HANI GUDA Staff asked 4 years ago
You are consulting on an 86-year-old female, and in reviewing the nursing progress notes, you read that the patient’s husband thinks that she has been much more confused since her hospital admission but in particular over the past 2 days since her hip replacement surgery following a fragility fracture 3 days ago. Prior to admission, she was “with it” according to him. Current medications are the same as pre-admission, with the exception of the naproxen and Tylenol #3.
Medications include: sertraline 50 mg po qhs, bisoprolol 5 mg po daily, digoxin 0.125 mg po daily, hydrochlorothiazide 25 mg po daily, lorazepam 0.5 mg po tid prn anxiety, phenytoin 300mg daily, naproxen 500 mg po bid and Tylenol #3 1-2 tablets q4h prn.
Lab work/Clinical information you have access to: Potassium 3.2 (normal 3.5-4.8), Magnesium 0.62 (normal 0.7-0.94), Serum creatinine 200, height 5’, weight 120 lbs, digoxin level 2.0, uncorrected Calcium 2.5 (normal 2.2-2.57), albumin 26 (normal 34-48), WBC 16 (normal 4.5-11) and #neut 10.2 (normal 2-7.5), phenytoin level not recently done and she currently has a foley catheter in place.
Blood pressure today: 180/82
How would you manage this situation? Explain in details.