case presentations: need to create the case with
patient suffering from an acute or chronic rheumatologic condition. If you cannot recall a rheumatology patient scenario, please select one or more of the rheumatology conditions from your course readings and create a case scenario. This presentation should include relevant labs only and relevant imaging results only, as well as your focused assessment and plan for the patient. Please use peer-reviewed articles to support your plan for the patient and follow the course rubric for discussion board posts.
PLEASE REVIEW THE ARTICLE ATTACHMENT. THANK YOU
EXAMPLE
Example of a daily presentation for a patient known to a team:
Opening one liner:This is Mr. Smith, a 65 year old man, Hospital Day #3, being treated for right leg cellulitis
Events of the past 24 hours:
MRI of the leg, negative for osteomyelitis
Evaluation by Orthopedics, who I&D’d a superficial abscess in the calf, draining a moderate amount of pus
PE remarkable for:
Patient appears well, states leg is feeling better, less painful
T Max 101 yesterday, T Current 98; Pulse range 60-80; BP 140s-160s/70-80s; O2 sat 98% Room Air
Ins/Outs: 3L in (2 L NS, 1 L po)/Out 4L urine
Right lower extremity redness now limited to calf, well within inked lines – improved compared with yesterday; bandage removed from the I&D site, and base had small amount of purulence; No evidence of fluctuance or undrained infection.
Labs and imaging remarkable for:
Creatinine .8, down from 1.5 yesterday
WBC 8.7, down from 14
Blood cultures from admission still negative
Gram stain of pus from yesterday’s I&D: + PMNS and GPCs; Culture pending
MRI lower extremity as noted above – negative for osteomyelitis
Assessment and Plan
This is a 65 yo male, hospital day 3, being treated for lower extremity cellulitis and abscess. Issues are as follows:
Cellulitis complicated by abscess, which has now been adequately drained. Exam improved and feels better. Likely organism is Staph, covering for MRSA until cultures back
Continue Vancomycin for today
Ortho to reassess I&D site, though looks good
Follow-up on cultures: if MRSA, will transition to PO Doxycycline; if MSSA, will use PO Dicloxacillin
Hypertension: When admitted, outpatient anti-hypertensive medications held as blood pressure was low due to sepsis. Now BP is climbing back to hypertensive range. No symptoms
Given AKI, will continue to hold ace-inhibitor; will likely wait until outpatient follow-up to restart
Add back amlodipine 5mg/d today
Renal: Now back to baseline kidney function, which is normal. On admission AKI due to sepsis. All improved as expected with control of infection. Appears euvolemic
Hep lock IV as no need for more IVF
Continue to hold ace-I as above
Disposition: Anticipate d/c tomorrow on po antibiotics – pending final culture results as above to determine best oral med.
Wound care teaching with RNs today – wife capable and willing to assist. She’ll be in this afternoon.
Set up follow-up with PMD to reassess wound and cellulitis within 1 week
