Brigham Young University
Student cared for P. L. on October 31, 2013. P. L. is a 70 year old male who was admitted to the hospital on October 29, 2013 for abdominal pain and nausea. After a CT scan was performed, the admitting diagnosis was a partial small bowel obstruction. His admitting physician was Shane Pendley, and two of the other doctors who worked with him were Lawrence Nobuhara and Michael Jemmett. P. L. has no known drug allergies and has a full code status. The patient’s secondary diagnoses and past medical history include coronary artery disease (CAD), hyperlipidemia, and a history of prostate cancer, hypertension (HTN), CAD with history of CABG X4 vessels, MI, and atrial fibrillation. The patient’s prostate cancer was treated with radiation and bradytherapy. The patient’s HTN has recently resolved so he is no longer on medication. The CABG procedure was performed in February of 2009, and the patient is currently taking aspirin as an anticoagulant following an ablation for the atrial fibrillation. Patient also underwent surgery in 2009 to repair an AAA and iliac artery aneurysm. The patient smoked one pack of cigarettes per day from age 18 until he was 59, but denies smoking now. The patient denies alcohol use. Other past surgeries include a right total knee surgery and a left ankle fusion.
The secondary diagnoses do not cause the primary diagnosis. Most of the patient’s past medical history has to do with the cardiovascular system, and does not have as much to do with a partial bowel obstruction. It is important to recognize the medical history however, because being in the hospital could cause stress on the body that could increase the blood pressure and increase the risk of further cardiovascular damage. It is important to monitor the cardiovascular system for adverse events in addition to monitoring the gastrointestinal system. Although there are many past medical concerns, the majority of them have been resolved through surgery or lifestyle changes.
The patient was admitted with a partial small bowel obstruction. A partial small bowel obstruction is a functional or mechanical obstruction that can prevent the normal transport of food, liquids and gases. This prevention of normal intestinal flow can cause severe abdominal pain and nausea that come and go. An unfortunate result of a bowel obstruction is that once a person has had it occur once, it is much more likely to occur again.
Coronary Artery Disease is commonly called heart disease. As plaque builds up in the arteries, known as atherosclerosis, the once elastic vessels become hardened and the build-up blocks the pathway for the blood. With this loss of elasticity and the blockage, the blood pressure increases to compensate so the body receives the oxygen and nutrients it needs. CAD leads to an increased risk of stroke or MI. Some of the symptoms that can accompany CAD include: shortness of breath, dizziness, nausea, and heart palpitations.
Hyperlipidemia is an excess of lipids within the blood. In general, it refers to too much cholesterol or too many triglycerides within the blood. An excess of cholesterol and triglycerides can also contribute to plaque build-up or blockages within the blood vessels. Then HTN and increased risk of cardiovascular events occurs. Hypertension is also known as high blood pressure. Blood pressure can increase for many reasons including blockages, stress response, smoking, genetics, and lack of exercise. The standard for a healthy blood pressure among the general public is a systolic pressure below 120mmHg and a diastolic pressure below 80mmHg. Many people may have HTN without even knowing it, but it is important to monitor because it can contribute to many other cardiovascular problems. A myocardial infarction is another name for a