Scenario P.M., a 24-year-old house painter, has been too ill to… ScenarioP.M., a 24-year-
Scenario P.M., a 24-year-old house painter, has been too ill to… ScenarioP.M., a 24-year-old house painter, has been too ill to work for the past 3 days. When he arrives at your outpatient clinic, he seems an alert but acutely ill young man of average build, with a deep tan overexposed areas of skin. He reports headaches, severe myalgia, a low-grade fever, cough, anorexia, and nausea and vomiting (N/V), especially after eating any fatty food. P.M. describes vague abdominal pain that started about the same time as the other problems. His past medical history (PMH) reveals he has no health problems, is a nonsmoker, and drinks a “few” beers each evening to relax. Vital signs (VS) are 128/84, 88, 26, 100.6° F; awake, alert, and oriented (AAO) X 3; moves all extremities well (MAEW) except for aching pain in his muscles; very slight scleral jaundice present; heart tones clear and without adventitious sounds; bowel sounds clear throughout abdomen and pelvis; abdomen soft and palpable without distinct masses.You note moderate hepatomegaly measured at the midclavicular line; the liver edge is easily palpated and tender to palpation. P.M. mentions that his urine has been getting darker over the past 2 days. P.M. is manifesting the key signs of hepatitis. Lab work is sent for identification of his precise problem. Results are Na 140 mmol/L, K 3.9 mmol/L, Cl 102 mmol/L, CO2 26 mmol/L, BUN 10 mg/dl, creatinine 1.0 mg/dl, platelets 86 thou/mm3, direct bilirubin 1.6 mg/dl, total bilirubin 2.3 mg/dl, albumin 3.8 g/dl, total protein 6.2 g/dl, alanine aminotransferase (ALT) 66 units/L, aspartate aminotransferase (AST) 52 units/L, lactate dehydrogenase (LDH) 205 units/L, alkaline phosphatase 176 units/L, PT 12 sec, INR 1.06, PTT 32 sec. Urine urobilinogen is 1.6 IU/L, albuminuria 160 mg/dl, positive for bilirubinuria, positive for anti-HAV (hepatitis A virus) IgM. 1. Which key diagnostic tests will determine exactly what type of hepatitis is present? international units per milliliter that can be detected within 2 weeks of exposure).2. A CBC, BMP, LFT, and PT/PTT were drawn. Which of the lab values listed above specifically, indicates liver disease? 3. List three drugs that can cause increased ALT levels. Health Science Science Nursing NURSING NUR 1020 Share QuestionEmailCopy link Comments (0)
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