Question

ICD 10

1. A 70-year-old female presented to the hospital with fever, myalgia, arthralgia, tachycardia, and dehydration and was believed to be septic. This patient has a history of hypertension, CHF, and migraines. Routine medications include Lasix 40 milligrams by mouth each morning, if needed, for significant pedal edema and Isordil 20 milligrams by mouth four times a day.

A variety of studies were obtained to further delineate the source of her problem. Urine cultures were negative. Blood cultures grew Escherichia coli. The blood urea nitrogen level was 22, and a random glucose was 149. An anterior-posterior film of the chest taken at the same time showed acute pulmonary edema.

The patient received intravenous fluids. The patient's routine medications were continued, and she received intravenous antibiotics. On the fourth day of her hospital stay, it was believed that the patient had reached maximal hospital benefit and was therefore switched to oral antibiotics and was discharged. The patient left the hospital in good condition.

DISCHARGE DIAGNOSES:

Septicemia due to Escherichia coli

Dehydration

Hypertensive heart disease

with heart failure

2. A 2-year-old male presented with fever, vomiting, and abdominal pain. The patient was severely dehydrated with a blood urea nitrogen level of 54, indicating acute renal failure. Blood cultures obtained grew Staphylococcus aureus. The patient was treated with a 10-day course of intravenous vancomycin. The patient also received intravenous fluids and had improved renal function. Upon admission, the patient was noted to have a rash on his buttocks and was treated with topical ointment. The patient improved and was discharged.

DISCHARGE DIAGNOSES:

Sepsis due to Staphylococcus aureus

Severe sepsis with septic shock

Acute kidney failure

Dehydration

Diaper rash

3. A 94-year-old male was admitted to the hospital with a chief complaint of abdominal pain and loss of weight. The patient had a history of coronary artery disease and myocardial infarction. There is no history of coronary bypass surgery. The patient had a nebulizer at home and takes metoprolol. These medications were continued during the patient's stay. Physicalrevealed abdomen to be tender to palpation in the left mid and lower quadrants with some rebound. Bowel sounds were present, and there was no guarding. Blood pressure was normal. Pulse, respirations, and temperature were normal.

During hospitalization, EKG showed sinus rhythm with myocardial changes of ischemia. Sputum cytology was suggestive of adenocarcinoma, compatible with bronchoalveolar growth. Chest x-ray showed metastatic lesions and chronic obstructive lung disease in both lung fields. Barium enema showed adenocarcinoma of proximal sigmoid colon. Abdominal series showed no evidence of obstruction, but moderate dilation of his transverse colon was evident. Patient was seen in consultation, and it was decided to do as little as possible at this time due to the patient's age and lung conditions. The patient agreed with this approach and requested discharge to home to receive hospice care.

DISCHARGE DIAGNOSES:

Carcinoma of sigmoid colon

Probable metastatic bronchogenic carcinoma, right lung

and left lung

Chronic obstructive lung disease

Coronary artery disease

Previous myocardial infarction

4.

This patient is a 43-year-old female with a long history of joint pain. Lately she had been feeling very tired and weak. She also has had intermittent abdominal pain with nausea and vomiting. Her joint showed tenderness of the knees. She denied any problems suggestive of hypothyroidism (myxedema). The patient's hematocrit was 27.6, serum iron was found to be decreased at 27, and thyroid functions were found to be markedly low. Upper GI series showed a 4-millimeter ulcer at the posterior wall of the duodenal bulb. The patient was transfused 2 units of packed red cells. She was started on ferrous sulfate 300 milligrams twice a day. She was also begun on Tagamet for the ulcer. Further questioning revealed that she had indeed been hypothyroid in the past and has been on thyroid medication until stopped by another physician. The patient was restarted on Synthroid 0.2 milligrams per day. She was discharged on the sixth hospital day. DISCHARGE DIAGNOSES: Hypothyroidism Anemia due to myxedema Acute duodenal ulcer 5. This patient is a 14-year-old African American male who was admitted due to sickle cell crisis and acute chest syndrome. His mother has sickle cell anemia, and his father has the sickle cell trait. Because of this, the patient was tested at birth; a blood sample was drawn, and it was sent to the laboratory for hemoglobin electrophoresis to obtain a definitive diagnosis. Unfortunately, the test was positive for sickle cell disease. The patient was given intravenous fluids and was started on Darvocet for pain management. When the Darvocet failed to keep his pain at an acceptable level, he was switched to Vicodin. The patient is to be discharged with follow-up in the pediatrician's office tomorrow. DISCHARGE DIAGNOSES: Sickle cell crisis with acute chest syndrome Family history of sickle cell anemia 6. A 31-year-old white male presented to the emergency room reportedly having taken 8 to 10 naproxen at home in a suicide attempt. He reported that he had been having trouble with his wife, and he is unemployed. He had apparently become despondent over this and attempted to take his own life with his girlfriend's pills. The patient is admitted to the telemetry unit due to paroxysmal ventricular tachycardia. The patient was started on metaraminol for the tachycardia. Fortunately, the patient seemed to sustain no other ill effects from the naproxen. The mental health service was consulted, and an appointment was made for outpatient services. He was given Prozac to treat his depression. At this time, the patient does not appear to be a threat to himself or to others. He appears remorseful and denies any suicidal ideations. He was discharged in good condition. DISCHARGE DIAGNOSES: Suicide attempt with naproxen Paroxysmal ventricular tachycardia Depression Unemployment Marital relationship problems Home (place of occurrence)

Answer 1

Q.N,1 The diagnosois is Septicemia due to E-coli

Here the patient is having Blood cultures positive for  Escherichia coli. Which suggest that patient is having septicemia. Septicemia is a serious blood infection cause by variety of bacteriae. Client dont have any history of UTI, since her urine culture is negative. Since the patient is having hypertension and other associated problems, she is not dehydrated. But she is already a known case of hypertensive cardiac disease with CHF.

Q.N.2 The diagnosois is Sepsis due to S. Aureus

The blood culture obtained grew Staphylococcus aureus. Which suggest a blood infection. The patient also received intravenous fluids and had improved renal function.Hence it is not Acute renal failure.With IV fluid, his dehydration status also improved. So other option can be excluded.

Q.N.3 The diagnosois is Carcinoma of sigmoid colon

The patient is already a known case of CAD and MI and chronic obstructive lung disease. Now he developed symptoms of abdominal pain and loss of weight. Barium enema showed adenocarcinoma of proximal sigmoid colon. So that is the primary site of cancer. the other manifestations shows, metastatic lesions in lung field indicating Probable metastatic bronchogenic carcinoma, right lung and left lung. So other options can be excluded.

Q.N.4 The diagnosois is Acute duodenal ulcer.

Here the patient is already a known case of thyroid disorder. Her symptoms of  intermittent abdominal pain with nausea and vomiting, and Upper GI series showed a 4-millimeter ulcer at the posterior wall of the duodenal bulb. All these indicate her intail diagnosis as acute duodenal ulcer. hence other options can be excluded.

Q.N.5 The diagnosois is Sickle cell crisis with acute chest syndrome

As he is admitted with all the manifestations of chest syndrome, and sickle cell crisis, with strong family history.The option family history with sickle cell anemia can not considered as a ICD diagnosis.

Q.N.6 The diagnosois is Suicide attempt with naproxen

Unemployment, Marital relationship problems, Home (place of occurrence) can not considered as medical diagnosis.He developed Paroxysmal ventricular tachycardia because of the effect of medications he consumed in high dose.He dont have any manifestations of depression also. Hence other options can be excluded.