Question

Patient Summary:                                                                                                                    Ali is a 68 yo. male admitted to acute care for possible dehydration, weight loss, generalized weakness, and malnutrition.

History: pt Dx with squamous cell carcinoma of tongue five yrs ago. pt previously treated with radiation therapy—no treatment x 3 yrs. pt. states that he has lost over 27 kg (60 lb) in past 1-2 yr. He lost some weight when Dx with cancer 5 yrs. ago but steady at approximately 100 kg (220 lb) even after completing radiation therapy 1–2 years ago, when he began losing weight. He states that he gets full easily and never feels hungry.

Medical hx:            HTN; hyperlipidemia; weight loss; primary tongue    

                                squamous cell carcinoma five yrs ago; PVD               

Surgical history:      s/p partial glossectomy five yrs ago

Medication:             at home Lipitor 80 mg daily; Monopril 10 mg daily

Tobacco use:          1 ppd for 60 + yrs
Alcohol use:             No
Family history:        Mother died of pneumonia; father died of lung cancer.

Marital status:                      Married—lives with wife (Number of children: 2—alive, ages 42, 45)

Education:                9 yrs.,
Occupation:              Electrician for 26 years; retired

Admitting Hx/Physical:

Chief complaint: “I just feel weak all over and don’t have the energy to do anything.”

General appearance: Cachectic, appears older than 68 years of age

PE: Heart:                    Regular rate and rhythm HEENT:                Head: Noted temporal wasting                               Eyes: PERRLA                               Ears: Clear                               Nose: Dry mucous membranes with petechiae                               Throat: Dry mucous membranes without exudates                                               or lesions Neurologic:           Alert and oriented; strength reduced Extremities:           Decreased muscle tone with normal ROM; loss of                                lean mass noted                                quadriceps and gastrocnemius; 1+ pedal edema Skin:                       Warm and dry with ecchymoses, Skin color pale.                                Skin turgor (tenting) Chest/lungs:           Respirations are shallow—clear to auscultation and                                percussion Peripheral vascular: Diminished pulses bilaterally Abdomen:               Hypoactive bowel sounds X4; nontender,                                 nondistended. Palpation of abdomen (soft),

Vital signs: BP:                  122/77 Pulse:               101 bpm Temp:              36 OC Ht.:                  190.5 cm CWT:              70.9 kg UWT:              100 kg

Laboratory Results:                                           Dietary intake:

Chemistry
Glucose (mg/dL)	141 H
Sodium (mEq/L)	150 H
BUN (mg/dL)	36 H
Creatinine serum (mg/dL)	1.4 H
Protein (g/dL)	5.8 L
Albumin (g/dL)	1.8 L
Prealbumin (mg/dL)	9 L
Hematology
WBC (3 103/mm3)	12.6 H
RBC (3 106/mm3)	2.4 L
Hemoglobin (Hgb, g/dL)	8.1 L
Hematocrit (Hct, %)	24.1 L
MCV	106 H
MCH	33.6 H
Transferrin (mg/dL)	382 H
Ferritin (ng/mL)	17 L

Meal type: Mechanical soft diet

Intake % of meals: 5%; sips of liquids

Fluid requirement: 2000–2500 mL

Usual intake (for past several months):

Breakfast:        egg, coffee, few bites of toast

Snack: ½ can Ensure plus
Lunch:             soup or ½ sandwich, milk

Dinner:            balls few bites of soft meat,

                    potatoes or rice. Tries to drink

                    the other ½ can of Ensure plus.

Estimated intake: 820 kcal, 45 g protein

1. Identify any signs or symptoms from the physician’s history, laboratory values, and physical that are consistent with dehydration.?

Answer 1

Ans.

Mild to moderate dehydration may cause few to no noticeable symptoms, but individuals may experience symptoms that include: Increased thirst. Dry and/or sticky mouth. Less frequent urination, and urine may be darker yellow, indicating concentration.

The most useful individual signs for predicting 5% dehydration in children are an abnormal capillary refill time, abnormal skin turgor and abnormal respiratory pattern. Combinations of examination signs provide a much better method than any individual signs in assessing the degree of dehydration.

Sign and symptom of dehydration--

• Not peeing or having very dark yellow pee.
• Very dry skin.
• Feeling dizzy.
• Rapid heartbeat.
• Rapid breathing.
• Sunken eyes.
• Sleepiness, lack of energy, confusion or irritability.
• Fainting.

laboratory value--

Electrolytes (sodium, potassium, chloride, bicarbonate (CO₂)) BUN (blood urea nitrogen) and creatinine, to evaluate kidney function; these are often increased in dehydration as well.