Case Study(CSI): Stomach flu? Anxiety? What's Going on Here?

On 11/19/2019 at 8:24 PM, RNDarling said:

I’d like to start with a current set of vitals along with an EKG and CBC, BMP, and cardiac enzymes please.

Thank you for reading and commenting! Here are the pertinent labs and vital signs:

Vital signs:

BP 160/98 RA sitting

HR 105

RR 18

T 98.2oF

HT 5’6”

WT 170 lbs

BMI 27.4

Laboratory Test Results:

Na 133 meg/L

K 4.3 meq/L

Cl 101

HCO3

BUN 14 mg/dL

Cr 0.9 mg/dL

Glucose, fasting 264 mg/dL

Mg 1.9

PO4 2.3

Cholesterol 213

Triglycerides 174

LDL 143

HDL 34

CPK 99 IU/L

CK-MB 6.3 IU/L

Troponin I 0.3 ng/mL

Hb 12.2 g/dL

Hct 40%

WBC 4,900/mm3

Plt 267,000/mm3

HbA1c 8.7%

Arterial Blood Gas

pH 7.42

PaO2 90 mm

PaCO2 34 mm

SaO2 96.5%

On 11/20/2019 at 8:32 AM, JKL33 said:

?

One 12-lead EKG please.

Lots of other info I would like to know (and another diagnosis in mind), but...

You got it (and thanks for reading and asking!)

Electrocardiogram: 4 mm ST segment elevation in leads V2-V6

On 11/19/2019 at 10:10 PM, nursej22 said:

What is her past medical history? Is she taking any medications or supplements?

Has she taken any steps to reduce anxiety? Does she drink alcohol, and if so, has her intake changed?

Ya'll ask good questions!

Past Medical History:

Type 2 DM X 5 years

Migraine with aura X 25 years

Hypertriglyceridemia

HTN X 12 years (poorly controlled, poor patient compliance)

Medications:

Amlodipine 5 mg po QPM

Glyburide 10 mg po QAM, 5 mg po QPM

EC ASA 325 mg po QD

Gemfibrozil 600 mg po BID

Terazosin 1 mg ph HS

Metoclopramide 10 mg PRN nausea related to migraine

Imitrex 25 mg PRN migraine pain

On 11/20/2019 at 6:57 AM, CommunityRNBSN said:

Thyroid panel

All normal, but good question.

11 hours ago, Lulu Belle said:

Has she been febrile? What did the vomit look like? Has she had a cough? Any findings on her abdominal exam? Where else is she having pain?

Can we make the BMP a CMP? Let's do a UA and a Utox too.

Would someone be able to educate me on why an LDH would or would not be useful here?

I posted the lab results - look at those and see if that gives you a clue about the LDH. No fever, vomit looked like partially digested breakfast, no cough.

Negative findings on abdominal exam. No other pain.

UA and Utox normal.

I forgot one:

she drinks "one glass of wine" per day (she didn't mention the SIZE of the glass) ?

1 hour ago, FNPDreams said:

Check cardiac echo & angio if indicated. Have posted a suggested dx in the Admin section.

FNPdreams - I'll post those results soon. We're experimenting with the format to try to make this the most fun for everyone. Stay tuned!

3 hours ago, Meul_20 said:

When is the last time she took her meds? and how many pills did she take?

Oh that's a great question and gives me an idea for a future CSI. She's taking her medications as ordered, on schedule. No PRN meds since her last migraine was a month ago.