PHATO PLEASE ANSWER THES S BASE ON CASE SENARIO 1. What…  PHATOPLEASE ANSWER THES S BASE ON CASE SENARIO  1. What constitutes a positive Babinski sign? Is a positive Babinski sign significant? Could this lead to any further complications? Please explain. 2. Identify 8 abnormal laboratory blood test values and identify one possible complication that could arise from each of them.  HISTORY:X.P. is a 24-year-old man, who presents to the urgent care clinic with complaints of rectal bleeding and weakness. Five days ago, he noticed bright red blood in his stools. Furthermore, daily bowel movements have increased to five or six with significant diarrhea. He states that urges to move his bowels have rapid onset, but there has been no incontinence. He has been weak for approximately 21/2 days. He has not traveled outside of the city, been hospitalized, or received antibiotics recently. PAST MEDICAL HISTORY:• Chronic sinus infections since age 15• Ventricular septal defect at birth, surgically repaired at age 1 year FAMILY HISTORY:• Strong positive family history of autoimmune disease on maternal side• Mother has SLE• Maternal grandmother (deceased) had Grave’s disease• Aunt has myasthenia gravis SOCIAL HISTORY:• College graduate• Recently discharged after 3 years of active military service• Currently employed as user consultant in information technology division at local community college• Social alcohol use only• Denies tobacco and IV drug use REVIEW OF SYSTEMS:• Negative for lightheadedness and feeling faint with standing• Negative for nausea, vomiting, visual changes or eye pain, abdominal distension with gas, and joint pain• Positive for occasional malaise, mild abdominal cramps, loss of appetite, and weight loss of 4 lbs during the past month MEDICATIONS:None ALLERGIES:NKDA PHYSICAL EXAM:GeneralA & O, pleasant, young, white male in NAD; skin color is paleVital SignsBP (sitting, left arm) 120/75, P 93 bpm, RR 20/min, T 99.4°F, SaO2 95% on RA, Wt 161 lbs (usual weight 165 lbs), Ht 5’10” Skin• Warm and dry with satisfactory turgor• Positive for pallor• No rashes or other lesionsHead, Eyes, Ears, Nose, and Throat• PERRLA• EOMI• Negative for uveitis• Funduscopic exam normal• TMs intact• Nose clear and not inflamed• Moist mucous membranesChest and LungsLungs CTA & PHeart• RRR• Normal first and second heart sounds• No m/r/g or extra heart soundsAbdomen• BS (+)• Soft and NT/ND• No palpable masses• No HSM• No bruitsRectal• Somewhat tender• No hemorrhoids or other lesions• Heme (+) stool Musculoskeletal and Extremities• Equal motor strength at 5/5 in both arms and legs• Sensation normal• No CCE• Peripheral pulses normalNeurological• A&O x 3• Sensory and motor levels normal• CNs II-XII intact• DTRs 2+• Babinski response negativeLABORATORY TESTS: Patient Case Table: Laboratory Blood Test Results Na+ 143 meq/L (Normal: 135-145 meq/L) (Panic: <125 or >155 meq/L) BUN 20 mg/dL (Normal: 8-20 mg/dL) Plt 315,000/mm3 (Normal: 150,000-450,000/ mm3) (Panic: <25,000/mm3) AST 33 IU/L (Normal: 0-35 IU/L) K+ 3.2 meq/L (Normal: 3.5-5.0 meq/L) Cr 1.1 mg/dL (Normal: 0.6-1.2 mg/dL ) ESR 24 mm/hr (Normal: Males: 0-10mm/hr; ALT 41 IU/L (Normal: 7-56 IU/L)(Panic: <3.0 or >6.0 meq/L) Females: 0-20mm/hr) Cl- 108 meq/L (Normal: 101-112 meq/L) Hb 10.8 g/dL (Normal: Males: 13.6-17.5 g/dL Females: 12.0-15.5 g/dL). (Panic: <7.1 g/dL) CRP 1.5 mg/dL (Normal: <0.5mg/dL) T bilirubin 0.9 mg/dL (Normal: 0.1-1.2 mg/dL) HCO3- 18 meq/L (Normal: 22-32meq/L) (Panic: <15 or >40 meq/L) Hct 36% (Normal: Males: 42-52%; Females: 37-46%) Ca+2 8.9 mg/dL (Normal: 8.5-10.5 mg/dL) (Panic: <6.5 or >13.5 mg/dL) PT 11.3 sec (Normal: 10.0-13.0 sec) Glu, fasting 132 mg/dL (Normal: 60-110 mg/dL) (Panic: <40 or >500 mg/dL) WBC 9,400/mm3 (Normal: 4,800-10,800/ mm3) (Panic: <1,500/ mm3) PO4-3 4.0 mg/dL (Normal: 2.5-4.5mg/dL) Clinical CourseThe patient received 1 L of 0.9% saline with 30 meq KCl IV for 4 hours and was discharged with instructions to return to the urgent care clinic or immediately contact his PCP if symptoms developed again. The patient was referred to the GI clinic.A proctosigmoidoscopy was conducted three days after the patient's discharge from the acute care clinic. Significant pseudopolyp formation could be seen. Biopsies of the colon revealed erosions of the mucosa and ulcerations into the submucosa with mixed acute (i.e., neutrophils) and chronic (lymphocytes and macrophages) inflammatory cells. No dysplastic cells suggesting the development of colon carcinoma were seen. No multinucleated giant cells suggesting Crohn disease were seen. Inflammation and ulceration were limited to the rectum and sigmoid colon only. Crypts of Lieberku¨hn were intensely inflamed. Marked hemorrhaging of capillaries in the mucosa was also observed.Pathologist's DiagnosisUlcerative colitisHealth Science Science Nursing NURSING PNP401

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