Apply diagnosis/procedure codes according to current guidelines...
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Apply diagnosis/procedure codes according to current guidelines...
Apply diagnosis/procedure codes according to current guidelines (Bloom's Level 3)
Classification Systems
ICD (ICD-9-CM, ICD-10, ICD-10-CM/PCS)
Taxonomies
Clinical Care Classification (CCC)
Nomenclatures
CPT, DSM, RxNorm
Terminologies
LOINC, SNOMED CT
Image transcription text
Inpatient Consultation
Patient Case Number: IPC53- Malone, Axel
Patient Name: Axed Malone
DOB: 11-13-57
Sex: M
Date of Service: 03-04-XX
Physician: Richard Henderson, MD
Reason for Consultation: Right great the wound
History of Present Illness:
This is a 61 yo female who presented to the hospital last night with complaints of right toe pain.
Upon admission, she has a gangrenous right great toe. The patient states that the wound has been
there for approximately 7 days, though I suspect it has been longer. Denies any fevers at home. She
has DMII. She was supposed to be taking medication for her diabetes including Metformin and
Insulin, however, she has not taken either medication for at least a year due to an insurance issue
and not being unable to pay for it. She has not seen a doctor since then. She takes no medications at
home. Denies any recent fevers or chills. Denies any drainage from the foot. Does not remember
how she obtained a wound on her foot to start with.
Allergies: NKDA
Medical History: DM, hin
Surgical History: Includes tonsillectomy, left great toe amputation, and endometrial biopsy for
postmenopausal bleeding.
Family History: Non-contributory
Review of Systems: A 12-point review of systems is negative unless stated otherwise in the above
HPL
Vitals:
Temperature
98 5-F
Pulse
80
Respirations
20
Blood Pressure
106/60
Sp02
98 % on room air
Physical Examination:
GENERAL: No acute distress. Alert and oriented x.3.
HEENT: Normocephalic, atraumatic. No jugular venous distention. No tracheal deviation.
LUNGS: Nonlabored. dear to auscultation bilaterally...
Image transcription text
HEART: Nontachycardia.
ABDOMEN: Morbidly obese.
EXTREMITIES: Bilateral upper extremities no clubbing, cyanosis, or edema. Left lower extremity,
no clubbing, cyanosis or edema. Noted previous left great toe amputation. Right lovwer extremity
right great toe with wet gangrene, odor, purulent drainage surrounding very erythematous skin and
cellulitic tissue, tracks to the mid portion of her forefoot. Cellulitis extends to the second and third
toes as well.
Numbness and tingling of byl extremities
Laboratory Data:
Hemoglobin 11.2, hematocrit 343, white blood cells 14 2, platelets 287. Sodium 130,
potassium 40, chloride 96, bicarbonate 18.9, BUN 23, creatinine 1.51. Lactate 1.2
Imaging-
X-ray of Right Foot Impression: Advanced osteomyelitis of the distal phalanx of the big toe with
surrounding soft tissue swelling and gas.
Impression:
1. Diabetic peripheral vascular disease, type 2, with gas gangrene of the right great the with
osteomyelitis of the distal phalanx.
2. Cellulitis of the right toe
3. Diabetes mellitus, uncontrolled-hyperglycemic and diabetic polyneuropathy.
4. Morbid obesity.
5. Hypertension.
5. Peripheral neuropathy.
6. Medication noncompliance due to financial reasons.
Plan:
1. IV antibiotics, Zosyn and vancomycin.
2. A.m. labs
3. Non
4. To Ol now for debridement and probable amputation of at left the great toe.
5. Discussed with attending, who agrees with above.
Electronically Signed By: Richard Henderson, MD...
Answer & Explanation
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Answered by ssmnashrafi on coursehero.com
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