Which diagnostic studies will you initially order and why? Due to Timothy’s persistent cough, tachypnea, wheezing, hypoxia with oxygen saturation of 89% on room air, tachycardia and history of asthma as well as dysphagia he will need a chest x-ray initially. Chest radiography can detect evidence of aspiration, pulmonary edema, or atelectasis (Cantwell, 2018). As discussed earlier the chest x-ray can be completely normal at presentation in patients who have had a near drowning or have drown (Mott & Latimer, 2016). Timothy will need blood drawn to evaluate glucose, electrolyte levels, lactate level, coagulation profile, and evaluation of hemoglobin/hematocrit and white blood cell count with differential (Cantwell, 2018). The tachypnea, hypoxia, and tachycardia could be from infection within the lungs due to aspiration and blood work could help rule that out to avoid sepsis. Ingestion of large amounts of water as discussed earlier can cause fluid shifts and
electrolytes to become out of balance which could cause more seizures in Timothy’s case or other issues due to fluid shifts. A complete metabolic panel can give us an idea of possible metabolic issue which could have caused the seizure, assess electrolytes, and evaluate if there is any liver damage occurring due to the antiepileptic medications (Chandy & Weinhouse, 2017). Timothy has global delay which would make this blood work necessary in making sure a thorough assessment is completed. Timothy’s history of seizures and the reason for the drowning would need to be evaluated by performing an EEG and assessing his medication blood levels. If his levels are not therapeutic that could be the reason for the seizure which caused the drowning event. Ensuring that his medication is at therapeutic levels and that he is not experiencing repetitive seizures is very important and these tests will help do that. The EEG can help rule out status epilepticus and the blood levels can help guide and evaluate the current seizure treatment plan for Timothy. A urinalysis can also be completed to rule out source of seizure being a urinary tract infection.
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- Summer '17
- Acute respiratory distress syndrome, Seizure, Drowning, NSG6435 Week 8 Discussion