I-human Ken Fowler

Heres Kens story:
Pt (K.F.) a 70 y/o M presents stating that \”went to see my doctor this morning because I have been feeling bad for the past few days and was instructed that his kidneys are failing.\” Pt has concerns of; fatigue/ tired, abnormal labs including creatinine and urine protein elevations. Pt has decreased oral intake for three days with vomiting starting three days ago. hx of resolved lower back pain that he explained was from lifting boxes that has resolved with use of naproxen twice daily with 2 tabs- unknown doses (250mg or 500 mg). Decreased urinary frequency with decreased urinary output. Pt also offers that he has had lightheadedness with position changes- usually standing up. No falls or LOC reported. Pt reports increased thirst with no reports of diabetes. Pt is AOx4 and has no pain or discomfort and ambulates with slow steady gait. NKDA.

Dx of acute kidney injury secondary to true intravascular volume depletion and medication related side effect (NSAIDS) causing prerenal azotemia. The use of NSAIDS (naproxen) for his back pain is likely the cause while taking his home meds: lisinopril, metoprolol and HCTZ.-

Primary Diagnosis is Medication-related side effect- ICD-10 Code # T50-905A

3 Differential Diagnoses- Why? What made you select each one as a DDX? How did you rule out? This would be a good area to include references….

Differential Diagnosis:

1)Primary: Medication related side effect. What it is and why?? With references

2) Uremia (prerenal Azotemia)- Wht it is and why?? With references

3) Uremia (intrarenal Azotemia)- What it is and why?? With references

Additional labs will be the 24-hour urine collection, CBC, BMP, UA, urine- sodium, urine eosinophils, and renal/ pelvic ultrasound. Should not need any pre authorizations on this testing…..

Consults: Endocrinologist?? Others??
If you are sending to hospital for treatment, what orders would you write for a direct admit???

Pharmacological and nonpharmacological management:

Health Promotion: Address risk factors as appropriate. Consider age-appropriate preventive health screening.

Patient education: Explanations

Disposition/follow-up instructions: when the patient is to return sooner, and when to go to another facility such as the emergency department, urgent care center, specialist or therapist.

References (minimum of 3, timely, that prove this plan follows current standard of care).\”

References

SAMPLE SOLUTION

Differential diagnosis is critical in helping to determine the healthcare condition of a patient. While making a diagnosis, it is possible that a healthcare provider can have either a single or multiple theory to the cause of the patient’s symptoms before making further tests that will help to narrow down on the suspected diagnosis (Gigante et al.,2017). Since conditions often share symptoms, differential diagnosis is key in understanding the exact condition faced by a patient. This task looks at the possible diagnosis of ken Fowler who is a patient showing multiple symptoms such as failing kidneys, elevation of urine protein and creatinine, persistent vomiting in the last three days and a reduced urinary frequency and lightheadedness with position changes.
Primary Diagnosis
The primary diagnosis as exemplified by the patient’s symptoms is ICD-10-CM Code T50.905A which is the adverse effects of the unspecified drugs especially in their initial encounter. In the case scenario, the patient was experiencing lower back pain that…