, diarrhea, or headache.
-The traditional Maalox liquid produces, comprising Maalox Advanced Regular Power and Maalox Advanced Maximum Power, are antacid produces that hold aluminum hydroxide, magnesium hydroxide and simethicone.
-Those products are used for the aid of acid indigestion, stomachache, sour or upset stomach, and gas.
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