This is not homework. This is about a patient I saw in the community (Psych-- but I do head to toe assessments) and it has me confused. Your thoughts would be much appreciated. Patient is new to me.
70 y old F with schizoaffective disorder bipolar type but currently stable on trilafon, lithium, abilify. Rt lower extremity is edematous. Pt states she has been dx'd by her PCP with cellulitis. And is going to see PCP tomorrow for follow up. She states that she had a "benign tumor" removed from her right thigh "many years ago" and gets edema distal to the surgical site intermittently ever since then. Her vitals: Pulse 52, BP 87/57. Temp 98.9 F. She is 59" and 140 lbs. She has lost 150 lbs over the last year, possibly related to a recent manic episode. Her lungs are clear to auscultation. I hear S1, S2 and S4 (the "Tennesse" sound). She is taking bactrim, kefflex, and lasix. She has a recent lab printout and it is all normal except that her hemoglobin and mchc are a little low. 11.5 for hemoglobin, IDR the other one. Her memory is mildly impaired short term and long term. She complains of pain in the edematous leg 5/10. Denies syncope, dizziness.
I am thinking I will call her PCP tomorrow to make sure she actually went, because I would have sent her myself anyway, but am I right to be thinking this is pointing to cardiac issue? I am just a little dumbfounded and new to community health. I worked inpatient psych before, so I just want to make sure I get her everywhere she needs to go.
Also in general I am asking-- can a patient be hypotensive and brady and also have heart failure? Because that is the crux of what confuses me here. Or... could the lasix be bringing her BP down? And what the heck is up with that heartrate?
And she is not my only patient with right LE edema!
