You should compare the patients history with the admission criteria and determine whether the patient meets at least one criterion in the severity of illness and one criterion in the intensity of service (Table 8.10) for admission to the hospital.

roved you Case Study Mandal to determine whether this patient meet the Sarator medical and surgical admission F numer pory and proport. Le the patient history and per The point of stone criterion in severity of the medications and our intensity of Service wy of an dow ownery hours or more often Concerto como entos Twain an indicated Restory cost every hours den following . The herg Comune nhados She underwendet we cada con recentem concomitente wfact on the giogram Allergies Nonown drugiegles Pest Medical story story of menses of the Past Surgical History Cw Medication Pupid 20 mg Cantom pobid, Noor 105 Social History: The point whose Habits Shed once and te Review of Systems The which of hernal dysfunction. She has had the pleading the Physical Examination CHEST Chetto CARDIOVASCULAR Replay. ABDOMEN Son GENITALIA RECTAL Deler EXTREMITES Mob. on The test www LABORATORY DATA Potheo 12 TEST RESULTS Angyen buration to the more in Apewe hung thon bus The evidence of Dende des woodes ENT Occluded and content and contact 2. Snow in the Hoof heroes to Pew The tent will be distendere wery why ever we were Catheriner der of the atient and to perform shortion of wer news to expected pewne of yet we MCVA, for bleeding never wanted bow we is well as the crew von Weine rooms we Table 8.3 is a set of admission criteria for medical and surgical admissions. Figure 8.10 shows ce 8.10) and the admission criteria (table 8.3) to determine whether this patient meets the criteria for example of one patient's history and physical report. Use the patient history and physical repon ssion to the hospital. The patient must meet at least one criterion in severity of illness and one crites se Study en intensity of service. 8.3. Admission criteria of admission Severity of Illness Intensity of Service Sudden onset of unconsciousness or disorientation Intravenous medications and/or fluid replacement Pulse rate: 140/min and not typical for patient Inpatient-approved surgery or procedure within 24 hours Blood pressure: systolic 200 mm Hg or diastolic Vital signs every 2 hours or more often 120 mm Hg and not typical for patient Acute loss of sight or hearing Chemotherapeutic agents requiring continuous observation Acute loss of ability to move body part Treatment in an ICU, if indicated Persistent fever Intramuscular injection every 8 hours Active bleeding Respiratory care at least every 8 hours Severe electrolyte/blood gas abnormality Glucose monitoring at least 4 times daily EKG evidence of acute ischemia Wound dehiscence or evisceration Widely fluctuating blood glucose levels Hemoglobin levels 1.4 times upper limit of normal Figure 8.10. Example of a history and physical report Reason for Admission: Severe, short distance, lifestyle-limiting right tower extremity claudication History of Present liness. This is a 32-year-old woman who developed new-onset eight lower extremay cao aication following right transfemoral cardiac catheterization for routine follow-up 10 years after cardiac tront plantation. The catheterization was approximately 10 days ago. Since that time, she describes symptomsad pain complete numbness in the right fool. The pain is relieved by rest. She does not have rest pain at night. She has never had any symptoms similar to this or any symptoms in the contralateral leg She underwent cardiac transplantation 10 years o90. Since that time, she has had annual routine evaluation by transfemoral cardiac catheterization. Dr. Smith, who reviewed the films from the catheterization, reports that there is evidence of mild narrowing in the common femoral artery, possibly due to prior catheterizations. There is also some concern regarding the possibility of arterial dissection more proximally, although this may be an artifact on the angiogram. Allergies: No known drug allergies Past Medical History: (1) History of hypertrophic cardiomyopathy, now status post cardiac transplantation (2) intermittent episodes of rejection (3) History of herpes zoster. Past Surgical History: Cardiac transplantation Medications: Pepeld 20 mg po bid. Vasotec 5 mg po bid, magnesium oxide 400 mg po bid, aspirin 81 mg po bid, CellCept 1 gm po bid, Neoral 100 mg gam and 75 mg apm Social History: The patient is a schoolteacher. Habits: She drinks alcohol occasionally and does not smoke cigarettes. Review of Systems: The patient has no active cardiopulmonary symptoms of which she is aware and no history of hepatorenal dysfunction. She has had no other episodes of bleeding or thrombotic disorders Physical Examination: HEENT: Unremarkable CHEST: Clear throughout to auscultation CARDIOVASCULAR: Regular rhythm without murmur, gallop, or rub ABDOMEN: Soft, nontender with no obvious masses or organomegaly GENITALIA RECTAL: Deferred EXTREMITIES No clubbing, cyanosis, or edema. There is no dependent rub or pallor on eleva- tion. The patient has normal sensation and motor function in the lower extremi- ties. Pulses are 3/3 except in the right lower extremity, where no palpable pulses are present LABORATORY DATA: Potassium 3.8; hematocrit 45: sodium 142 TEST RESULTS: Angiography demonstrated occlusion of the external liac artery from near the bifurcation to the distal common femoral artery, which reconstitutes just above its own bifurcation. A guide wire passed easily through this suggesting soft throm bus. There is excellent collateralization and no evidence of distal abnormalities Duplex ultrasonography performed earlier demonstrated no evidence of deep or superficial thrombophlebitis. Noninvasive vascular studies also suggested aortoillac/femoral occlusive disease with good collateralization distally Impression: 1. Occluded right external illac and common femoral artery following transfemoral cardiac catheterization 2. Status post cardiac transplantation for hypertrophic cardiomyopathy 3. History of herpes zoster Plan: The patient will be admitted to the hospital to undergo operative intervention to repair the femoral artery Injury. Several possibilities exist including possible dissection of the artery and injury to the artery during the catheterization or development of a collagen plug post anglography. I have discussed these possibilities with the patient and I plan to perform an exploration of the right femoral area and, if necessary, a right lower quadrant retroperitoneal incision to expose the proximal bifurcation and a bypass if necessary. Discussed the possibility of vein patch angioplasty as well. We also discussed the risks of the operation including MI, CVA death, infec tion, bleeding, nerve injury, embolization and tissue loss, bowel injury, etc. She understands all these things as well as the indications for operative Intervention. We plan to operate tonight as soon as an operating room is available