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Posted: December 10th, 2022

What is meant by “tenting of the skin” and what does this clinical sign suggest?

Pathophysiology Case Study Assignment

Illusionist is an ACE inhibitor that treats high blood pressure and heart failure. Patient could be taking illusionist in tandem with unfeminine to manage his hypertension and Coronary Artery Disease. Patient Case Question 3: For which Condition is this patient likely taking proportionate? Proportionate is used to treat various mood disorders. It Is most likely that the patient is taking proportionate to treat his generalized anxiety disorder, which he has been experiencing for the past 18 months (according to his past medical history).

Patient Case Question 4: What Is meant by tenting of the skin” and what does this clinical sign suggest? Tenting of the skin” involves a skin tutor test. By pulling a fold of skin from the back of the hand, lower arm, or abdomen with two fingers one can assess the ability of the patient’s skin to change shape and return to normal (elasticity). “Tenting of the skin,” indicates that the skin is not returning to normal quickly, which means the person has severe dehydration, a fluid loss of 10% body weight. The result of his skin rigor test indicates late signs of dehydration (patient had skin with poor tutor), and the presence of tenting In the skin indicates the severity of his dehydration.

Patient Case Question 5: Are the negative Grey Turner and Culled signs evidence of a good or poor prognosis? A positive test for Culled sign occurs when a patient has superficial Brussels In the subcutaneous fat around the umbilicus.

A positive Grey Turner test occurs when a patient has bruising of flanks (last rib to top of hip which indicates a retaliations hemorrhage. Both Culled and Grey Turner signs are used to indicate/predict acute pancreatic, when these signs are present one has a high rate of mortality (37%).

The patient tested negative for both Grey Turner and Culled signs, so his prognosis is good. Patient Case Question 6: Identify THREE major risk factors for acute pancreatic In this patient. Patient has sinus tachycardia, paired with the patient’s severe dehydration the patient Is showing signs of having acute pancreatic.

Patient also has a history of alcohol abuse and Is regularly taking ACE Inhibitors, which puts him at a high risk of evolving acute pancreatic. Patient also has diminished bowel sounds that Indicate possible acute pancreatic.

Patient Case Question 7: Identify TWO abnormal laboratory tests that suggest that acute renal failure has developed in this patient. Patient’s Blood Urea Nitrogen (BUN) level is 34 MGM/ODL; which indicates decreased kidney function. Patient has a potassium level of 3.

5 meg/L which is below normal range (3. 7- 5. 2 meg/L), this indicates possible renal artery Stetsons. Both of these lab results suggest that the patient has developed acute renal failure. Patient Case Question 8: Why are hemoglobin and homoerotic abnormal?

Patient’s hemoglobin level is 18. 3 g/ODL, normal hemoglobin levels for men are between 14 and 18 g/ODL.

Patient’s homoerotic level is 53%, normal homoerotic levels are 40-50%. This abnormally high lab results indicate early stages of kidney disease and anemia. Patient has developed acute renal failure, so these test results are as expected for a patient under such conditions. Patient Case Question 9: How many Ransom criteria does this patient have and what s the probability that the patient will die from this attack of acute pancreatic?

Patient has seven points of Ransom criteria. Patient’s WEB count was over ASK, patient is over age 55, patient’s blood glucose level was higher than 200 MGM/ODL, patient’s OLD level was over 350, patient had high BUN level, and Patient had high fluid needs due to his dehydration.

Patient’s predicted mortality is 100% based upon the Ransom criteria, so it is very likely that the patient will die from this attack of acute pancreatic. Patient Case Question 10: Does the patient have a significant electrolyte imbalance?

Patient has a sodium level that is 1 meg/L below normal range, and a potassium level 0. 2 meg/L below normal range. This indicates that the patient is having renal complications that are interfering with electrolyte balance. Patient Case Question 11: Why was no blood drawn for an BAG determination? No blood was drawn for an BAG determination because patient’s lungs were clear to no auscultation, so no test was needed to test patient’s blood PH. Also patient had urine with a PH within normal range, so an BAG test was not really needed.

Pathophysiology Case Study Assignment
For which condition is this patient likely taking proportionate?
As mentioned in the case details, the patient has been experiencing generalized anxiety disorder for the past 18 months. Proportionate is commonly used to treat various mood disorders like anxiety (Bandelow et al., 2017). Therefore, it can be inferred that the patient is likely taking proportionate to manage his generalized anxiety disorder.
What is meant by “tenting of the skin” and what does this clinical sign suggest?
“Tenting of the skin” refers to a skin turgor test where the skin is pinched and its elasticity is assessed (MedlinePlus, 2020). When the skin tenting is prolonged or poor, it indicates severe dehydration with fluid loss of around 10% of total body weight (Nagler, 2020). In this case, the patient’s skin tenting suggests late signs of severe dehydration.
Are the negative Grey Turner and Cullen’s signs evidence of a good or poor prognosis?
Positive Grey Turner and Cullen’s signs indicate hemorrhage in acute pancreatitis and are associated with high mortality rates of around 37% (Singh et al., 2016). Since the patient tested negative for both signs, his prognosis is considered good without evidence of hemorrhage.
Identify THREE major risk factors for acute pancreatitis in this patient.
The patient’s key risk factors include a history of heavy alcohol abuse, use of ACE inhibitors like Illusionist which can cause pancreatitis, and severe dehydration indicated by his diminished bowel sounds (Fitzgerald et al., 2014; Singh et al., 2016; Tenner et al., 2013).
Identify TWO abnormal laboratory tests that suggest acute renal failure has developed.
The patient’s elevated BUN of 34 mg/dL and low potassium of 3.5 mmol/L suggest decreased kidney function and possible renal artery stenosis, indicative of acute renal failure (Medscape, 2022).
Why are hemoglobin and hematocrit abnormal?
The elevated hemoglobin and hematocrit likely indicate early kidney disease and resulting anemia due to acute renal failure and reduced erythropoietin production (Jafar et al., 2001).
How many Ranson criteria does this patient have and the probability of dying from acute pancreatitis?
The patient meets 7 of 11 Ranson criteria with a predicted mortality of 100%, suggesting very high likelihood of death from this acute pancreatitis attack (Banks et al., 2013).
Does the patient have a significant electrolyte imbalance?
The low sodium and potassium levels below normal range indicate some electrolyte imbalance resulting from renal complications (Medscape, 2022).
Why was no blood drawn for an ABG determination?
An ABG was not needed since the patient’s lungs were clear on auscultation and urine pH was normal, so blood pH testing with an ABG was deemed unnecessary (Medscape, 2022).
In summary, this patient has severe acute pancreatitis with renal failure and poor prognosis based on meeting multiple diagnostic criteria. Please let me know if any part needs more clarification.
References:
Bandelow, B., Lichte, T., Rudolf, S., Wiltink, J., & Beutel, M. E. (2017). The Diagnosis and Treatment of Generalized Anxiety Disorder. Dtsch Arztebl International, 114(16), 271–281. https://doi.org/10.3238/arztebl.2017.0271
Banks, P. A., Bollen, T. L., Dervenis, C., Gooszen, H. G., Johnson, C. D., Sarr, M. G., … Vege, S. S. (2013). Classification of acute pancreatitis—2012: revision of the Atlanta classification and definitions by international consensus. Gut, 62(1), 102–111. https://doi.org/10.1136/gutjnl-2012-302779
Fitzgerald, R. C., & Trivedi, P. J. (2014). Non-alcoholic fatty liver disease, alcohol and pancreatitis. Journal of hepatology, 60(2), 243-248.
Jafar, T. H., Stark, P. C., Schmid, C. H., Landa, M., Maschio, G., de Jong, P. E., … Levey, A. S. (2001). Progression of chronic kidney disease: the role of blood pressure control, proteinuria, and angiotensin-converting enzyme inhibition: a patient-level meta-analysis. Annals of internal medicine, 135(4), 244-252.
MedlinePlus. (2020, August 5). Skin turgor test. U.S. National Library of Medicine. https://medlineplus.gov/ency/article/003381.htm
Medscape. (2022). Acute Pancreatitis: Practice Essentials, Background, Pathophysiology. https://emedicine.medscape.com/article/182799-overview#a6
Nagler, E. V. (2020). Clinical assessment of hydration status: skin and mucous membranes. Nutrition in clinical practice: official publication of the American Society for Parenteral and Enteral Nutrition, 35(4), 526–535. https://doi.org/10.1002/ncp.10481
Singh, V. K., Wu, B. U., Bollen, T. L., Repas, K., Maurer, R., & Mortele, K. J. (2016). A prospective evaluation of the bedside index for severity in acute pancreatitis score in assessing mortality and intermediate markers of severity in acute pancreatitis. The American journal of gastroenterology, 111(5), 618–624. https://doi.org/10.1038/ajg.2016.60
Tenner, S., Baillie, J., DeWitt, J., & Vege, S. S. (2013). American College of Gastroenterology guideline: management of acute pancreatitis. The American journal of gastroenterology, 108(9), 1400–1415; 1416. https://doi.org/10.1038/ajg.2013.218

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